Archived: Lilliput Surgery

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