Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Old School Surgery on 17 December 2014. Overall the practice is rated as Good.

Specifically, we found the practice to be outstanding for providing effective services. The practice was good at providing caring, safe, responsive and well-led services including services for the working and student population, families and young patients, older patients, patients experiencing poor mental health and patients whose circumstances make them vulnerable.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• 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 practice has a good working relationship with the attached pharmacy with the same aim to provide good quality patient care.
• The practice had a proactive approach to understand the needs of the large student population registered with them including attending key student days and working with student forums to promote the service the practice could provide to them.

We saw several areas of outstanding practice including:

• The practice was the first to employ a full time clinical pharmacist in the area. They have developed this role to help support with patient medicine reviews and the management of long term conditions. This had assisted the practice in reducing unnecessary patient medicines alongside reducing the prescription cost per year.
• Dementia awareness and training of staff has proved successful due to increased patient diagnosis, recognising signs of dementia and better support and information for patients and their relatives.
• Young patients under the age of 25 years old were able to access the practice for confidential sexual health and relationship advice. The practice told us and the ‘4 young people’ Bristol website, provided confirmation they had been accredited with the ‘young people friendly’ and ‘you’re welcome’ award. This meant they were a welcoming place for young people to attend to gain information about their sexual health or relationships, aware of young people’s health issues in the area, ability to work with other services and had the appropriate training and facilities for young people to use.

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

Importantly the provider should;

• Ensure all staff were risk assessed to determine their level of involvement with patients and whether they require a criminal background check alongside other recruitment checks to prevent unsafe patient care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. The well led domain was rated as outstanding.(Previous inspection December 2014 - 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? - Outstanding

We carried out an announced comprehensive inspection at The Old School Surgery on 10 May 2018 as part of our inspection programme.

At this inspection we found:

• 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. However, arrangements for medicines management did not always ensure the security of blank prescription stationery.
• 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 strong focus on continuous learning and improvement at all levels of the organisation.

We rated well-led as outstanding because:

• We saw evidence of effective leadership with a strong focus on innovation and improvement. For example, improvements to the services delivered to patients diagnosed with dementia, a true engagement of patients and staff to seek contributions and feedback to make improvements.
• The practice took a leadership role in its local health system to identify and proactively address challenges and meet the needs of the population. For example, taking a lead within the local transformation programme to improve access to patients and integrate care and improving student healthcare locally and nationally.

We saw some areas of outstanding practice:

• The practice was using innovative and proactive methods to improve patient outcomes, with services tailored to the needs of students including a dedicated mental health nurse employed by the practice; sexual health services for young people and through the Catheter Care pathway.
• A dedicated nursing team supported frail and older patients, including through urgent and routine home visits; management of long-term conditions; and care for patients with a diagnosis of dementia and their carers.
• The practice had continued to develop its practice based, prescribing clinical pharmacist role; and close working with the attached pharmacy, to enhance patient care. Both schemes had won national recognition from NHS England as case studies for innovation in primary care.

The areas where the provider should make improvements:

• Review and implement arrangements for the security of blank prescription stationery.
• Continue to monitor and improve the uptake of cervical screening, childhood immunisations and lower exception reporting for long term conditions and improve patient outcomes.

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