We carried out an announced comprehensive inspection at The Exchange Surgery on 5 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

This practice is rated as Good overall – Good in Safe, effective, caring, responsive and well domain and good for all population groups except for vulnerable people which we rated outstanding. (Previous rating July 2016 – Good)

We found that:

• 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.
• The involvement of other organisations and the local community were integral to how services were planned and ensured that services met patient needs.
• There was a proactive approach to understanding the needs of different groups of people and to ensure they received the care to best meet their needs, particularly those people who were vulnerable.
• Improvements since our last inspection included, improved care for patients diagnosed with diabetes demonstrated by the annual national Diabetes audit and the employment of a clinical pharmacist to rationalise and optimise medicines management.
• The practice had a policy of continuous improvement which had developed their services for vulnerable people and people experiencing poor mental health (including people with dementia) in particular.

The areas where the provider should make improvements are:

• Continue to monitor and improve the uptake for childhood immunisation and for the cervical screening programme.
• Continue to monitor and improve patients experience when telephoning the practice.
• Take action to ensure staff have received appropriate immunisation.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Exchange Surgery on 17 March 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks within the practice were assessed and well managed though the practice did not have immediate access to all information in respect of risks managed by the building manager.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients told us that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well-equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice

• Twenty five percent of the practice’s population suffered from a mental health condition yet QOF scores for mental health indicators were much higher than the national average and exception reporting lower. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 97% compared to 88% nationally. The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 91% compared to 84% nationally. The practice had 0% exception reporting for dementia patients compared to 8.3% nationally, 12% for patients with depression compared to 25% nationally and 1% for other mental health patients compared to 11% nationally.

The areas where the provider should improve are:

• Have prompt access to risk assessments, policies and procedures that are held by the building manager.

• Review processes around the provision of basic life support training.

• Undertake analysis to identify additional patients with chronic obstructive pulmonary disease.

• Consider strategies to improve the identification of patients with caring responsibilities

• Continue to liaise with the CCG with a view to improving telephone access

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice