This practice is rated as Good overall. (The practice was previously rated in November 2016 as Outstanding)

The key questions at this inspection are rated as:

• Are services safe? – Good
• Are services effective? –Good
• Are services caring? – Good
• Are services responsive? – Outstanding
• Are services well-led? - Good

We carried out an announced comprehensive inspection at Salisbury Medical Practice on 20 November 2018, as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw a two areas of outstanding practice:

• The practice had a clear vision of using social prescribing and social care signposting to support patients, by improving their social network, encouraging social activity and making souces of help and advice more easily accessible. There was a small team of staff who led this work and the strategic focus was embedded in policies and annual development plans that were reviewed regularly. They held regular one-off events and had developed a wide range of support groups for patients with particular needs. For example, there was a fibromyalgia and a carers group that met monthly. Staff leading this work also attended nurse led clinics such as the practice diabetic clinic and leg club to give patients information and advice on a range of available support.
• The practice ran weekly Dementia Friendly Tai Chi sessions for people with dementia and their carers. As part of this service they offered sessions in a number of local care homes.

The areas where the provider should make improvements are:

• Complete the actions they have identified to improve their system for monitoring the fridge temperatures and take steps to ensure the improvements are embedded in the practice.
• Improve their assurance systems so the practice can evidence that actions taken as a result of safety and medical alerts have been completed, and learning points identified from significant events and complaints are shared with all appropriate staff including those unable to attend meetings where they are discussed.
• Review the arrangements for ensuring all staff have completed the training necessary for their role, to ensure it is effective and records are up to date.
• Take steps to ensure they meet the national target for cervical screening.
• Take steps to reduce the number of patients they are excepting from their quality outcome data.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fisherton House on 15 November 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.

• The needs of vulnerable patients had been identified and measures had been put in place to bridge gaps. For example, the practice ran cafes for those who were socially isolated to help boost patients wellbeing.

• 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.

• Eighty five percent of the patients surveyed said they found it easy to make an appointment with a named GP and added 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. For example, there was a fully equipped operating theatre on site. The practice was clean, tidy and hygienic. We found that suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.
• The practice participated in promotional events, for example career conventions, at a local school and encouraged sixth formers into the practice for work experience.
• Fisherton House was commissioned to provide extended surgical and dermatology services. GPs with Special Interest delivered these, so patients were able to access rapid diagnosis and treatment for conditions such as low risk skin cancer.

• A “leg club” was held at the practice for the management of ulcer and other leg conditions. These clinics were held weekly to ease access to district nursing appointments and increase recovery rates for patients.

• Education evenings, with health trainers to discuss, diet and exercise were held at the practice to help reduce the impact of obesity in long-term health conditions

• The practice was run efficiently and was well organised. There was a clear leadership structure and staff felt supported by management. 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 leadership, governance and culture of the practice put quality and safety as its top priority in delivering person centred care and treatment. We saw many examples of this throughout the inspection and noted strong leadership was a common thread seen in the areas of outstanding practice.

We saw areas of outstanding practice:

• The practice employed a consultant nurse practitioner specialised in the care of the frail older patients. Their role was to lead an older persons team within the wider primary care setting to deliver a rapid response assessment and intervention service for the older frail and vulnerable patients. Staff were able to carry out routine health checks, observe the patient in their own environment and pick up any early signs that they were not coping. Care plans were then put in place.The practice were able to give us examples of where admission to hospital had been avoided as symptoms had been recognised and treated before hospitalisation was required.

• A practice vision was to deliver care that addressed the physical, social and psychological needs of patients and their families including running patient support cafes. They employed a health and wellbeing advisor who was responsible for liaising with voluntary agencies to support each café. Each café had a different theme; for example, dementia, aimed at supporting different patient needs. In addition to the cafes they organized the health and wellbeing signposting board ensuring patients knew what services were in the community, together with which services and cafes were coming in each week. The practice promoted this internally and externally, with each clinician having access to the timetable so they could direct patients to the support cafes, and when agencies were coming into the surgery. Patients benefitted from these café’s through wider social contact, information about their conditions and support for their carers

• The practice had gone out into the local schools and invited sixth formers into the practice for work experience to encourage a career in the health profession. In recent years the practice provided 33 apprenticeship places which allowed young people to gain experience of working within a GP practice and learn new skills. 13 had remained at the practice others had been supported to work within the health profession helping sustain the local health economy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice