Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Royal Crescent and Preston Road Practice at the Royal Crescent Surgery on 20 October 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. We received consistently positive feedback from patients including the 73 comment cards we reviewed. 

• Staff were motivated and inspired to offer kind and compassionate care and would deliver prescriptions when there was an urgent need and drive patients home when they or their carers had been taken unwell at the practice.

• The practice had worked with people with a learning disability in the development of information about the annual review process and the easy read invite letter included a photograph of the clinician who would be undertaking the review. 

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by the management team. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of and complied with the requirements of the duty of candour.

   

The area where the provider should make improvement is:

• The practice should consider how they monitor the quality and outcomes framework exception rates so they are more in line with national averages and patients receive appropriate services.

We saw three areas of outstanding practice:

• One of the GPs within the practice had been supported to develop a range of services to some of the most vulnerable patients within the Weymouth and Portland area and had secured funding for two community nurses to provide physical and mental health support to the homeless population. Alongside this the GP provided one session per week to the community alcohol detox addictions service supporting 60-70 patients in receipt of substitute prescribing. 

• The practice had a visiting team providing services for the over seventy five year olds. A GP was supported by nurse practitioners and a community matron in the provision of weekly or fortnightly visits to 18 nursing homes within the catchment area supporting 208 residents . The team also provided home visits to 160 housebound patients.  The practice met regularly to review the impact of this service and conducted nursing home surveys, and analysed data about hospital admission rates and uptake of vaccines. We were told that emergency hospital admission rates from nursing homes had decreased by 30% since 2014 and that requests for same day GP visits from care homes had decreased by 57% between 2014 and 2016. 90% of care home residents and 95% of housebound residents had received a flu vaccine at the time of the inspection.

• The practice had developed a service called ‘Community Angels’, which was provided from the branch Preston Road Surgery. This was a joint venture between the practice and the local church. It provided a volunteer befriending service, transport for patients to attend hospital appointments and a support scheme to address social isolation. The practice employed a coordinator who managed this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice