Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wistaria & Milford Surgeries on 17th August 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.
• 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.
• The practice was aware of challenges and future concerns and worked towards sustainability and collaboration across local practices. A systematic approach was taken to working with other organisations to improve care outcomes.
• There were high levels of staff satisfaction with a good staff retention rate. Staff were proud of the organisation as a place to work and speak highly of the culture.
• The practice participated in national and local audits and research. There was also a strong focus on continuous learning and improvement at all levels within the practice.

We saw one area of outstanding practice:

• The lead practice nurses had designed a teaching package for non-clinical staff to be able to assist in chaperoning.The training was very thorough ensuring the staff understood their roles and responsibilities in performing the role and also included practical demonstrations of equipment and what the staff should expect to observe in the examinations they may be asked to chaperone. The training also allowed those members of staff who were unsure of the chaperoning role to be fully informed and they can make an informed decision to take on the role or decline it. This meant patients had a trained member of staff who understood and wanted to do the role.

The areas where the provider should make improvement are:

• The practice should make efforts to improve the care and support of patients for healthy lifestyles and long term conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The provider accommodated the needs of people with disabilities. We found that both practices met the requirements of the Disability Discrimination Act (DDA) 1995. We saw that both surgeries were wheelchair accessible. The consultation rooms at The Wistaria Surgery were situated on the ground floor with four consulting rooms upstairs and accessible by a lift. Patients' diversity, values and human rights were respected. During our inspection we saw the consultations with the GP and Practice Nurse took place in single rooms which afforded privacy and confidentiality.

During our inspection we spoke with 14 patients, (seven at each surgery) eight members of staff (including two GPs and two nurses), the practice manager and deputy practice manager and reviewed records in relation to 10 patients. Patients were happy with the care provided. One patient told us that the GP had been “very thorough” and another said: “The doctor was lovely today as always”.

We saw that medicines kept in the surgery, for use in the event of an emergency, were in date and checked weekly by nursing staff. Anaphylaxis kits were kept in nurses rooms. These were drugs which needed to be administered if a patient suffered a severe allergic reaction to a vaccine. The surgery did not keep any controlled drugs on the premises.

Suitable and appropriate checks were undertaken for successful candidates including disclosure and barring service (DBS) checks or enhanced Criminal Records Bureau (CRB). We were informed that the selection and interview process adhered to Equal Opportunities. We were shown the personnel file for five staff members. They included appropriate checks, a copy of their job application, two references and a copy of two forms of identification.

Decisions about care and treatment were made by the appropriate staff at the appropriate level. We found that the patients’ who used the service received appropriate care, treatment and support and the risks to their health, welfare and support were appropriately assessed and managed. The records we looked at were up to date, signed and reviewed each time the patient visited the practice if required.