Letter from the Chief Inspector of General Practice
This practice is rated as Good overall. (Previous inspection 8 April 2015 – Good)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Outstanding
Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at Park View Surgery on 5 December 2017 as part of our inspection programme to inspect 10% of practices before April 2018 that were rated Good in our previous inspection programme.
At this inspection we found:
- The practice generally had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, actions to manage the low risk of legionella in the practice water system needed to be implemented. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings.) Also, risk assessments for staff working conditions and for emergency medicines held by the practice needed completion.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. There was a practice quality lead who managed many aspects of practice quality improvement.
- Staff acted on information in patient safety alerts although these actions were not always clearly documented.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
We saw three areas of outstanding practice:
- The practice clinical pharmacist worked with the lead pharmacist for medicines management training at the hospital to improve the way that discharge summaries were written. This work had resulted in further training for both junior and senior pharmacists at the hospital and a revised protocol for producing patient discharge summaries for all patients discharged from the hospital. We saw evidence that the lead hospital pharmacist had affirmed that this work had reduced errors made in patient hospital discharge summaries and the practice confirmed that there were fewer observed inaccuracies since this intervention.
- The practice quality lead took the lead in working with the local safeguarding team and a home for children with complex needs. As a result of this, several changes to procedure were made, the home employed a nurse to act as a focus for the children’s health needs and communications with the children’s service were improved. The practice clinical pharmacist also visited the home to advise on the storage of medicines. Also, as a result of this work, staff from the local safeguarding team reviewed how all children known to the local child and adolescent mental health team were transferred from other areas and subsequently managed. This improved patient safety for all local practices with regard to the transfer of patients from outside the area.
- Practice staff worked closely with staff from a local women’s probation service facility. They arranged for staff from the service to attend a practice meeting in order to set up procedures for prescribing medicines for patients in the service. This improved procedure associated with prescribing for these patients and ensured better patient safety.
The areas where the provider should make improvements are:
- Continue to implement the policy to reduce the risk of legionella in the practice water system.
- Consider introducing a confidential health questionnaire to risk assess working conditions for new staff.
- Consider documenting a formal risk assessment for emergency medicines held in the practice.
- Look at improving the documentation of actions taken as a result of patient safety alerts.
- Continue to improve the identification of patients who are also carers.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice