Springbank Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Springbank Surgery on 14 September 2016. Overall the practice is rated as outstanding.

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

• The practice carried out a thorough analysis of the significant events. The practice demonstrated they recorded all incidents and near misses and monitored trends over a period of time. All staff were involved in this process.
• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines. The practice used these guidelines to positively influence and improve practice and outcomes for patients.
• The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high quality care.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice demonstrated a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality.
• 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 had good facilities and was well equipped to treat patients and meet their needs.
• There was a strong focus on continuous learning and improvement at all levels within the practice. The practice team was forward thinking and part of local pilot schemes and practice initiated schemes to improve outcomes for patients.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw many areas of outstanding practice, examples included:

• Significant incidents deemed appropriate were reported to the National Reporting and Learning System (NRLS). The practice had been part of an initiative with Harrogate CCG and the Improvement Academy (IA) to embed Human Factors thinking into the management of healthcare thereby improving patient safety and achieving betters lives for people. The IA looked at an example of a significant event from each practice involved. They identified the practices management of the event reviewed as exemplary.
• Dispensing errors which reached patients and near miss dispensing errors were recorded as part of the significant event log. The practice had recognised that themes identified in significant event meetings in relation to the dispensary were not being adequately solved. They subsequently sought the assistance of the Improvement Academy, part of Yorkshire and Humber Academic Health Science Network, who were running a TAPS programme in dispensing. TAPS stands for Training and Action for Patient Safety. The programme recognised themes and the aim of the programme was to improve safety. Participating in the TAPS programme (which reviewed the dispensing arrangements at the practice) had led to significant improvement in how the practice managed significant events and near misses. There was clear evidence of impact, with a reduction of significant events and greater involvement of the practice team.
• A robust system was in place for monitoring prescriptions that had not been collected on a monthly basis. If prescriptions had not been collected within a three month period a note was sent to the GP and an entry was made in the patient’s record and discussed with the patient.
• A GP partner committed 60 hours of their own time to work at the local Out of Hours service. This was to enable a nurse from the practice to attend with them as part of their mentoring arrangements and their competency assessment to triage patients. In addition to this, from March 2016 the practice had commissioned a ‘medical actor’ to attend the practice and play out scenarios with the trainee doctors. To date four trainees had undertaken this as well as the new practice nurse. The actor was scheduled to attend the practice every four months to run scenarios and review the recorded consultations with trainee doctors and other identified staff. The aim being to further improve patient engagement and satisfaction.
• The practice had implemented a system whereby young people could direct message the GPs to ask for an appointment which the GP booked, bypassing the need for them to contact the practice via the reception. Pocket sized cards had been put in place in an age appropriate format to promote this facility and were given out by practice staff and other professionals who kept a stock of these. We were provided with a number of examples to demonstrate how this had made a difference for a number of patients.
• The practice had put in place a system to search electronically for patients with memory problems who had an appointment at the practice that day. This system prompted reception staff to contact the patients to gently remind them of their appointment.
• The practice paid for a member of the public to hand deliver the practice newsletter.
• The practice provided a home delivery service staffed by volunteers. All volunteers had received appropriate checks. As part of the consent for home deliveries, the practice included a photograph, with name, of each volunteer which the patient kept at home for reference. The practice had also generated photo identity badges and prescription signature books which ensured a full audit trail for deliveries.
• The practice had attended local schools to give talks on health related matters at least annually. Children from a local school attended the practice regularly to display their artwork.
• The Patient Participation Group (PPG) was extremely active and beneficial. For example the PPG had organised and facilitated four cardio pulmonary resuscitation (CPR) courses at the practice for patients in the last twelve months.
• It was clear this practice had an excellent learning culture.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice