Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Crewkerne Health Centre on the 12 November 2014. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, members of the patient forum, interviewed staff of all levels and checked that the right systems and processes were in place.
Overall the practice is rated as good. This was because we found the practice was good at providing caring, effective, responsive and well-led services. The practice were also good for providing services for all population groups. The practice required improvement for providing safe services.
Our key findings were as follows:
- The practice provided patients with a good triage system which enabled patients to see a GP within two days. Patients who wanted to see a preferred GP may have had to wait longer.
- Patients generally told us staff were respectful and compassionate towards them when they visited the practice.
- The practice had good communication with other services and health professionals to ensure patients received joined up care packages.
We saw several areas of outstanding practice including:
- The practice was involved in the programme called ‘Productive General Practice’ supported by NHS Improving Quality. This programme has now been completed and last year the practice had been voted the best practice to have gained the most from the projects set out of all 20 Somerset practices that had participated. They continue to use this approach in their practice. For example, prescription staff changed their working hours to increase the availability for patients to receive their prescriptions during busier times.
- The practice had established through the Joint Strategic Needs Assessment for Somerset that Somerset had a higher than national average adult obesity. The Clinical Innovations Group piloted a weight management project, which has now ended. The practice found this a successful pilot and has continued with weight management clinics. Approximately 95% of patients that attended these clinics lose the targeted weight.
- There was a proactive system for double checking all patients with chronic obstructive pulmonary disease had ‘just in case’ medicines prior to Christmas and New Year holidays.
However, there were also areas of practice where the provider needs to make improvements.
Importantly, the provider must:
- Ensure actions are addressed promptly following audits and assessments, such as fire risk assessments and infection control audits, to ensure they protect patients from risks that could have been detected.
- Regularly carry out clinical audit cycles to evidence whether improvements had been made and the measure of patient impact since the previous audit and shared with the team and new protocols formed, where necessary.
- Ensure there is a formal process to ensure results and research from audits and incidents, such as medical emergencies are shared with the team for additional learning and where necessary form new practice protocols.
In addition the provider should:
- Ensure a risk assessment is completed so appropriate medicines to use on a home visit are contained within the home visit bag and consider where it is kept in the practice to ensure it is held securely.
- Ensure they have appropriate evidence to provide proof of identification when recruiting new staff.
- Inform patients of the confidentiality arrangements in the reception area to reduce them from being overheard when discussing personal information.
- Ensure information on complaints is easily available for patients to access.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice