Archived: The Nelson Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Nelson Practice on 12 April 2016. Overall the practice is rated as good.

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 used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, a GP at the practice held regular minor surgery sessions which included vasectomies to the male population of Doncaster. This negated the need for patient’s registered at the practice and other practices in Doncaster to travel to the hospital for the procedure to be performed. 
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met patients’ needs. For example, t he practice had developed a care pathway for patients who resided in care homes. A copy of the care plan was kept with the resident and at the practice and updated accordingly. Staff told us it  promoted consistency in the support and care offered and enabled them to provide patient centred care as the patient's preferences were noted. It included details of next of kin, preferences for admission to hospital and acute care plans to follow if the resident's condition changed.  It had also been adopted by other practices in the area.
• 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. For example, following feedback from the patient participation group the practice introduced a triage system with the GPs for patient's requesting same day appointments.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw some areas of outstanding practice including:

• The GPs told us they would contact carers regularly, particularly when they were aware conditions or situations changed. They would routinely ask how they were doing and if there was anything the practice could do to offer help and support. Carer's told us this helped them feel 'cared for' and gave them the opportunity to reflect on their own needs.
• The practice had identified an additional 49 patients who staff perceived may be vulnerable due to their circumstances. These patients may not have been necessarily reviewed on a regular basis as they may not have a long term condition. They were offered three monthly reviews with a GP or practice nurse and any attendance at accident and emergency or other healthcare provider would be followed up by making contact with the patient and reviewing their circumstances. If the patient contacted the practice staff had access to their care plan within the patient record and would offer them an appointment with either the named GP or practice nurse.

However there was one area of practice where the provider should make improvements:

• Consider how to notify patients of the practice complaints process.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice