Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woodbury Surgery on 20 September 2016. Overall the practice is rated as outstanding.

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. Woodbury Surgery was proactive in identifying frailty and managing vulnerable patients and those with long term health conditions registered at the practice. An intuitive IT system facilitated the early identification of patients who could also be at risk of developing long term conditions enabling early interventions to take place.
• 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.
• There was high patient satisfaction, with all 46 patients confirming 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.

• People’s individual needs and preferences were central to the planning and delivery of tailored services.We saw several examples of this illustrated by: Longer 15 minute appointments as a standard; seeing patients in the setting they were most comfortable with; a flexible and responsive service by clinical staff for housebound patients; bridging gaps bringing services closer to home such as specialist clinics for patients with long term conditions and building a trusting rapport with hard to reach vulnerable groups such as the travelling community. 

• 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.
• The GP partnership provided a total team approach to monitoring the health and well being of patients with innovative new ways of providing care and treatment.
• The leadership, governance and culture at Woodbury Surgery was used to drive and improve the delivery of high-quality person-centred care.
• Learning was celebrated and the practice was proactive in using opportunities to improve services by seeking and acting upon feedback from staff, patients and other stakeholders.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

People’s individual needs were central to planning and the delivery of tailored services. For example, the practice had initiated a complex condition clinic where patients were seen by a GP and other specialists to ensure patients received a comprehensive holistic review that met all health and social care needs. The practice understood the impact of living with chronic and life limiting conditions such as chronic kidney disease. Clinics were held with consultant and specialist nurse input facilitating closer monitoring of these patients.

The practice had invested in a software risk management system, which enabled patient records to be analysed to produce risk profiles and target audit activity and health screening. For example, the system enabled the practice to identify patients and led to timely diagnosis of coeliac disease so that they could receive appropriate support and treatment to manage this condition.

Action the provider should take to improve:

Ensure that pre appointment checks for locum staff are carried out for every new period of cover at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This was Woodbury Surgery’s first inspection since registering with the Care Quality Commission. During our visit to the surgery we spoke with the practice manager, four patients and two carers, two of the four GPs, the Friends of Woodbury co-ordinator and a volunteer, receptionists, a practice nurse and the dispensary manager.

Patients expressed satisfaction with the service they had received. They said that the receptionists were polite and helpful. They told us they could see a doctor of their preference. One patient said "The surgery is brilliant and the receptionists are very good. The doctors try hard to understand our particular needs.” And another said “It’s a very family orientated practice. The GPs are mainly part time but they all work as one. I rang up and said ‘it’s me!’ and they knew exactly who I was”. One patient had moved from another surgery and their carer said “The other surgery didn’t understand our situation but this one is brilliant, I’m so relieved that my relative will be well looked after and I will be involved”.

They told us they had a good service when they telephoned for an appointment and were given a slot at a convenient time. One patient said “The doctor even rang me at home to see how I was doing, certainly nothing to complain about”.

Patients were referred to other healthcare services when required. The provider maintained detailed consultation notes in order to ensure patients received appropriate care and treatment that met their needs in a timely way. We saw how the practice maintained excellent communication between each other and all patients we spoke to said how well the practice met their needs regardless of whoever they were seen by.

People's privacy, dignity and independence were respected. People's views andexperiences were taken into account in the way the service was provided and delivered in relation to their care. People who used the service told us that the GPs explained treatment options and they felt involved and able to make informed choices. Records reflected this. One patient said "The doctor and I discussed my options. It’s wonderful, we can make any suggestions, they listen and I have nothing but praise and thanks”.

Staff were clear about what action they would take if they saw or suspected any bad practice or abuse. Staff had been given information and received formal training in this area and we were given examples of how the local reporting process had been used and information shared appropriately.

There were effective systems in place to monitor the quality of the service provided and patients felt able to give feedback about the service they received which was listened to and acted upon.