Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elliott Hall Medical Centre on 17 November 2016. Overall the practice is rated as outstanding.

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

• There was a strong, open and embedded culture at the practice in respect of patient safety and the practice used every opportunity to learn from incidents. We observed a genuine open culture in which all safety concerns raised by staff were highly valued and integral to learning and improvement. All staff were encouraged to participate in learning and to improve safety as much as possible. We saw evidence that incidents were shared externally to enhance learning on a wider basis.
• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safeguarded from abuse.
• Comprehensive systems were in place to keep people safe, which took account of current best practice. For example, there was an effective system in place to review patients on high risk medicines which included a nominated lead, an alert on the clinical system, a recall system and regular patient audits to ensure prescribing was in line with safe and best practice.
• There was evidence of quality improvement including clinical audit. We saw that the practice had put in place a comprehensive audit programme which was driven by the needs of the practice population in order to improve patient outcomes.
• Feedback from patients about their care was consistently positive. Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care.
• 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 and there were innovative approaches to providing integrated patient-centred care. For example, patients over the age of 65 and with complex long-term conditions and multiple health problems were supported through the ‘Virtual Ward’ system which provided multidisciplinary care management of complex patients to prevent unnecessary hospital admissions and avoid readmissions.
• There was a strong, visible, person-centred culture. We observed staff members to be highly motivated to offer care that was kind and promoted people’s dignity.
• The practice had a very proactive and engaged Patient Participation Group (PPG) which the practice referred to as the Patient Association (PA). This worked closely with the practice to support and provide services to its patients, which included bereavement and carer support.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. The provider was aware of and complied with the requirements of the duty of candour.
• Leaders had an inspiring shared purpose and 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 and the Patient Association. There was a high level of constructive engagement with staff and a high level of staff satisfaction.
• There was a strong focus on continuous learning and improvement at all levels. The practice took pride in its role as a teaching and training practice and we saw that a learning and reflection culture was embedded in the organisation.

We saw several areas of outstanding practice:

• There was an holistic approach to assessing, planning and delivering care and treatment to people who use services. For example, the practice had developed over several years the ‘supportive care register’ (SCR) and anticipatory care plan which enabled patients to have choice and make decisions about their care. Both of which had been adopted within the locality and the latter being recognised locally for an award.

• The practice had a very proactive and engaged Patient Participation Group (PPG) which was known as the Patient Association (PA). This worked in conjunction with the practice through a team of volunteers to help support patients and reduce social isolation through carers’ groups, home visiting and bereavement support services. A patient transport service supported patients unable to use public transport with access to the practice.

• The partners led an innovative and committed team, and promoted a strong inclusive culture with a focus on continuous quality improvement. The partners encouraged effective communication within the team and demonstrated a comprehensive meeting structure which included daily clinical and non-clinical meetings to enhance their formal operational and governance frameworks.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice