Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Croft Practice on 17 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for the six population groups.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The GPs were proactive in identifying and undertaking regular audits of clinical care to improve treatment and ensure best practice was being implemented.
• There was a strong culture of multi-disciplinary working. All of the GPs were actively engaged in meetings with representatives from health and social care in order to avoid hospital admissions for patients with complex health and social care needs.
• The practice had expertise in providing high quality end of life care and bereavement support.
• Patients said they could always get to see a GP on the same day if they needed to but that it was sometimes difficult to get through on the telephone, particularly in the mornings.
• Staff felt supported by management.
• The practice premises were clean and hygienic.

We saw one area of outstanding practice:

• All of the GPs were actively engaged in multi-disciplinary team meetings to discuss patients with complex needs. For example, those with multiple long term health conditions and complex social needs. All of the GPs attended fortnightly meetings with the “pro-active care” (PAC) team which included community nurses, social workers, and a community pharmacist where decisions about care planning were made and documented in a shared care record. The practice provided us with evidence that demonstrated the number of patients under the care of the PAC team had increased by 65% since 2013. It was also able to demonstrate a reduction in hospital admissions.

The areas where the provider should make improvement are:-

• Ensure that a written policy and procedure is in place for reporting significant events which includes the definition of a significant event and the procedure for recording and reporting.
• Ensure significant events and safety alerts are recorded in a consistent format in order to demonstrate what lessons have been learned, how these have been shared with staff and what action has been taken as a result.
• Organise regular clinical meetings for medical and nursing staff to facilitate knowledge sharing and learning from significant events on a more structured basis.
• Continue to implement and review measures to improve telephone access for appointment booking.
• Ensure that measures being implemented to improve patient participation are fully embedded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The Croft Surgery is the main surgery and all practice administration is run from there. Meadowcroft and Flintcroft Surgeries are smaller and have more limited opening times. Flintcroft Surgery is for advance booked appointments only. We visited The Croft and Meadowcroft Surgeries for this inspection.

We spoke with nine patients on the day of the inspection visit. We also spoke with four GPs, the practice manager, one practice nurse, four administration staff and three external community health care professionals.

Patients told us that they felt well informed and involved in making decisions about their care and treatment. They said that all staff were approachable. Confidentiality was protected. Patients were happy with the care and treatment they received and valued the local services provided.

We found that there were systems and processes in place to protect patients from abuse and that staff demonstrated knowledge of how to report any concerns.

There were good recruitment processes in place. Whilst there was no formal training programme in place for everyone, staff told us that they had training and development opportunities and that they were well supported by the provider. They felt qualified for their roles and responsibilities.

We found processes in place to review and monitor the quality of the service provided. There was learning from the processes and the information was used to improve the service.