Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Elms Practice on 2nd July 2015. Overall the practice is rated as good. Specifically the practice is rated as good for providing safe, effective, caring, responsive and well-led services. The practice is also rated as good for providing services to the population groups of 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 and people experiencing poor mental health, including people with dementia.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents. Incidents were reviewed and learning from incidents was shared with practice staff.
• The practice used proactive methods to improve patients’ outcomes and maximise efficiency. For example, if patients needed more than one review these were completed at the same appointment.
• Patients said they were treated with compassion and dignity and that they were involved in decisions about their care.
• The practice made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had achieved 99.6% of the total quality points available and this was higher than the national average of 94.2%.

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

In addition the provider should:

• Ensure that airway tubes are in date. 
• Review the policy for the retention of receipts for faxed referrals.
• Produce a vision, strategy and business plan.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection July 2015 – Good)

The key questions 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 The Elms Practice on 22 May 2018 as part of our inspection programme.

At this inspection we found:

• The practice had introduced a new ‘Advice Line’ service for patients to contact. A response to any query was intended to be returned to patients within two working days of contacting the service.
• To protect patient confidentiality at the practice’s reception desk, the practice had introduced a ‘quick message’ system. This was a form that patients could complete at the desk, without needing to discuss personal issues in front of other patients, and a response would be returned to them within two working days.
• The practice was consistently higher than the local clinical commissioning group and national averages with regards to patients’ responses in the National GP Survey.
• The practice supplied evidence of risk assessments for the premises but these needed to be first sourced from NHS Property Services, who owned the building.
• Non-clinical staff were not able to consistently identify the ‘red flag’ signs of sepsis. However, they were able to report they would contact a clinician if a patient presented at the practice as extremely unwell.
• 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.
• 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 focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review the arrangements of how non-clinical staff are informed of the symptoms of sepsis.
• Review how the practice assured that all risk assessments at the practice are in place.
• Review how changes to service developments are monitored and evaluated.
• Review how the practice can maintain the uptake for childhood immunisations in line with national guidance.
• Review how the practice can improve the uptake of patients receiving a cervical smear in line with national guidance.
  

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice