Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Wyndham House Surgery on Wednesday 26 August 2015. Overall the practice is rated as outstanding.
Our key findings across all the areas we inspected were as follows:
- There was a safe track record and staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
- Risks to patients were assessed and well managed. Medicines were well managed and the practice had good facilities and was well equipped to treat patients and meet their needs
- Patients’ needs were assessed and care was planned and delivered following best practice guidance.
- 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.
- Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
- There were clear recruitment processes in place. Staff had received training appropriate to their roles and any further training needs had been identified and planned
- The practice was well organised and there was a clear leadership structure. The practice proactively sought feedback from staff and patients, which it acted on.
We identified areas of outstanding practice:
The practice had two schemes in place that particularly supported older frail patients, housebound patients with long term conditions and vulnerable patients.
- A ‘BERTIE’ pharmacy delivery service which delivered over 1310 prescription products per month to over 300 vulnerable, isolated and housebound patients. This service had led to improved communication and feedback between patients and the practice with practice staff being alerted sooner to any special needs of patients. The service had proved popular with patients and meant that very frail patients who had their medicine organised in Dosette boxes were guaranteed a weekly visit from one of the ‘Bertie’ team. We were given examples of where these visits leading to much earlier clinical interventions and so removing need for hospital admission.
- The practice employed an outreach nurse who had been commissioned by the friends of Wyndham group. Her role was to individually target older, frail, vulnerable or isolated patients to review care plans, conduct risk assessments and provide health care advice; this scheme had helped patients to maintain their independence at home and reduce the need for hospital admission. This opportunistic visiting had led to examples of uncovering social and medical needs which can be tackled proactively and to involve reablement teams, clarify medicines and involve carer support agencies. The scheme also included falls assessments, routine health checks, advice on diet, exercise, mobility etc. The nurse also offered osteoporosis checks, dementia assessments and reviews of care plans. The nurse had also performed checks on the wellbeing of the patient during adverse weather conditions and promotion of, or the gaining of agreement to, the use of the pendant alarm system.
One of the GPs wrote regular columns in two local parish magazines. The monthly articles had included updates on public health or medical education issues. The GP also gave an annual presentations to patients in the town outlining and explaining local healthcare issues. These talks had been attended by over 100 people and have become a part of the annual community calendar.
However, there were also areas of practice where the provider needs to make improvements.
Importantly the provider should:
- Introduce a more formal record to show competency of dispensary staff had been performed in line with the dispensary safety quality scheme (DSQS)
- Records should be kept of safety alerts relating to medicines and the action, if any, that has been taken in relation to these.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice