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Inspection carried out on 19 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lilliput Surgery on Wednesday 19 October 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they found it easy to make an appointment with a GP and said there were urgent appointments available the same day but added that they sometimes had to wait to see a GP of their choice.

  • The practice had developed three teams to meet specific needs of patients at the practice. These included the routine and long term condition team, the same day care team and the vulnerable and domiciliary team.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice employed a clinical pharmacist to identify and act upon high risk medicines, oversee prescribing patterns, review patients who were taking 10 or more medicines, review post discharge medicines and support long term condition management.

  • Flu clinics were used to offer patients additional screening and reviews. This included a pulse check for all patients over the over the age of 65 years old to exclude abnormal heart patterns, blood pressure checks, asthma checks and chronic obstructive pulmonary disease reviews.

  • Text reminders were used to remind patients of their appointment but could be used to cancel appointments and had resulted in a reduction of ‘did not attend-DNA’.

  • The practice had engaged with the IRIS project (

    Identification and Referral to Improve Safety

    ) IRIS

    is a general practice-based

    domestic violence

    and abuse training support and referral programme

    to raise the profile of potential hidden domestic violence. The training for all staff explored ways of asking patients about domestic violence either as perpetrators or victims.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had developed clinical templates for medicines management and contraception and had shared this learning with other neighbouring practices.

  • Recruitment procedures and checks were completed as required to ensure that staff were suitable and competent.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour
  • Governance, administration and performance management arrangements were non-hierarchical, organised, detailed, structured and kept under review by the whole team. The management and leadership had an inspiring shared purpose and motivated staff to succeed and develop services.

  • The practice worked with and actively shared learning with other organisations and the local community to improve how services were planned and delivered to ensure that services meet patient need.

    We saw one areas of outstanding practice:

    The practice had been creative in offering alternative ways to offer patients additional services. For example, using flu clinics to offer additional screening and the use of additional teams to meet specific needs of patients. For example, the practice were offering screening for atrial fibrillation (AF) which is an abnormal heart rhythm. Data showed a rise in AF diagnoses during the autumn flu campaign and a sustained diagnosis rate. Since May 15 the number of patients on the AF register had risen from 365 to 404. The practice had been identified as having higher AF diagnosis rates in the clinical commissioning group (CCG) and had performed 25 long term conditions reviews during the last flu sessions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 2 June 2014

During a routine inspection

Lilliput Surgery provides primary medical services for about 9,700 patients in the Parkstone area of Poole in Dorset. The address of the surgery was Elms Avenue, Poole, Dorset, BH14 8EE.

The practice provided a range of services for patients in all the population groups. The practice was registered with us for the following regulated activities: Diagnostic and screening procedures, Family planning practices, Maternity and midwifery practices, Surgical procedures and Treatment of disease, disorder or injury .

There were clinics for themanagement ofchronic diseases such as asthma and diabetes. They also offeredothermedical practicesincluding antenatal and postnatal care, minor surgery, childhood vaccinations and well-person check-ups.

The majority of patients we spoke with, or those who completed our comment cards or responded to the practice patient survey in 2013, were positive about the practice and staff.

There was evidence of collaborative working between the practice and the local clinical commissioning group (CCG). A GP partner was the chair of a group of practices within the CCG.

The group was involved in influencing and shaping local practices to meet local patients needs.

The practice anticipated and responded to patients needs to ensure they were met effectively.

Older patients were particularly well supported by the practice.

The practice had responded appropriately to safeguarding concerns and had clear and effective processes and procedures to keep vulnerable adults and children safe.

There were good governance system and management systems in place

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone.