We carried out an announced comprehensive inspection at Severn Valley Medical Practice on 17 January 2019 as part of our inspection programme.

At the last inspection in April 2015 we rated the practice as good overall.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• The practice had developed a template for all high-risk medicines to ensure appropriate monitoring and safe prescribing. In addition, a Direct Oral Anti-Coagulant (DOAC) template has been introduced outlining advice and safety aspects for prescribing for clinical staff. This included a calculation for accurate and correct dosage in renal impairment.
• The practice worked proactively with other organisations to ensure patients had access to a range of services to support their health and wellbeing.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
• The practice had employed a patient liaison worker (PALS) who worked across sites to engage with patients and signpost them to support services. Stress management, holistic therapies and carers support were available for patients to access in the practice.
• There were innovative approaches to providing integrated person-centred care.
• The practice had identified areas where there were gaps in provision locally and had taken steps to address them.

Whilst we found no breaches of regulations, the provider should:

• Complete a risk assessment for the clinical handwash sinks in line with best practice.
• Review how to improve the security of waste storage bins outside of the practice.
• Develop an effective system to record, monitor and track the immunisation status of staff members in line with Public Health England (PHE) guidance.
• Embed a formal process to ensure that leaders have oversight to support good governance and management.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Severn Valley Medical Practice on 15 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well led services. It was outstanding for providing services to older people and good for providing services to patients with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and those experiencing poor mental health or living with dementia.

Our key findings were as follows:

• The practice had systems for monitoring and maintaining the safety of the practice and the care and treatment they provided to their patients.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• The practice was clean and hygienic and had arrangements for reducing the risks from healthcare associated infections.
• Patients’ needs were assessed and the practice planned and delivered care following best practice guidance.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had an established a well trained team with expertise and experience in a range of health conditions.
• Patients said their GP listened to them and that they received prompt care and attention. They told us staff were polite, informative and compassionate.
• Information about services and how to complain was available and easy to understand. The practice responded to complaints in a positive way.
• The practice communicated with patients and acted on feedback to improve the service they provided.

We saw several areas of outstanding practice including:

• The practice employed a prescribing pharmacist for 30 hours a week. This resulted in increased numbers of medicines reviews completed and greater availability of GP appointments. Other improvements included more proactive checks of patients’ medicines on discharge from hospital and a faster turnaround for repeat prescriptions.

• The practice proactively followed up and monitored patients with risk factors for osteoporosis, a condition that affects the bones, causing them to become weak and fragile and more likely to break. Individual appointments were arranged throughout the year and the practice also held osteoporosis clinics twice a year. The practice had scored 6.6% above the CCG average and 16.6% above the England average in QOF for prevention of fractures due to patients having fragile bones.

• The practice worked closely with Age UK and with local care homes for older people. They had introduced an assessment template to support care home staff to make timely and appropriate requests for GP visits. The practice had also initiated regular meetings with care home managers to improve communication and multi-disciplinary working. Patients from the care homes had been invited to join the practice’s patient participation group (PPG). The practice was working in partnership with Age UK on an over 75s care project aimed at identifying and addressing unmet social need and had a member of the team with responsibility for co-ordinating this. The practice hosted a monthly Age UK clinic at the branch surgery to make it easy to refer patients to see one of their team about non-medical concerns.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Review and update the complaints procedure including removing references to the primary care trust (PCT) a commissioning organisation which no longer exists.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice