Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cleveleys Group Practice on 3 March 2016. Overall the practice is rated as outstanding.

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.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice employed a qualified nurse as a care co-ordinator who contacted all patients who had been discharged from hospital, providing a home visit and full assessment if necessary. We were told that this model of care was to be adopted by the Clinical Commissioning Group (CCG) for other practices.

• Feedback from patients about their care was consistently and strongly positive. Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice met with other practices in the neighbourhood for monthly meetings that included representatives from community services, the police, ambulance services, social services and health and wellbeing workers.

• 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 a patient complaint, the practice reduced the number of appointments that patients with more than one long-standing health condition attended. The practice provided additional training to staff and brought health checks together into one appointment to reduce patient visits to the practice. Longer appointments were provided for this.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• 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 attained the Royal College of General Practitioners (RCGP) accreditation in 2014. (This award is to reward practice teams who have improved their organisational quality of care to best practice recommended levels). The practice had used the learning from this to produce a performance dashboard that, together with feedback from staff meetings, audit, significant events and patient complaints was used to inform a quality improvement plan. This plan was regularly reviewed and updated at practice meetings.

• There was a clear leadership structure and staff felt supported by management.

• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice including:

• The practice pharmacist had developed a risk-profiling tool to identify patients who were most in need of having their medications reviewed by the practice staff. The pharmacist continued to audit this work to ensure that risks were reduced and we saw evidence of this.

• One of the practice GPs received direct alerts from the police when they had a concern regarding a vulnerable patient. This enabled the GP to arrange an appointment or visit the patient. The practice was the pilot site for this project.

• A charity providing memory screening for patients attended every fortnight and patients were able to self-refer to these clinics as required. The practice also arranged for this charity to attend a flu clinic on a Saturday.

• The practice had purchased a light box to facilitate staff training and hand hygiene. (A light box enables staff to identify poor hand hygiene practices).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice