Letter from the Chief Inspector of General Practice

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

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

• There was a 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.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. A regular programme of clinical audit reviewed patient care and ensured actions were implemented to improve services as a result.
• The practice planned and co-ordinated patient care with the wider multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe.
• The practice was committed to staff training and development and the practice team had the skills, knowledge and experience to deliver high quality care and treatment. The practice had an effective appraisal system in place.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The practice analysed and acted on feedback received from patients.
• Information about how to complain was available upon request and was easy to understand, although no details were displayed in the waiting area. Improvements were made to the quality of care as a result of any complaints received.
• Patients provided mixed views on their experience in making an appointment to see a GP. However, we saw that patient feedback on access had improved in the latest GP survey, and the practice was taking proactive steps to address this issue.
• Longer appointments were available for those patients with more complex needs. A nurse practitioner triaged calls and ensured that any patient requiring an urgent appointment was seen on the same day.
• Risks to patients were assessed and well managed. However, the practice needed to update their fire risk assessment.
• The practice had good facilities and was well-equipped to treat patients and meet their needs.
• The practice funded a specialist respiratory nurse who attended the practice once a fortnight to monitor and review patients with breathing difficulties.
• The practice had developed their own detailed chaperoning guidelines for staff which were designed around specific examinations. For example, when acting as a chaperone during a breast examination.
• The practice had developed robust contingency planning arrangements.
• 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 had a clear vision for the future and ensured that the whole practice team were included in reviewing and planning service delivery. The aspirations of the partners were in line with the CCG strategy of delivering high quality care closer to the patient’s home.

We saw the following areas of outstanding practice:

• We received a number of examples demonstrating where staff had provided care above and beyond expectations. This included visiting patients at home during the weekend; organising a hospital discharge for a complex patient to comply with a patient’s wishes; and providing a course of treatment outside of opening hours to enable a patient to attend work. We observed that patients would have had to be admitted into hospital, retained in the hospital, or attended the hospital to access treatment, without this level of commitment to care by practice staff.
• The practice provided access to a range of mental health support that included a psychotherapist; a counsellor; a consultant psychiatrist for older people; and a cognitive behavioural therapist to support patients with mental health needs. At least one of these professionals was present in the surgery each working day. These services were accessible to all people who resided locally. Outcomes for mental health care were above local and national averages.

The areas where the provider should make improvement are:

• Undertake an up to date fire risk assessment.
• Display information on the complaints procedure in the waiting area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice