Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr DJ Collins (The Springs Health Centre) on 28 September 2016. Overall, the practice is rated as good.

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

• There was an effective system in place for the reporting and recording of significant events. Learning was applied from events to enhance the delivery of safe care to patients.

• Clinicians kept themselves updated on new and revised guidance and discussed this at clinical meetings. Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• We saw evidence of an active programme of clinical audit that reviewed care and ensured actions were implemented to enhance outcomes for patients.
• Patients told us they were treated with compassion, dignity and respect. They also said they were involved in their care and decisions about their treatment. This was corroborated bythe outcomes of the latest national GP patient survey and CQC comment cards.
• The practice planned and co-ordinated patient care with the wider health and social care multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe. Fortnightly meetings took place to discuss and review patients’ needs.
• The practice directly employed two community matrons and a part-time care co-ordinator to deliver and co-ordinate care and support to vulnerable patients in their own homes.
• The practice had an appraisal system in place and supported staff training and development. The practice team had the skills, knowledge and experience to deliver high quality care and treatment.
• Arrangements were in place to assess and manage risk effectively.
• Feedback from patients we spoke with on the day, and from CQC comment cards, demonstrated that people had good access to GP appointments.
• The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were accessible for patients with impaired mobility.
• The practice provided care to residents across three local care homes for older people. Regular planned visits to the home by both the community matron and by a GP ensured continuity of care and a reduction in the number of acute visits.
• There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice meetings occurred, and staff said that GPs and managers were approachable and always had time to talk with them.
• The practice management team consisted of the GP partners, the practice manager and the nurse manager. All decisions were agreed collectively as a team rather than solely as a partnership, demonstrating a more inclusive approach to decision making within the practice.
• The partnership had a vision for the future. They were proactively engaged with their Clinical Commissioning Group (CCG) in order to provide joined-up care closer to people’s homes via an integrated care model.
• The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received.
• The practice had a patient participation group (PPG) which met bi-monthly. The practice consulted with their PPG, although we did not see evidence of the PPG driving change within the practice.

We saw the following areas of outstanding practice:

• Two community matrons worked a total of 47 hours per week. The practice directly funded half of these hours. The two matrons proactively engaged with the wider multi-disciplinary teams to deliver responsive care to support patients and their families, and provided bereavement support following a patient death. One of the matrons had worked with the CCG’s lead medicines management technician on a deprescribing project (deprescribingrefers to reducing or stopping the prescribing of medicines that may be causing harm, may no longer be providing benefit, or may be considered inappropriate). The outcome of the project resulted in cost savings of almost £14,000 with 18% of prescribed medicines being stopped. Other medicines were reduced, changed or new medicines initiated after the review.
• The practice had significantly higher rates of screening for cervical and breast cancer in relation to local and national averages. For example, uptake for the breast screening programme for 50-70 year olds within six months of invitation was 84.3%, which was above the CCG average of 79.6% and the national average of 73.2%. The practice also had higher bowel screening rates than the national average and had achieved good performance in the uptake of NHS health checks. This was due to a proactive approach taken by the practice team including opportunistic reminders to patients, and motivating patients to receive screening if it was observed that they had refused the test.

The areas where the provider should make improvement are:

• Improve the uptake of annual health checks for patients with a learning disability.
• Review immunisation training updates for nurses in line with recognised standards.
• Consider a review of infection control management within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice