Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Whittington Moor Surgery on 5 November 2015. Overall the practice is rated as outstanding.

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

• Feedback from patients about their care was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• There was an open and transparent approach to safety and a highly effective system was in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from incidents were maximised and inclusive of the whole practice team

• The practice worked with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs. For example, the practice had contributed to the implementation of a telehealth service with a local care home to address high call outs by giving immediate telephone access to clinical advice.

• 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. For example, a member of the group had witnessed the reception staff dealing with an aggressive patient and when this was reported to the practice, staff were given training in dealing with confrontation and information was displayed in reception regarding unacceptable behaviour.

• The practice used clinical audits to review patient care and took action to improve services as a result. For example, the practice had audited its referrals to gynaecology and this helped to reduce the number of referrals through discussion on appropriate cases with the other GPs.

• 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, and learning was applied from complaints to improve services for patients.

• The practice had a clear vision which had quality and safety as its top priority. The partners had developed a robust strategy for business and clinical practice with lead areas of responsibilities for individual GPs. The supporting plans contained clearly defined goals and aspirations. The strategy to deliver this vision was regularly reviewed, and had been discussed with staff.

• Risks to patients were assessed and well managed in conjunction with the wider multi-disciplinary team.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• 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.

• High standards were promoted and owned by an enthusiastic and motivated practice team with evidence of highly effective team working.

We saw several areas of outstanding practice including:

• The practice demonstrated an exceptional approach to safety and had a designated lead GP for significant events who had undertaken additional training to support this role. Events were risk rated to identify those with more serious implications for patient safety to prioritise them for action. Positive events were also recorded to ensure these could be celebrated and shared as good practice with the team.

• The practice contracted a pharmacist to provide clinics within the practice for substance misuse and Warfarin monitoring. This enabled vulnerable patients to be seen locally and within a familiar environment, and also facilitated rapid communication regarding any identified concerns between the GPs and the pharmacist. The pharmacist had seen 32 patients for ongoing anticoagulation monitoring and seven patients for substance misuse issues over the last 12 months. The substance misuse service was quality-based to help keep patients stable on their medication regime, and the practice had audited patient satisfaction with the anticoagulation service in 2015 and this demonstrated positive feedback from patients.

• There was a high level of constructive engagement with staff and a high level of staff satisfaction. For example, the practice had undertaken a staff survey during October 2015. The whole team had all contributed to the development of the practice’s vision. Annual away days recognised the contribution made by staff to deliver practice achievements.All staff we spoke with told us they felt valued and that their work was appreciated.

• A comprehensive set of reception protocols had been developed as a reference document for staff to provide information on what to do in response to any issues they may encounter when dealing with patient queries or presenting issues.

• The practice had been involved in establishing a telehealth system at one of the care homes which gave care home staff access to immediate clinical support via an external nurse triage facility. If the problem could not be resolved by telephone advice, the triage service requested the GP to visit. The impact of the scheme was evidenced by a reduction of 33 GP visits per month to the care home.

• The practice ensured that any children at risk from actual or potential abuse who re-located to another area were followed up by arranging a discussion with the new GP practice to share any known concerns.

One area where the provider should make improvement is:

To review access to a male GP by working with other local practices

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice