We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions effective, responsive and well led. We did not look at the safe or caring key questions as part of this inspection.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall. During our previous inspection we rated safe and caring as Good. During this inspection we rated effective, responsive and well led as Good.

We rated the practice as Good for providing effective, responsive and well led services because:

• The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
• The practice was able to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
• The practice organised and delivered services to meet patients’ needs.
• There was compassionate, inclusive and effective leadership at all levels.
• There were clear responsibilities, roles and systems of accountability to support good governance and management.

We rated all population groups as Good because:

• The practice had a frailty team led by an advanced nurse practitioner who triaged and carried out home visits and carried out ward rounds at the five local nursing homes which were linked to the practice.
• Patients identified as pre-diabetic were offered a support program.
• The practice employed a cardiovascular pharmacist, to ensure the efficacy and safety of drug therapy for patients with hypertension and coronary heart disease.
• There was a weekly audit of frequent practice attenders to address their needs.
• The practice offered early and late appointments for patients.
• End of life care was delivered in a coordinated way which considered the needs of those whose circumstances may make them vulnerable.
• Patients experiencing poor mental health had access to longer appointments.
• The practice actively identified patients who were homeless and worked with them to determine a treatment plan which met their changing needs and accommodated changes of location. The practice maintained contact with patients through the local pharmacy and substance misuse services.
• The practice had an ‘autistic passport’ for those patients living with autism. This clearly described for staff, how they would like to be communicated with.

The areas where the provider should make improvements are:

• Review the complaints procedure so it is easily accessible to patients.
• Continue to review and respond to patient feedback around access to appointments.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Highlands Practice on 16 August 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed apart from those associated with vaccine management.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns. The practice had gathered feedback from patients through the Patient Participation Group (PPG) who were shown complaints and asked for their opinion on how they might respond.
• Patients 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.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review the identification of carers by the practice and implement a support mechanism for this patient group.
• Improve governance arrangements in the practice for the administration of vaccines under patient group directions (PGD) to ensure staff are competently trained and that the PGD is completed in a timely manner to ensure that nurses do not practice outside of the legal framework.
• Review the system for access to same day appointments to ensure equal access for all patient groups.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice