Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Swan Practice on 27 October 2015. Overall the practice is rated as good.

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.

• 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 was provided to help patients understand the care available to them.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• The practice had a vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• The practice had an effective governance system in place, was well organised and actively sought to learn from performance data, incidents and feedback.

• The leadership and culture within the practice were used to drive and improve the delivery of high-quality person-centred care.

We saw several areas of outstanding practice including:

• The practice had excellent access to appointments and could demonstrate the impact of this by reduced use of secondary care services (specifically accident and emergency and out of hours GP services) and positive patient survey results.
• The nurse team leader had recently been made a Queen’s Nurse. A Queen's Nurse is someone who is committed to high standards of practice and patient-centred care. The Queen’s Nurse Institute supports innovation and best practice, in order to improve care for patients. The title is available to individual nurses who have demonstrated a high level of commitment to patient care and nursing practice. This award reflected the work of the nurse team leader whose smoking cessation clinics resulted in a high success and cessation rate.
• There was a specific designated GP point of contact for the four care homes, three schools and the university which the practice provide GP services for. Contact details of the designated GP were shared with the relevant staff, patients and their families, enabling continuity of care and quick access to the right staff at the practice.
• The practice had a very active patient participation group (PPG) and actively used social media to work directly to improve patient and practice communications. Communication via a popular social media medium was updated daily and included updates including new clinic times, responses to health related news articles and the Care Quality Commission inspection details.
• The practice had reviewed the different types of appointments available and how they were accessed via the appointment system. The practice and PPG created an appointment committee to complete a full 360 degree detailed audit of the appointment system ensuring there is the correct balance of availability for acute and chronic conditions across the whole patient list. The appointment committee was a group comprising of patients and staff.
• The practice were aware of lone elderly patients who were vulnerable, and without request would make regular home visits to check on their welfare. GPs carried out home visits to older patients presenting with more urgent health needs and the practice provided GP services to the community hospital; completing ward rounds five times each week.

However there were areas of practice where the provider needs to make improvements. Importantly the provider should:

• Ensure all staff are up to date with mandatory training.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice