This practice is rated as outstanding overall. (The previous inspection was in July 2015 – when the practice was rated outstanding)

The key questions 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 St Leonard’s practice on 12 June 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 there was a genuinely open culture in which all safety concerns raised by staff and people who use services were used as opportunities for learning and improvement.
• 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.
• Patients said the care and treatment they received was very good and added that 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.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• 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.
• There were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture.
• The practice was an active National Institute Healthcare Research (NIHR) centre.

We saw areas of outstanding practice:

• There was a culture of learning and education at the practice and staff had obtained further education including master degrees, doctorates and had other roles including professorships, university sub deans and clinical leadership roles. Three of the GPs had been awarded the bronze Clinical Excellence Awards, by the Advisory Committee on Clinical Excellence Awards (ACCEA). One of the GPs was recognised in particular for the educational innovations carried out at the practice that had been subsequently used in national and international contexts.

• The practice had an in house research team and undertook its own original research which influenced policy and educational curriculum changes at both local and national level. This included improving patient care and outcomes, reducing unexpected hospital admissions, improving education and improving the management of long term conditions.

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

Letter from the Chief Inspector of General Practice

We carried out an announced inspection at St Leonard’s Practice on 28 July 2015. The practice is rated as outstanding overall. It was outstanding for providing effective, responsive and well led services and good for providing safe and caring services. It was rated as outstanding for providing services for the population groups of older people and people with long term conditions, families, children and young people, vulnerable people and people experiencing poor mental health. It was rated as good for providing services to working age people.

Our key findings 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.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s 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 (PPG).
• The practice had excellent facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We identified areas of outstanding practice;

Patients newly diagnosed with cancer were contacted by a nurse practitioner and offered an appointment. The nurses provided care for patients with cancer normally only available in hospital, such as the care of their intravenous lines. This avoided the need for frequent patient visits to hospital.

In June 2015 the practice had carried out a pilot primary care ophthalmology service to assess patient response to eye treatment at a GP practice. Findings had been positive. Of 27 eye patients, 23 had been successfully treated at the practice. The remaining four had been referred into secondary care. All 27 had been very happy with the service.

The practice was an internationally recognised lead for learning, research and improvement. GPs at the practice had a great deal of published work in medical journals and books to support this. There had been an extremely positive impact of this primary research and its publication to a global audience. Examples included the adoption of a system for the identification and management of type two diabetes, due to research and published work carried out by GPs at the practice.

Research at the practice had led to the development of the ‘Devon Predictive Model’ (DPM) which was adopted by the local clinical commissioning group (CCG) and also nationally to improve care for older people. The DPM works by close liaison with all healthcare providers to supply an analysis of all available data to provide a proactive and effective approach to patient care, especially for older people and at risk groups.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice