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 (Ridgacre House Surgery) on 8 March 2016. Overall the practice is rated as outstanding.

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. 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.
• The practice used innovative and proactive methods to improve patient outcomes and had worked with other local providers to share best practice. A range of schemes developed by the practice to deliver service improvements have been implemented widely with support from the CCG. These include ambulance triage, GP referral triage and a medicines waste project.
• Feedback from patients about their care was positive.
• The practice had worked closely with other organisations in planning how services were delivered to ensure that they met patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. Feedback from the patients survey had highlighted difficulties in patients seeing the same GP. The employment of several associate partners is hoped to create greater stability in the workforce and improve patient satisfaction as patients get used to the associate partners.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had business resilience in that they had multiple premises and staff that worked across sites. This meant it could adapt quickly to service disruption.
• 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 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 (148 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 hospital services and 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. This approached successfully led to the eradication of hepatitis C in three patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice