Letter from the Chief Inspector of General Practice

We inspected this service on 3 December 2014 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found the practice to be good in the safe, effective, caring, responsive and well-led domains. We found the practice provided good care to older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health. 

Our key findings were as follows:

• Patients were kept safe because there were arrangements in place for staff to report and learn from key safety risks. The practice had a system in place for reporting, recording and monitoring significant events over time.

• There were systems in place to keep patients safe from the risk and spread of infection.

• Evidence we reviewed demonstrated that patients were satisfied with how they were treated and that this was with compassion, dignity and respect. It also demonstrated that the GPs were good at listening to patients and gave them enough time.

• The practice had an open culture that was effective and encouraged staff to share their views through staff meetings and significant event meetings. 

We saw several areas of outstanding practice including:

• The practice provided an Xpert Diabetes Programme (XDP). The aim of this programme was to provide patients with the knowledge, skills and confidence necessary to self-manage their diabetes. The practice was able to demonstrate a sustained reduction in blood sugar levels among patients who had attended this programme.

• Data reviewed showed that Wyre Forest Clinical Commissioning Group (CCG) had the highest rate of excess weight in four to five year olds out of the six Worcestershire districts. This summer the practice was involved in a community engagement exercise at a local primary school. Clinical staff including GPs had a stand at the school for a day during the school fete. They offered weight, blood pressure and blood sugar checks and health promotion and healthy eating advice to the public.

However there was also an area where the practice needed to make improvements. The provider should:

• Review the recruitment policy to ensure it reflects current regulatory requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous rating 04/2015– Good)

The key questions at this inspection are rated as:

Are services safe? – Outstanding

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 Stanmore House Surgery 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 recorded and learned from low, moderate and high risk incidents.

•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 had carried out 17 audit cycles, including two and three cycle audits.

•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.

• One of the GPs visited the local primary school to engage with the local community. The GP delivered sessions on Dermatology, Diabetes and healthy eating to raise awareness.

•The GPs would often do teaching sessions for the nurses at the practice on their day off. They had done talks on Thyroid disease and Hypertension amongst others to highlight current NICE guidance and upskill nurses. The nurses found the impact of these sessions very helpful when they carried out weekly ward rounds in the local care homes.

•The Advanced Nurse Practitioner at the practice did some training sessions at one of the local care homes for day staff and night staff. The teaching session was about verification of death. The intention was to confidently verify a death in house so that they did not have to call external agencies in which was kinder for bereaved families.

•The practice proactively identified carers and supported them. There were 316 carers registered with the practice which was 3% of the patient list.

We saw several areas of outstanding practice:

•The practice had an effective approach to managing safeguarding for children and vulnerable adults. This included having a clinical and non-clinical safeguarding lead and reviewing the notes of every new child and their family who registered at the practice. The practice reviewed the notes of all newly registered children and their household contacts every four weeks via a search on the computer system.

•The practice had a very robust system in place for monitoring patients on high risk medicines.

•The practice had an innovative way of dealing with external safety alerts. The practice manager had devised a system on the computer which was colour coded and ensured all clinicians saw every alert. The system also allowed clinicians to comment on the alerts.

•The GPs and other members of the team would walk with the “Stanmore Strollers." This helped to create a community feel and prevent isolation. There were two walking groups: one fast group and one slow group to allow for all abilities. The practice shared examples where patients had returned to this country after a number of years and the Stanmore Strollers helped them to find friends in the community again. They shared an example where a patient had been a carer to their parent. When the parent went in a nursing home they had felt isolated, now they often run the walking group. The practice allowed patients registered with other practices to register as Stanmore Strollers. They would go for refreshments to the local pub after their walk.

•The practice was rated top out of 65 surgeries in Worcestershire for their overall experience of the surgery in the national patient survey.

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.