Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of St Peter’s Surgery on 6 July 2015. Overall the practice is rated as good.

Specifically, we rated the practice as good for providing safe, effective, caring,responsive and well led services. The service provided to the following population groups was rated as good:

• Older people
• People 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
• People experiencing poor mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All opportunities from incidents were maximised and lessons learnt were communicated widely to support improvement. Complaints were analysed in order to identify potential themes and trends. Learning from complaints was shared with staff.

• Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. The practice recognised the care, treatment and support needs of their patients and offered services accordingly.

• Staff had received training appropriate to their roles. There was evidence of appraisals and personal development plans for all staff with practice wide learning objectives identified.

• Patients we spoke with said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

• Following patient feedback the appointment system had been reviewed and changes made. Completed audits identified that telephone access required ongoing improvements.

• There were effective systems in place to ensure the quality of the service provided was monitored and reviewed. The systems in place were well managed and supported continuous improvement to the service provided.

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

The provider should:

• Review the practice policy for registration of new patients to include those who have no fixed abode to ensure a clear process which allows easy access to the service for patients without an address.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating July 2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at St Peter’s Surgery on 21 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.
• The practice understood the needs of its population and tailored services in response to those needs. There was evidence of a number of projects and services the practice had been involved with to ensure patients’ needs were met.
• The practice was participating in the Macmillan Cancer Champion project. A member of reception staff and one of the practice nurses had undertaken additional training to fulfil this role. One of the GP Partners was the Macmillan GP Facilitator.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had amended the appointment system to increase the number of same day appointments and were in the process of installing an additional telephone line to improve telephone access.
• Action had been taken to strengthen the clinical leadership through the development of lead roles for clinicians, with protected time in finance, transformation, education and quality and training.
• The practice had participated in Clinical Commissioning Group support programmes, which had enabled to the practice to implement a workflow management system which reduced the paper workload for GPs.
• The practice management had a deep understanding of issues, challenges and priorities in their service, and beyond. For example: the clinical staff worked closely with the external colleagues such as the substance misuse team and support workers from a local hostel to provide a service for vulnerable patients.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. For example: staff had undertaken additional training to become an IRIS (Identification and Referral to Improve Safety) trained practice, and protected practice education sessions (PES) had been introduced.
• The practice had participated in the National Cancer Diagnosis Audit 2017. They were the only practice within the CCG to have participated in the audit.

The areas where the provider should make improvements are:

• Document risk assessments for those staff whose immunisation status was not known, until the complete immunisation status for all members of staff has been obtained.

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.