Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Village Green Surgery on 24 March 2015. Overall, the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses. Information about safety was appropriately recorded and reviewed;
• Risks to patients were assessed and well managed;
• The practice was clean, hygienic and good infection control arrangements were in place;
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• The practice had scored very well on clinical indicators within the quality outcomes framework (QOF). They achieved 99.3% for the year 2013/14, which was above the average in England of 96.47%;
• Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their care and treatment;
• Information about the services provided and how to raise any concerns or complaints, was accessible and easy to understand;
• Most patients said they found it easy to make an appointment and urgent same-day access was available;
• The practice had good facilities and was well equipped to treat patients and meet their needs;
• The practice was clean and effective arrangements were in place to reduce the risk of infections;
• There was a clear leadership structure and staff felt supported by management. The practice actively sought feedback from patients;
• We found there was good staff morale in the practice, with high levels of team spirit and motivation. There was a strong learning culture evident in the practice. This came across clearly through staff interviews, but was also evident in the approach to adopting and championing new initiatives and technology. The practice took a leading role in identifying new resources and sharing these with other practices across the locality.

We saw several areas of outstanding practice including:

• The Medicines Optimisation for patients in the local care home resulted in significant reduction in medicines prescribed. (Medicines optimisation is an approach which seeks to maximise the beneficial clinical outcomes for patients from medicines with an emphasis on safety, governance, professional collaboration and patient engagement). The practice calculated the approach had resulted in a 17%decrease in medicines prescribed, with no untoward effects reported. The results of this project were reported on at the National Pharmacy Congress conference in April 2015 as an area of good practice.
• The practice directly employed a pharmacist and we found their support had led to improvement in outcomes for patients.
• The multi-disciplinary diabetic clinic, which supported good outcomes for patients with diabetes. Patients had access to advice from the dietician and retinal screening during the clinic and following the clinic the diabetic team met to discuss any concerns or queries. This service was well regarded by patients. Performance against the Quality Outcomes Framework (QOF) for diabetes mellitus was at 99.8%, which was 5.8 percentage points above CCG Average and 9.7 above England Average.
• There was strong evidence throughout the practice that team spirit and motivation was high. Of particular note was the general feeling of ‘all of us feel valued and of equal importance’.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice