Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Laurel Bank Surgery on 10 November 2016. Overall the practice is rated as outstanding.

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

• The practice had developed an open, blame-free culture with regard to the identification and notification of significant events and incidents. A thorough analysis of the events was carried out and these were discussed at the daily and monthly clinical team meetings. The GP trainer kept a log of historical significant events which they used with GP registrars as a training aid.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. They participated in a number of Clinical Commissioning Group (CCG) led initiatives which delivered integrated care and improved service co-ordination.

• The practice had a proactive view to wider service improvement and co-operated with other bodies which required GP practice input. For example, they had worked with the Department of Work and Pensions to develop and trial new online systems to support terminally ill patients accessing appropriate benefits in a timely way.

• Audit and compliance assessment was a fundamental part of the culture of the practice. A programme of audits had been developed based on patient safety alerts, effective prescribing, guidance updates and any issues highlighted within the practice. Over the previous 12 months the practice had carried out 46 audits.

• Feedback from patients about their care was consistently positive and above local and national averages.

• 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. For example, the practice worked with others locally to provide weekend appointment access, this service being delivered at a nearby surgery.

• The practice delivered care to specific vulnerable groups which included those with a learning disability.

• The practice implemented suggestions for improvements and had made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had a vision which had quality and safety as its top priority. The practice had developed a clear strategic approach which was supported by a business plan and practice improvement plan and used these to deliver this vision.
• The practice had a strong commitment to training and told us that training formed a key part of the culture of the organisation and that this ensured the delivery of knowledgeable, informed and effective patient care.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw two areas of outstanding practice:

• The practice had adopted a systematic approach to service improvement and had developed a practice improvement plan (PIP). The PIP identified key areas where it was demonstrated that improvement was required. These areas were identified from patient surveys and feedback, performance reports, public health reports, audits and risk assessments. The PIP was maintained by the practice manager, however all staff were involved in its development and in supplying content. The PIP was also used to track and report on progress and its content was discussed at team meetings. As an example, the practice had identified cervical screening as a subject area and included actions to increase screening in the PIP. At the time of inspection screening rates had improved from 76% to 81% from 2014/2015 to 2015/2016.

• The practice provided services for residents of a local bail hostel for recently released ex-offenders. The practice had to cope with a rapid turnover of patients from the hostel, many of whose residents had pre-existing or developing health conditions.

However there was an area where the provider should make improvement:

• Review the immunity status of staff in relation to measles, mumps, rubella and chickenpox in order to assure themselves that their staff are adequately protected in line with the latest guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice