Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stanhope Surgery on 18 May 2017. Overall the practice is rated as requires improvement.

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

• There was a system for reporting and recording significant events. Staff were aware of the significant event reporting process. However, there was limited use of the system to record and report safety concerns, incidents and near misses. We were informed that significant events were often managed informally, they were discussed at staff meetings but there was no documented learning from these.
• Data showed patient outcomes were comparable with the others in most areas but significantly lower for diabetes related indicators. Although some audits had been carried out, they were only in relation to medicines management and were completed following direction from the local clinical commissioning group (CCG).
• Patients we spoke with said they were treated with compassion, dignity and respect. However the practice scored below average in most areas of the national GP patient survey published in June 2016. For example, 62% of patients said the GP was good at listening to them compared with the clinical commissioning group (CCG) average of 88% and the national average of 89%.
• The practice had adequate arrangements to respond to emergencies and major incidents. However, a copy of the business continuity plan was not kept off site by the GP partners or other staff members so could not be used for reference if the building was not accessible.
• Risks to patients were assessed and well managed.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had identified 203 patients as carers, which equated to approximately 3% of the practice list.
• The practice employed a clinical pharmacist as part of a pilot programme to test the role of clinical pharmacy in general practice. They submitted a bid to the local CCG and were approved for funding to take part in the pilot. They recruited a pharmacist and supported their training to become an independent prescriber.

The area where the provider must make improvements are:

• Identify, document and investigate safety incidents thoroughly and ensure that patients affected receive support and a verbal and written apology and ensure learning from incidents are documented, shared and trends are considered.

In addition the provider should:

• Continue to make improvements to the care and monitoring of patients with diabetes (long-term conditions).
• Ensure a process for continuous clinical improvement is introduced. For example, practice specific clinical audit and re-audit to improve patient outcomes.
• Continue to encourage patients to attend national screening programmes for bowel and breast cancer screening.
• Continue to monitor and ensure improvements to national patient survey results in all areas including access to the practice by telephone and availability of appointments.
• Keep a copy of the business continuity plan offsite for use if the building is inaccessible.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice