This practice is rated as outstanding overall. (Whilst under their former providers, each of the four practices which now make up Lancaster Medical Practice were previously rated good overall with one domain or population group rated outstanding. Inspections of these practices took place between October 2014 and December 2015)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at Lancaster Medical Practice on 2 and 3 August 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.
• All of the 167 staff at the practice had completed mandatory training and had received an appraisal in the past 12 months.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The involvement of other organisations and the local community was integral to how services were planned and ensured services met people’s needs. The practice had lead roles in the integrated care community and worked closely with the university.
• Leaders had the capacity and skills to deliver high-quality, sustainable care. They had an inspiring shared purpose, strived to deliver and motivated staff to succeed.
• Staff told us they felt supported and engaged during and since the merger.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We also saw several areas of outstanding practice:

• The practice used a cultural values assessment tool to understand the culture and values of staff at each of the four legacy practices and to determine the desired cultural values for the merged practice. Staff were given “cultural training” to try and further embed these shared values and encourage staff to think as one practice, rather than as four separate entities. Staff we spoke to told us that this exercise had been an important factor in ensuring the success of the merger.
• As well as public consultations at each of the sites, the practice set up a dedicated email address for patients to communicate with the practice about the merger. They released a range of informative material to keep people up-to-date, such as lists of frequently asked questions. They kept in touch with patients via letter, email and social media. The practice devised a methodology and key messages for engaging with patients, staff and external partners to ensure that the information they were giving was consistent and clear.
• The practice had developed a new role following the merger: Patient Care Administrators (PCAs). They performed an administrative and coordination role for the clinical teams. This reduced the workload of clinicians and gave them more time for appointments. As PCAs were assigned to particular teams they developed close links with both the patients and the clinicians.
• Group consultations had been trialled at the practice to assist patients following treatment for cancer. The nurse leading the consultations used the Macmillan concerns checklist to gauge patients’ wellbeing and found that each of the patients reported a more positive outlook following the intervention. The project won the Most Innovative Group Consultation award from Health Education England (HHE) in November 2017. The practice planned to use the same method to help patients with other long-term conditions, such as diabetes.
• A nurse at the practice was awarded a grant to establish a mental health support group for new students at the university. This was set up in response to a review that found 9% of the practice’s 11,000 student population had attended the practice within the past 12 months with concerns about their mental health. Feedback collected by the practice showed students found the programme beneficial.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

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