We carried out an announced comprehensive inspection on 11 August 2015. Overall the practice is rated as outstanding.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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.

• There is a holistic approach to assessing, planning and delivering care and treatment to patients who use the services. The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice joined with a neighbouring practice to improve the care and treatment of patients in older peoples care homes they visited by producing standards of care and with measurable outcomes.
• Staff actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking, peer review and accreditation are proactively pursued.
• The continuing development of staff skills, competence and knowledge is recognised as integral to ensuring high-quality care.
• Patients said they were treated with compassion, dignity and respect and staff went the extra mile when patients required extra support. Information was provided to help patients understand the care available to them. The practice had produced detailed care plans for patients.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they were meeting the needs of their patients. The practice reviewed the Joint Strategic Needs Analysis (JSNA) and local census information to understand and plan services to meet the needs of their patients.
• 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 systems to manage and share the information that is needed to deliver effective care are coordinated across services and support integrated care for people who use the services.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The building was designed to meet the needs of patients. 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.
• There was a high level of constructive engagement with staff and a high level of staff satisfaction. Staff are proud of the organisation as a place to work and speak highly of the culture. Staff at all levels are actively encouraged to raise concerns and ideas.
• There is a systematic approach taken to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value.
• The leadership drives continuous improvement and staff are accountable for delivering change. There is a clear practice approach to seeking out and embedding new ways of providing care and treatment.

We saw several areas of outstanding practice including:

• The practice had a very good skill mix which included a nurse practitioner and was able to see a broader range of patients than the practice nurse. There was a preceptorship programme in place to support practice nurses employed in the practice.
• The practice had produced detailed care plans for certain conditions such as those with mental illness, older people and other long term conditions. These plans advised clinicians on what they should be monitoring, questions they should ask patients about their condition and when they should refer patients to a consultant or acute care. We saw data that indicated the number of patients accessing mental health out patient’s services had decreased since the care plan had been put in place.
• The practice used a screening tool to reduce polypharmacy and the prescribing of medicines that may cause side effects in older people. We saw that there was a reduction in admissions of older people to acute services from the previous year.
• The practice, in collaboration with a neighbouring practice developed Clinical Standards for the care delivered in the care homes they visited. The standards set out what care the patient and staff in the homes should expect and how they would monitor their effectiveness.
• The practice developed a range of templates and guidance for staff in the management of patients not included in Quality Outcome Framework (QOF). Examples of these were the care of patients suffering from coeliac disease, splenectomy and those patients taking novel oral anticoagulants. The templates also provide evidence based information on how these patients should be effectively supported.
• The practice provided a dermatoscopy service. Two GPs had undertaken training to deliver this service. The practice continually reviewed and audited the process to improve in house referrals and the photographing of skin lesions as an accurate record into the patients notes.
• The practice had developed a Memorandum of Understanding for mutual aid and this was updated in 2015. The document describes how the design of primary care estate can improve the resilience of GP provision when challenged. This was developed by the practice and seen as best practice and was adopted widely across practices in the North East and other strategic health authorities as part of the pandemic influenza preparedness plan during 2009/10.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice