Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr C R Dalton’s Practice (also known as Darwen Healthcare) on 31 August 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. We saw that learning opportunities from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. Training was proactively identified for staff as part of staff and service development and we saw that the training resulted in changes to practice to improve patient care and outcomes. These changes were monitored to demonstrate their effectiveness.
• The practice used innovative and proactive methods to improve patient outcomes, for example around pre-diabetes.
• Patients praised the practice highly and said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The organisation was flexible to best meet the needs of its patients. The practice had tailored its staffing structure and the roles within it according to the needs of the service in order to streamline processes and improve the quality of care.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw three areas of outstanding practice:

• We saw that the practice conducted audits regularly to ensure that best practice was being followed when staff were asked to act as chaperones. The audits examined whether the chaperones themselves recorded their presence at the consultation in the electronic patient record in free-text format as well as selecting a pre-created read-code box in the software. These audits demonstrated that as well as the chaperone’s presence being coded appropriately in the records 100% of the time, the use of free-text descriptions to supplement the coding had improved from a rate of 66% to 91% of the time over the previous year.

• The reflective and learning ethos of the practice was thoroughly embedded. The practice was proactive in maximising learning following complaints and incidents. We saw that not only was appropriate action taken to mitigate against an incident being repeated, but that the opportunity was taken to scrutinise that aspect of the service and assess whether further improvements could be made. For example, following a complaint regarding a delayed issue of a death certificate, not only was the administration protocol for such an event updated to mitigate against reoccurrence, but processes around end of life care were holistically examined and the practice produced a bereavement pack to ensure improved care and advice was offered to families who had suffered a bereavement.

• A recent audit around the diagnosis and coding of diabetes and pre-diabetes demonstrated that 95 new diabetes diagnoses had been made in the previous 12 months. In addition the practice increased the number of pre-diabetic patients identified from 83 in June 2015, to 325 in June 2016. When these pre-diabetic patients had clinical tests repeated following their identification, 66% of them showed a reduced risk of developing diabetes as a result of the lifestyle advice the practice had given to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice