Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Mill Medical Practice on 12 April 2016. Overall the practice is rated as outstanding.

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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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.
• The practice participated in the local initiative to improve care for the frail elderly and had very positive feedback from the care homes they looked after.
• Practice nurses ran a clinic for those patients over 75 who did not have any long term conditions. This ensured that this group of patients had proactive care and identified any unmet needs.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment for an urgent matter, for some patients it was harder to make appointments with a named GP.
• An urgent surgery was held every day which enabled ill children to be seen quickly. The practice had developed a template for reviewing unwell children following national guidelines on febrile illness. This included a leaflet for parents explaining what to look out for if a child deteriorates.
• The practice had very good facilities and was well equipped to treat patients and meet their needs.
• The practice had a strategy to promote high levels of care for patients and ran services which were not remunerated because they felt they provided good patient care. For example the ultrasound clinic.
• 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 several areas of outstanding practice:

• The practice provided a wide range of services to improve care for the frail elderly; this included a care coordinator, virtual ward rounds, working with Age UK and the community matron to look after the most vulnerable patients. They provided a very good service for managing elderly patients in the community and the impact of this work was shown in reduced emergency admissions and A&E attendances for over 65 year olds. The practice had the second lowest ambulance conveyance rate per practice in the CCG, with the activity level over a rolling 12 months showing the practice rate to be 93.71 compared to other practices where rates ranged from 88.38 to 198.24. Emergency hospital admissions had reduced by over 4% over the last year and A&E attendance for over 65 year olds had reduced by 6.5% compared to the previous year.
• The leadership of the practice had introduced and developed clinical systems, and shared these widely, to enhance how patients were managed resulting in improved patient care. For example they had developed an individualised care plan for diabetes and shared this with other practices in the clinical commissioning group (CCG). The care plan listed patients’ results, explained how to interpret the results and listed individualised targets that the patient and GP had agreed in the consultation. In addition the lead GP was running education sessions on this work which had been highlighted as excellent by the clinical systems provider.
• The practice had increased the number of patients diagnosed and treated for atrial fibrillation by 40% in the last four years through carrying out pulse checks at the annual flu clinics and putting an alert on the clinical system.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice