Amersham Vale Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Amersham Vale Practice on 24 June 2015. Overall the practice is rated as outstanding.

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

• The practice had robust safeguarding processes in place and effective systems to ensure at risk children were monitored, for example, frequent child attendees in accident and emergency (A&E).
• The practice used innovative and proactive methods to improve patient outcomes.
• The practice worked with local organisations to support vulnerable patients, including a homeless shelter and took part in a local project to support patients with severe mental illness.
• The practice had a range of registers to monitor the most at risk and vulnerable patients including those at risk of unplanned admissions to hospital.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• A range of appointment options were available, and the practice had increased appointment length to 13-15 minutes for all patients.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice had a clear vision which all staff were aware of. Staff felt supported and motivated by the management team and felt happy to make any suggestions or raise concerns.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was evidence of actions and learning from incidents that occurred, however the practice did not have an incident reporting policy.
• Some risks were assessed and managed including infection control, however the practice did not have assurances that regular health and safety and fire risk assessments for the premises were carried out by the buildings management company, and whether any risks had been identified.

We saw several areas of outstanding practice including:

• Safeguarding processes for the practice were embedded in practice culture and all staff had a clear understanding of their roles and responsibilities. The practice had a child protection clinical and administrative lead and there was evidence of regular links externally with the clinical commissioning group (CCG) safeguarding meetings as well as discussion in weekly clinical meetings.
• The practice demonstrated improved patient outcomes in a range of population groups, for example, increased point of care testing for HIV, contributing to HIV guidelines to manage HIV in primary care; improved chlamydia screening rates and improved uptake of cervical screening and subsequent treatment following a study where HPV self-swabs were implemented.
• The practice had set a higher target to achieve than the national QOF target, in line with best practice, to ensure they were monitoring more patients with the potential for uncontrolled diabetes and they had improved the patient pathway for diabetes care.
• The practice had increased the flexibility of access to appointments for vulnerable patients who were unable to utilise the standard appointment and telephone system, by implementing a register of those patients in the practice and prioritising them for appointments. Patients on this register were seen within an hour of attending the practice, or received an urgent call back.
• The practice worked closely with a local homeless shelter to provide general medical care. These patients were able to access traditional primary care through the practice, including nursing care and vaccinations.
• The practice had a very active patient participation group (PPG) and had implemented an administrative PPG lead to work directly to improve patient and practice communications. The PPG meetings included external speakers and themed PPG meetings.

However, there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Obtain assurances that health and safety risk assessments for the premises, including buildings assessments and fire risk assessments have been completed and whether any risks have been identified.
• Improve the incident reporting process to include reporting of near misses and non-clinical incidents as well as significant clinical events and ensure an incident reporting policy is in place.
• Update infection control policies, to ensure policies include those for sharps, spillages and management of bodily fluids and control of substances hazardous to health (COSHH).
• Ensure that all practice procedures are documented and are available for staff to refer to where necessary, including temporary staff and trainee GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice