Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elmwood Health Centre on 12 August 2015. Overall the practice is rated as good.

Our key findings were as follows:

• Patients said they found it easy to make an appointment with a preferred GP, there was continuity of care and urgent appointments were available the same day.
• Patients’ needs were assessed and managed. Care was planned and delivered following best practice guidance.
• Patients told us they were treated with kindness, warmth, compassion and respect by staff.
• 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 (PPG).
• There was a clear leadership structure and staff felt supported by the management and GP partners.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded and addressed.

However, there were areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Ensure a health and safety risk assessment for the premises is completed and an action plan implemented in accordance with the findings.
• Ensure where the decision has been made not to carry out a DBS check for non-clinical staff who act as chaperones, there is a written risk assessment in place.
• Ensure all staff are aware of the practices business continuity plans.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous rating 12 August 2015 – Good overall, with the key question of safe rated as requires improvement.)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at Elmwood Family Doctors on 10 July 2018 as part of our inspection programme.

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 improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The practice had a significant number of patients residing in homes for older people. They provided a weekly ‘walk around’ with a supporting detailed policy to monitor the health and well-being of this group of patients. The practice was able to demonstrate that only one of their registered patients who resided in care homes had died in hospital in the last three and a half years.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients spoke positively about the care they received from the practice, which was in line with the friends and family test and above the national average for the results in the national GP patient survey data 2017.
• There were high levels of staff and patient satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation.
• Staff told us the leadership team was supportive and approachable.
• The practice was organised, efficient, had effective governance processes and a culture which was embedded effectively and used to drive and improve the delivery of high-quality person-centred care.
• The involvement of other organisations, voluntary services and the local community were integral to how services were planned and ensured that services met patient’s needs.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care and were clear, supportive and encouraged creativity.
• The practice was an active National Institute Healthcare Research (NIHR) centre. This benefitted patients by accessing potential screening, treatment and resources.
• The practice is also a Royal College of General Practitioners surveillance site for monitoring of disease trends and feeding this information into public health, helping predict and manage flu outbreaks and pandemics.

We saw areas of outstanding practice:

• The practice had developed the ‘Elmwood Template Menu’ and embedded it within the service to ensure all clinicians were using up to date agreed templates. We were told that this reduced variability in using read codes as well as improving the safety of work carried out by new members of staff, clinical trainees and locums. The templates also promoted patient safety, with prompts for clinicians during and after the consultations to ensure referrals and investigations were completed.
• Services were tailored to meet the needs of individual people are were delivered in a way to ensure flexibility, choice and continuity of care. The practice had identified areas where there were gaps in service provision locally and had taken steps to address these. Feedback received from patients and other stakeholders on the changes made was positive.
• The practice had designed, developed and improved processes for ensuring it maintained its ability to deliver both urgent and routine GP appointments in order to meet its patient’s needs. The system identified patient demand for appointments after a long-term audit of appointment availability and use, analysing capacity and patient demand. The results were used to ensure sufficient urgent appointments were provided each day, linked to demand. The impact had been a significant reduction in the volume and unpredictability of unscheduled work. We were told this led to less pressure and stress for patients and staff.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.