Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Silton Surgery on 11 October 2016. Overall the practice is rated as good.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.

• Feedback from patients, and those who were close to them was completely positive about the way staff treat them. Patients were treated with dignity, respect and kindness during all interactions with staff and relationships with them were positive. Patients felt supported and said staff cared about them.

• The practice was in a rural location and travel to the local district hospital was often problematic for older patients. The practice worked closely with the local hospital consultants making active use of email advice to optimise patients care and reduce their need to travel to the acute hospital. In addition there were acute clinics including the RACE (Rapid Access Care of the Elderly) where elderly patients were seen by a consultant geriatrician within a few days of referral to get experienced clinician input about their condition and avoid hospital admission.

• The practice was a dispensing practice, this is where GPs were able to prescribe and dispense medicines directly to patients who lived in a rural setting. The Silton Surgery dispensed to patients who did not have a pharmacy within a mile radius of where they lived. The dispensary provided medicines in blister packs for older people with memory problems and had a weekly delivery service for those who struggled to get to the practice.

• 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 with a named GP and 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 found two aspects of outstanding practice.

• The practice worked hard to avoid unplanned admissions to hospital by working closely with secondary care providers. For example the practice was part of a local group of rural practices, they ran a local TCOP (Transforming care of the older patient) scheme. This involved sending birthday cards to patients over the age of 75. The card also included health questions for the patients to try and discover their health concerns or find any unmet health needs. Patients with issues raised on their birthday cards were then invited to a clinic at the practice to see the ‘Eldercare facilitator’, an experienced nurse, to review any unmet needs they had. A second aspect of the TCOP scheme was for the practice to perform extended face to face reviews of those patients over 75 to optimise their care. The practice worked hard to avoid unnecessary admissions to hospital and had one of the lowest unscheduled admission rates in Wiltshire.

• The practice were able to loan out equipment which monitored patient’s heartrates to check for irregularities. The practice had software on their clinical computer system which enabled them to interpret the data and implement a treatment plan. This service prevented patients from having to go to the district hospital for treatment and provided a swifter diagnosis of their condition.

The areas where the provider should make improvements are:

The practice had a good awareness of patients who performed a caring role, however their patient record system did not have a formal identification for carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice