Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tower House Surgery on 22 June 2016. Overall the practice is rated as good.

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

• 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.
• The practice used innovative and proactive methods to improve patient outcomes. For example, extra services were implemented to support children and adolescents with mental health concerns and for patients with alcohol dependency.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 saw one area of outstanding practice:

The practice identified a higher number of children and young people who were presenting with mental health concerns and either had a long wait for a Child & Adolescent Mental Health Service (CAMHS) referral or would not quite meet the criteria the practice had assessed the need for a supplementary service. They had applied for and received additional funding from the clinical commissioning group to commission a child psychology service. Over the last 12 months the service had seen and assessed 26 children following referral from a GP. All referrals were considered appropriate by the psychologist. The cases seen were those which did not meet the threshold for CAMHS but were in crisis. Following assessment follow on sessions were provided for each patient. The service supported patients through anxiety, low mood, behavioural and identity issues. A course of treatment was completed or used to stabilise while awaiting referral to a specialised service. We identified a number of cases were a positive impact was seen for patients in managing their health, providing social and personal support or help for the families with younger children in crisis or need of mental health support.

However there were areas of practice where the provider should make improvements:

• To review monitoring of patient care to ensure where exception reporting is high that other ways of engaging patients are explored, to ensure that minority communities and cultures are encouraged to attend for national screening procedures and health reviews.

• To ensure that the stock of emergency medicines are risk assessed and made clearer to staff.

• To explore more ways of identifying carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice