Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Hall Practice, Hampden Road, Chalfont St. Peter, Gerrards Cross, Buckinghamshire, SL9 9SA. The practice had been inspected in 2013. However, this was the first inspection under the new CQC comprehensive inspection approach and was undertaken to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Overall the practice is rated as outstanding. It delivers outstanding effective and caring services and services to the population groups of patients with long term conditions and those in circumstances that may make them vulnerable are also outstanding. The practice is rated as good delivery of safe and responsive services and for being well led.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them. Patient feedback on the care they received was consistently positive and patients commented that they were partners in making decisions about their care and treatment.
• The practice had adequate facilities and was well equipped to treat patients and meet their needs. The practice recognised they needed additional space in which to treat patients and plans were in place to move to larger premises.
• Information about how to complain was available and easy to understand.
• The appointments system was flexible and patients reported no problems in accessing appointments with their named GP. Patients and staff were positive about the benefits of a named GP giving continuity of care.
• The practice was clean and tidy and there were robust systems in place to reduce the risk of cross infection.

We saw areas of outstanding practice including:

• A member of the practice staff carried out the role of carers coordinator. They made annual contact with every carer, personally, on the practice register to ensure they were receiving the care and support they required and updated the carers register based on their contact.
• The practice had completed over 300 coordinated care records for patients with most complex health needs. These had been securely transferred to the out of hours service to support patient care when the practice was closed.
• The practice manager met all newly registered patients and during this meeting they advised patients how to use the appointments system. We saw that 47% of patients were signed up to use the online appointment booking facility and many did so.
• One of the GPs had special interest and expertise in dermatology. There were fewer referrals to hospital dermatology departments compared to other practices because this GP was able to provide appropriate care and treatment at the practice for many dermatological conditions patients presented with.
• Five GPs held additional qualifications in obstetrics and gynaecology. This meant they could support the care and treatment of women presenting with gynaecological conditions and the referral rate to hospital gynaecology departments was lower than other practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with ten patients who used the service. Patients told us they felt able to openly discuss the reason for their visit with the GP or nurse and they were given sufficient information on any treatment required. Some comments included “I always feel involved...appropriate leaflets are given out to explain any new drugs given to me” and “Very inclusive approach, backed up with literature.”

The patients we spoke with were complimentary about staff and told us the practice met their needs. One patient told us “The GP spends time reinforcing the information and I never felt hurried." Another patient described the practice as “Brilliant.” Most patients told us they could get an appointment when needed.

The patients we spoke with told us they felt comfortable, safe and were able to discuss issues with staff. However, patients who use the service were not fully protected from the risk of abuse, because the provider had not taken all reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found the provider had some systems to regularly assess and monitor the quality of the service that patient's received. However, the practice did not monitor the staff training that had taken place and when refresher training was required. The practice did not have effective systems in place to monitor and review the practice policies and procedures.