The CQC has published a further 91 reports on the quality of care provided by GP practices following recent inspections. Once again the rating given to the overall standard of care being provided rose, with four practices receiving outstanding ratings and 71 rated as good. At the other end of the scale, nine practices require improvement and four are inadequate.

The best

Looking at the practices that received outstanding ratings, what did the inspectors really like?

John Hampden Surgery in Great Missenden, Buckinghamshire, was praised for helping patients to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill health. For example, there was a designated staff member who arranged and scheduled childhood immunisations. This was evident as immunisation rates were higher when compared to the CCG and national averages.

The same practice had recognised that carers’ health often takes second place, or is neglected, and so was offering designated clinics every Friday for carers. Of the 70 carers registered, 38 (54%) had attended a carers clinic and the remaining 32 had been contacted and had an appointment scheduled.

A glowing report

Pendleside Medical Practice in Clitheroe, Lancashire received a glowing review from inspectors and was praised for a number of initiatives. For example, the practice worked closely with the other GP practice and other healthcare professionals located within the same building to develop local clinical pathways. A clinical pathway for guidance and management of atrial fibrillation had been agreed and implemented. This ensured patients living in the locality received consistent, evidence based care and treatment for atrial fibrillation.

Practice staff also demonstrated how they had the support of the GP partners to identify and review healthcare conditions not routinely reviewed or monitored. For example, one practice nurse reviewed the treatment and support provided to patients with Coeliac disease. As a result, patients with Coeliac disease were offered an annual review and received a planned consistent standard of treatment and support.

Inspectors liked the practice’s innovative approaches to providing integrated person-centred care. The practice has, for example, employed a nurse specifically to review and support patients aged over 75 who did not have a recognised long-term condition.

Responsive services

One of the key questions inspectors ask covers whether or not services are responsive to people’s needs.

The Stennack Surgery in St Ives, Cornwall, scored particularly highly in this area. The inspector’s report, which can be read in full at www.cqc.org.uk, said that the practice is rated as outstanding for providing responsive services because of the following:

• It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
• The practice had listened to patients needs in nearby Carbis Bay and found a way to fund a branch surgery through sharing premises with a private pharmacy. This was due to open in 2016.
• There were a range of appointments and walk in services available, while a same day service for patients needing to be seen urgently and late appointments from Monday to Friday were available for working patients and those with minor illnesses.
• A Minor Injuries Unit was run from the practice, which was open every weekday including bank holidays. During the summer months, when there is a greater influx of temporary visitors to the area, the minor injuries unit had been open 7 days a week.
• At the inspection, patients remarked positively about the appointment system.
• The number of patients delivered each week was slightly above that expected. For example, 900 appointments were planned with 952 being delivered.
• All 12,499 patients on the practice list had a named GP and there was continuity of care, with urgent appointments available the same day.
• There were dedicated staff dealing with prescriptions to provide a responsive and personalised service for patients.

Evidence matters

Throughout visits, inspectors will ask to see evidence that care initiatives are working and this evidence can be presented in numerous formats. For example, The Valley Surgery in Nottingham provided inspectors with all 29 thank you cards that had been sent in over the last year by patients and their relatives praising the staff for the high level of care and compassion they received. This helped draw attention to its outstanding services, examples of which can be seen on the CQC website.

Not so good

Finally, while there were plenty of examples of good care, some practices didn’t do so well. Here’s a snapshot of some of the negative points raised by inspectors:

• Inspectors found that patients were at risk of harm because appropriate systems for infection control, staff recruitment and complaints were not in place.
• Medicine management arrangements did not keep patients safe. Inspectors found out-of-date medicines and single use equipment amongst practice supplies. A broken refrigerator had also not been appropriately repaired.
• Staff were not clear about reporting significant events, incidents and near misses and there was no evidence of shared learning or communication with staff.
• Health and safety risks to patients were either assessed inconsistently, or not assessed at all. The processes for addressing issues identified from risk assessments were weak.
• Reasonable adjustments had not been made to the practice premises to support the needs of patients with a disability.

The majority of negative findings from inspections revolve around processes and practice policies (the same errors appear frequently), which highlights the value of ensuring everything is up-to-date. A read through the latest tranche of reports is time well spent, especially if you’ve got an inspection coming up soon.

What do you think of the latest inspection results? Let us know by commenting below or head to the Practice Index Forum thread here.

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