Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holland Park Surgery on 11 May 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.

• Throughout our inspection there was a strong theme of positive feedback from staff and patients. Patients said they were treated with compassion, dignity and respect and they felt involved in their care and decisions about their 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 had a well-established shared care service which they managed in conjunction with community outreach workers. This allowed the practice to effectively manage physical and psychological problems that may coexist with illicit substance misuse.

• Feedback from patients about their care was consistently positive.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and the patient participation group. For example to bring more services closer to patients homes the practice listened to feedback and therefore implemented a Anticoagulation clinic (a blood test which tells clinicians how long Warfarin a blood thinning medication is delaying the blood from clotting) and carried out ultrasound and advanced dressings including compression dressings.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and assessed how they were being managed and responded to, improvements were made as a result.
• The practice was proactive in identifying and managing significant events. For example all significant events were thoroughly investigated and opportunities for learning from internal and external incidents were maximised.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership with robust governance arrangements in place. There was a regular programme of practice meetings and the overarching governance framework supported the delivery of the practice’s strategy and good quality care. Governance and performance management arrangements were proactively reviewed to reflect best practice.

The practice used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. There were clear systemic processes in place and a strong learning culture with development opportunities for all staff. The practice was well organised and made full use of their resources to respond to changing population needs. We saw several areas of outstanding practice for example:

• The practice attended the yearly canal event in order to promote services available to those who would not normally access health care services. As a result the practice identified a number of people who were not registered with the practice. The practice now registers and supports ‘Liveaboards’ (people living aboard canal boats).

• The practice holds a yearly Awareness Day which they invite professionals such as the hospice Palliative Care Consultant, local Macmillan Nurse, Pathways4Life (a dementia support worker service for hard to reach groups), life coaches and diabetes UK to raise community awareness of the range of services available. Topics discussed on the day such as end of life care created much interest amongst patients and their carers.

• The practice had a strong culture of continued professional development and was keen to encourage younger people to take up a career in general practice. For example the practice helped young professionals gain employment and training in a health and social care environment by employing two clinical healthcare support apprentices.

• Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example the Patient Participation Group PPG was involved in the registrars and student nurses induction plan, for example they provided talks on topics such as an overview of services from the eyes of patients.

However there were areas of practice where the provider should make improvements. For example:

• The practice should continue to increase the uptake of health checks for patients aged 40 to 70 and over 75s.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice