PRACTICE PROFILE  ORCHARD COURT SURGERY What looks like


Jim Killgore visits a Darlington GP practice among the select few to have been awarded a top rating on inspection by the Care Quality Commission


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T’S HARD to say what I was expecting on my visit to Orchard Court Surgery. Certainly not the ordinary one-storey brick building I arrive at by taxi, hidden among almost identical houses in a tightly packed residential area of Darlington. Inside the waiting room it’s bright and


pleasant but again little different from a hundred other GP practices across England – and yet this somehow makes it seem even more extraordinary given that Orchard Court was in May of this year rated “Outstanding” by the Care Quality Commission (CQC). Sue McMillan, CQC deputy chief inspector


of general practice, said: “The care we observed at the practice really was excellent. It sets a high standard that every GP practice should seek to attain.” I have come to meet practice manager


Karen Fuat to try and discover what has set Orchard Court apart in the eyes of the regulator – and also to ask how the practice prepared for the ordeal of a CQC inspection.


COMETH THE INSPECTORS Karen has worked at Orchard Court for over 27 years, joining first as a young receptionist. Today it has a medium-sized list of around 7,700 patients, reasonably distributed over age ranges and with deprivation levels lower than the national average. The practice is unusual in having seven


doctors, all but one of them part-time (making rotas tricky). There are also three practice nurses, a practice assistant, a secretary and no fewer than seven part-time receptionists. Karen also works with a deputy manager. Certainly her long experience in primary


care has been an important factor in the success of the practice. “I know general practice inside and out.


I have been there and gone through all the changes,” she says. First hearing that the practice was to be


inspected by the CQC was a bit unnerving, admits Karen. “You get notified a fortnight in advance. All of Darlington were told they would be visited – and we were going to be


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the first. But I didn’t feel scared because I was organised. I think if you weren’t organised it would be a bit of a nightmare.” In fact Karen had been anticipating this


day ever since the practice first registered with the CQC. She had read all the information available on the CQC website, highlighting what was required and working through training slides with practice staff. “Every general practice in England knows


that at some stage they are going to be visited by the CQC. You know more or less what they are going to be asking for. You just have to be organised and methodical.” First thing that Monday morning after learning of the inspection Karen began gathering the evidence required by the CQC in advance of the inspection. All of this had to be compiled as email attachments: practice statement of purpose, minutes of PPG (patient participation group) meetings, patient surveys, SEA reports, clinical audits, complaints audits, recruitment and training policies, induction checklists and more. “I also had to do an essay,” says Karen.


“They wanted to know evidence and examples of the quality of care provided for six specific population groups.” In preparation she met with her deputy, the GPs and other practice staff and ran through a standard set of key lines of enquiry (KLOEs) which the CQC use to help rate practices. These relate to five key questions – are services safe, effective, caring, responsive and well-led.


INSPECTION DAY On the appointed day three CQC inspectors arrived at 8:30am. The team comprised a CQC lead inspector, a GP and practice manager. Karen first gave a 30-minute presentation setting out the philosophy at Orchard Court: “we aim to provide accessible high quality healthcare to all patients in a friendly, open, non-judgemental and professional atmosphere.” She then explained how this was reflected in the practice culture and its management and approach to patients


– and particularly in relation to the five key questions. The inspection team then split up to focus on different aspects of care such as treatment and outcomes, infection control, governance and HR policies. “The practice manager [inspector] walked


around the waiting room looking at all our posters, seeing if they were relevant,” says Karen. “She talked to patients, interviewed my healthcare assistant. She then interviewed a member of our PPG.” This was followed after lunch by a three- hour meeting in which the inspector asked Karen to run through all the practice policies and procedures. “She basically sat in my office and asked can I have a look at this and a look at that. And I had everything to hand.” The visit finished later that day with a


meeting in which the inspectors provided some immediate feedback to the senior practice team. In the case of Orchard Court it was almost all positive. Says Karen: “It was great to get feedback. We all work hard and it helps to be told once in a while that you are doing a good job.”


THE REPORT Twelve weeks later when the CQC published its report Karen was both shocked and delighted. “We weren’t really expecting Outstanding. We know we are good. We always aim to be very good but we didn’t expect to be Outstanding.”


AUTUMN 2015  ISSUE 13


PHOTOGRAPHS: SIMON RYDER


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