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Practice makes perfect

23 February 2015

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Shrewsbury surgery, Radbrook Green, is one of a tiny minority of practices to receive an ‘outstanding’ rating from Care Quality Commission inspectors. What’s the secret? 

Radbrook Green Surgery’s managing partner Tony Marriot jokes that their first ever Care Quality Commission (CQC) inspection didn’t exactly go according to plan.

“I had to be honest I was a bit worried because at the time, there had been a lot of talk about the CQCs list of prioritised surgeries, so I rang the CQC and they confirmed it was a routine inspection,” he said.

“Of course when they arrived, we had just been hit by a nasty computer virus. Prior to this, I had been quite relaxed because we had done quite a lot of work to prepare for the inspection but then suddenly it had all gone.

“My colleagues were pulling out all the stops to fight the virus and then on top of that the CQC were coming as well.” Despite the technology hiccup, Radbrook Green managed to receive an “outstanding” rating from the CQC.  It is one of three surgeries in the UK that has managed to achieve this out of all 76 practices inspected so far.

Based in Shrewsbury, the surgery has approximately 9,100 patients on its books and only a weekly basis can deal with up to 1,000 appointments.

Ironically, the computer virus, which could have been a catastrophic start to the inspection process, ultimately worked in their favour.

As Marriot explains: “It definitely focused the mind. We were able to demonstrate that our business continuity plan actually worked as we had to use it.”

The concept of “support” is crucial to the everyday running of this practice.

“Our ethos is two-fold” says Marriot. “ The patient is at the centre of everything we do, but we also try and make Radbrook Green a great place to work.”

The evidence of staff support and development was something that was picked up on throughout the CQCs inspection. As well as funding their practice manager to do a National vocational qualification (NVQ) in business management and funding a member of their nursing team through two years at university, the practice also takes staff members’ medical interests into account when considering what services to provide.

“One of our nurses came to me as she had a great interest in respiratory disorders. Her dream job had always been to work in a specialist respiratory unit. She came to me and when she managed to achieve this and regretfully, handed in her resignation.

“I asked her if she was working full-time at the respiratory unit and she said no, so instead of accepting [the resignation] we re-negotiated her contract and she became the specialist lead for respiratory care.

“It has been absolutely brilliant. She comes in to the surgery and runs clinics for me, but I have an added advantage that she’s also working in the dedicated unit so she’s exposed to all of the latest thinking and knowledge in the field and she was also able to bring in the consultant from the unit who is able to review our patients and identify anyone with COPD who hasn’t yet been diagnosed.”

However, of all the support groups offered to patients at Radbrook Green, it is the diabetes service that has been the most successful to date, with two of the patients with Type-2 diabetes now no longer needing medication.

The idea for a diabetes support service came into being after concerns were raised regarding the number of registered diabetes patients and the workload of the specialised GP. 

Marriot explains: “ The first Monday of every month my colleague has a portion of patients and she contacts them and makes an assessment about whether they need to be seen or whether they can attend the clinic. Those that can attend the group come to the practice on the Thursday and the GP will see them initially so she’s still having contact with them, but she can see quite a few people in ten minutes as opposed to just one person.”

“Then the group clinic is run by a specialist diabetic nurse who has a specialist knowledge in nutrition, there’s a question and answers session and our practice diabetic nurse can see patients one-on-one to answer more personal questions or get any clinical data needed.”

The surgery’s responsiveness to patients’ needs, as well as the caring nature of the services provided were two of the areas where Radbrook was given an “outstanding” rating.

In the inspection report the CQC describes how the surgery ‘initiated positive service improvements for its patients that were over and above its contractual obligations’ and that ‘ staff were motivated and inspired to offer kind and compassionate care.’

One of the ways this is achieved is through working with local charities to provide specialist information, as well as social support groups for those with long-term health conditions. A support group for the carers of dementia patients was set up in line with local clinical commissioning groups (CCGs) and a chronic fatigue group was set up in partnership with the Shropshire Myalgic Encephalopathy (ME) Group.

Across the practice, GPs also found that there were a number of patients booking doctor’s appointments to help cope with bereavement as they didn’t know where else to turn. Working with the Shropshire Independent Advocacy Service the surgery set up a bereavement support group. To date it has been so successful that it has had to be split into two groups: the recently bereaved and those capable of self-help.

Marriot says: “With all of these conditions, a ten minute consultation isn’t going to give patients what they need. An on-going benefit is that patients find people in similar situations and they can emotionally support each other

“As far as the chronic fatigue group goes, there is still this culture of  ‘is chronic fatigue a serious condition?’  ‘Is it taken seriously in the NHS?’ The fact that our practice has a dedicated group to deal with the condition has been really well-received.”

However, support services are not only limited to the practice premises. As well as offering home visits to a number of local care homes, the surgery also works to support a 12-bed rehabilitation unit for vulnerable patients needing extra support following hospital discharge.

“In Shrewsbury, we don’t have a cottage hospital, but we established that there was a need for one. So we decided to create a virtual one using the resources that were available to
us which were the experienced nursing homes.

“The actual rehabilitation ward is commissioned by CCG and this is for patients who are post-op and on the verge of recovery but not well enough to go back to their own homes. People that may be considered ‘bed blockers’ in secondary care.

“As well as doing the weekly round in the care home, we also run two rounds on this ward. Patients are surrounded by a multi-disciplinary team but the GP works as the clinical lead,” he says.

So what exactly does the “outstanding rating” mean to Tony and his colleagues?

“Given all our hard work, it is a very rewarding way of passing back to all my colleagues what a great job they are doing.”

“Not withstanding the fact that we had a major issue [on inspection day], we have still been recognised as a really great practice. I strongly believe that we are such a great practice because we are such a great team. Teamwork and co-operation; that’s what it is all about.”