Letter from the Chief Inspector of General Practice

At our previous inspection on 23 and 24 October 2014, we rated the practice as good overall and outstanding for people with long-term conditions. At this inspection, we have also rated the practice as good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Cheviot Medical Group on 16 January 2018 to check that the provider continues to meet the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and made improvements.

• The practice routinely reviewed the effectiveness and appropriateness of the care and treatment they provided. Staff ensured that care and treatment was delivered in line with evidence- based guidelines.

• Quality Outcomes Framework (QOF) data, for 2016/17 showed the practice had performed well in achieving 100% of the points available to them for providing recommended treatments for the most commonly found key clinical conditions.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Feedback from patients about access to appointments, the practice’s opening hours and the quality of their care and treatment was continuously very positive. The results of the NHS National GP Patient Survey, published in July 2017, showed patients rated the practice higher for almost all aspects of care, when compared to the local clinical commissioning group (CCG) and national averages. This high level of achievement had been sustained over a number of years.
• Leadership at the practice was compassionate, inclusive and effective at all levels. Leaders were able to demonstrate they had the high levels of experience, capacity, capability and skills needed to deliver very high-quality, sustainable care.
• The culture of the practice was to deliver person-centred care and treatment. All the staff were highly committed to delivering a quality service.
• There was a very strong focus on continuous learning and improvement at all levels of the organisation. The practice proactively used performance information to drive improvement.
• There were rigorous systems and processes in place that supported learning, continuous improvement and innovation. Safe innovation was celebrated and there was a clear and proactive approach to seeking out and embedding more effective ways of working.
• The practice had a clear vision and credible strategy to deliver high-quality care and promote good outcomes for patients, and leaders demonstrated a clear commitment to system-wide collaboration and leadership.

We also saw areas of outstanding practice:

• People can access services and appointments in a way and at a time that suits them. The practice had a very responsive appointment system. They used a ‘patient-decided’ consultation approach that actively encouraged patients to choose the length of their appointments. This had resulted in a high level of patient satisfaction as demonstrated by the results of the most recent national GP Patient Survey. Leaders had reviewed the effectiveness of this approach and had published their findings so learning could be shared nationally to promote improvement.

• There was an innovative approach to providing responsive, integrated person-centred care, particularly for older people and people with complex needs. The practice understood that these patients were at more risk, if emergency services were delayed because of their rural location. To address this, the practice had collaborated with the local ambulance service to set up a rural community paramedic service. Clinical staff had provided training and clinical support to the paramedic team for which they received no extra funding. There was also a telephone ‘hot-line’ which paramedics could use to obtain clinical advice and support from the GPs. This had helped to significantly reduce the number of accident and emergency attendances. For example, in 2014/15, there had been 726 attendances. In 2017/18, this had reduced to 453 attendances.

The areas where the provider should make improvements are:

• In addition to the routine environmental audits carried out by the local trust, carry out regular infection control audits.

• Review the arrangements for using non-clinical staff as chaperones so that they are in line with the guidance issued by the General Medical Council.

• Carry out a risk assessment to determine whether non-clinical staff carrying out chaperone duties should undergo a Disclosure and Barring Service check.

• Record refrigerator temperatures in line with the practice’s standard operating procedure.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected the practice on 23 and 24 October 2014. We inspected this service as part of our new comprehensive inspection programme. Overall, we rated the practice as good. Our key findings were as follows:

• Patients reported good access to the practice, including the provision of same day appointments for those with urgent needs;
• Patients reported they were treated with kindness and respect, and received safe care and treatment which met their needs;
• Patient outcomes were either in line with, or better than average, when compared to other practices in the local Clinical Commissioning Group (CCG) area;
• Practice staff followed guidance produced by the National Institute for Health and Care Excellence (NICE) when providing care and treatments to patients;
• The practice was involved in research to help improve the treatment they provided to their patients;
• The practice was clean and hygienic, and good infection control arrangements were in place;
• The practice learned from significant events and incidents and took action to prevent their recurrence;
• The practice was well-led, and had good governance arrangements and staff felt well supported.

We saw an area of outstanding practice:

• Cheviot Medical Group is an accredited research and training practice and runs a number of research studies at any one time.

However, there was also an area of practice where the provider could make improvements:

• The practice should review its systems and processes for the safe handling of prescriptions to make sure it complies with guidance issued by NHS Protect in August 2013 regarding the security of prescription forms.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice