Northam Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northam Surgery on 17 February 2016. Overall the practice is rated as outstanding.

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

• There was open and transparent approach to safety and an effective system in place for reporting and recording significant events. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, leading and working with other local providers to share best practice. For example they piloted an improved diagnostic pathway for patients with suspected urine infections, which had been rolled out across the CCG area.
• There was a holistic approach to assessing, planning and delivering care and treatment to people using services.Examples included: risks to patients were assessed, well managed through the integration of teams, for example benefitting patients with learning disabilities. Robust audit of demand and capacity took place to determine appropriate staffing resources and skills needed to deliver services safely for patients. The practice invested heavily in its staff providing advanced training opportunities such as nurse prescribing qualifications and supported other staff across the health and social care sector to extend their skills for the benefit of patients.

• Feedback from patients who used the service, family members and carers, and stakeholders was continuously positive about the way staff treated them and other patients. Patients said staff went the extra mile to support patients and the care they received exceeded their expectations. Feedback from all 69 patients about their care was consistently and strongly positive.

• Patients needs and preferences were central to the planning and delivery of tailored and flexible services. Examples included: male patients from the practice were able to attend a Friday evening and Saturday morning vasectomy clinic.

• 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, including: use of social media to reach younger people, effective and responsive review of the appointments system and improved online services.

• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw areas of outstanding practice:

• Northam Surgery has taken a systematic approach to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money.Examples seen included: piloting improved care and treatment pathways and sharing learning across the locality. The practice has streamlined monitoring patients with long term conditions through the concept of polyclinics (Polyclinics are intended to offer a one stop shop for patients where all of their chronic diseases are monitored in one consultation), providing extended length appointments and ongoing continuity by named GPs.

• The practice strategy and supporting objectives are stretching, challenging and innovative. There were several examples of this, including the approach taken in recognition of the link between social isolation and heightened health risks. Innovative communitarian initiatives such as a Sunday afternoon tea club were soon to start at practice, with a GP and nurse available to see patients.Health promotion was key for patients at the practice and across the locality, with a nurse helping to deliver diabetic education sessions for patients in North Devon for newly diagnosed patients.

• The practice was caring and extremely patient centred with a strong community presence. Thirty nine patients we spoke with, and comments received in the 30 comment cards, said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.The practice had a taxi fund, which it used to support vulnerable patients enabling them to get to and from appointments safely when needed. In support of carers a GP partner held a key role in a charity, raising funds with staff to take disadvantaged, disabled children and young people from the practice area on an annual holiday.

• The practice had audited patients who had limb amputations following clinical commissioning group reports. Actions taken by the practice had seen wound healing rates for patients reduce from around 12 months to under six months and the number of appointments needed to support patients had reduced from 21 down to nine.

• The practice had listened and acted on feedback from patients and other stakeholders about access to appointments particularly during Winter months when there was more pressure. Several changes were made, including: introducing changes to leave arrangements; increasing appointment sessions and numbers of GPs and nurses during peak times every day; having a nurse led minor illness clinic; amending call answering protocols and improved customer care through training for staff; GPs answered incoming calls at 8am to better understand better patient needs and conducted demand audits so that effective proactive rostering was arranged every month.

The areas where the provider should make improvements are:

• Audit patient records to ensure that clinical findings are documented in a consistent way to support decisions about treatment pathways.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice