Archived: Drs Brinksman, Conlon, Manley, Saunders, Hull & Martins

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Brinksman, Conlon, Manley, Saunders, Hull & Martins (The Nechells Practice) on 15 March 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. Partners at the practice had developed an incident reporting system to encourage reporting. The system used was adopted by other practices and resulted in higher rates of reporting and increased openness in the locality.
• Risks to patients were assessed and generally well managed.
• The practice had worked closely with other organisations in planning how services were delivered to ensure that they meet patients’ needs
• Feedback from patients about their care was positive. However, some patients told us they did not always find it easy to access the service. Same day urgent appointments were available.
• Although the practice had tried to obtain feedback from patients about the services they had struggled to gain enthusiasm for this.
• Information about how to complain was available and easy to understand and complaints were thoroughly investigated and handled in a sensitive and timely manner.
• 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. Strong governance arrangements with clear staff roles supported the running of the service and service improvement.

We saw areas of outstanding practice:

• The provider had developed a reporting tool for incidents and significant events which risk rated incidents. The tool had been adopted by other practices within the local clinical network and had been recognised by the CCG as improving reporting. Practice staff were proactive in reporting incidents. The practice had high levels of incident reporting (73 in the last 12 months). High reporting is viewed positively as it enables the practice to identify trends, reflect on incidents that occurred and learn from them. Weekly clinical governance meeting ensured incidents and significant events underwent regular review and were acted on. Learning was shared internally and with other providers.
• The provider was a key player in the CCG for driving innovation and developments for service improvement. Schemes developed by the provider that had been adopted by others included: Ambulance triage in which GPs gave advice and support to paramedics at the scene to reduce unnecessary referrals to A&E and provide more appropriate care. Early indicators show the number of patients that had attended A&E had reduced from 70% to 12% since September 2016 across participating practices. The provider had also undertaken a medicines waste project in which a savings of £1563 had been achieved in two months by targeting patients where over prescribing had been identified. This scheme was also being adopted by the CCG.
• The provider had operated an internal triage referral system for 10 years, during which time over 4000 referrals had been reviewed by colleagues to improve the accuracy of referrals across both of their sites. With CCG funding this system was being extended within the locality with a pilot due to start in April 2016. GPs with specialist interests and training were being identified to undertake referral triage within a set time frame to help improve the quality of referrals and help reduce pressure on secondary care.
• The provider worked with the drug workers team to combine hepatitis C treatment for relevant patients with the treatment for substance misuse. By combining the treatments it was felt patients were more likely to comply.

The areas where the provider should make improvement are:

• Ensure arrangements are in place that assure the practice that risks around premises are appropriately managed.
• Review systems for gathering patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice