Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at James Alexander Family Practice on 30 August 2017. Overall the practice is rated as good.

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

• The practice had become registered with the Care Quality Commission in May 2016 and was on a trajectory of improvement. This was a new registration following a practice split. Some initiatives such as improvement in patient satisfaction scores and Quality outcomes framework were not demonstrable in the national figures quoted as they included some data from the previous governance team but we saw evidence of improvement on the day of inspection.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• There were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke very highly of the culture. There were consistently high levels of constructive staff engagement.

• Staff at all levels were actively encouraged to raise concerns.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• Staff told us that they had seen many improvements in the practice since registration.

• The practice had strong and visible clinical and managerial leadership and governance arrangements. The practice had funded leadership training for two of the key members of staff. This had resulted in nominations by practice staff and also from doctors training at the practice for awards in inspirational leader and best team categories.

• The practice proactively sought feedback from staff and patients, which it acted on.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example a jointly funded pilot scheme had recently been completed; evaluation had shown a reduction in pain and an improvement in mental well-being in patients suffering from arthritis and multiple sclerosis. This was due to be presented to local commissioners with a view to becoming shared across the area.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

• 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.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• 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; the practice had introduced GP telephone triage, introduced a new automated telephone system and recruited staff to build a multi-disciplinary team to suit the needs of their patients.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• 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.

We saw areas of outstanding practice:

• Members of staff were inspired to care for patients and we saw numerous examples of this care.

• The practice had recognised that Hull had the highest incidence of Ischaemic Stroke in England and was an outlier. The practice had funded equipment to screen patients for atrial fibrillation and had identified patients with previously undiagnosed atrial fibrillation who were now receiving treatment. This indicated undiagnosed atrial fibrillation in almost 10% of patients tested. They were in negotiation with the CCG to be a pilot for this service with the aim of roll out across the area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice