Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Freshford Practice on 24 May 2016. Overall the practice is rated as Outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• All staff received annual basic life support training and emergency medicines were easily accessible to staff in a secure area of the practice and all staff knew of their location.

• There was a named GP responsible for the dispensary and all members of staff involved in dispensing medicines had received appropriate training and had opportunities for continuing learning and development.

• The practice achieved consistently high levels of performance in the Quality and Outcomes Framework across the majority of healthcare indicators.

• The practice focused on helping patients understand their conditions, and signposted patients to relevant services such as Empower for patients newly diagnosed with diabetes, exercise on prescription, smoking cessation and healthy lifestyle clinics.

• There was a strong, visible, person-centred culture within the practice. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.

• Patient satisfaction rates were higher than the local and national averages across all areas measured.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, a visiting GP offered a community cardiology clinic which registered patients and other neighbouring practices could access this service.

• The practice proactively sought to educate their patients to manage their medical conditions and improve their lifestyles. Additional in-house services were available and delivered by staff with advanced qualifications, skills and experience.

• Patients with a learning disability and those with dementia were supported to make decisions through the use of care plans, which they were involved in and agreed with.

• The practice actively reviewed complaints and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• There was strong leadership for all clinical and non-clinical areas such as monitoring patient experience of the quality of care and treatment.

We saw several areas of outstanding practice including:

• The practice had excellent facilities and was well equipped to treat patients and meet their needs. Due to the rural location the practice offered many in-house diagnostic facilities including phlebotomy, ultrasound, X-ray DEXA Scanning, near patient testing, D-Dimer, Troponin (this is a sensitive and specific indicator of damage to the heart muscle and measured in the blood to differentiate between unstable angina and a heart attack) and many others. Patient feedback was very positive about having local facilities.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers. In-house digital X-ray and scanning equipment was linked with other organisations so images could be shared. This meant the consultant at the acute trust could view results and advise the GP of future treatment; this reduced outpatient appointments at the hospital.

The areas where the provider should make improvement are:

• Ensure a regular stock check is made of the controlled drugs and that accurate records are maintained in the register.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice