This practice is rated as Outstanding overall.

We last inspected the service in November 2014, when it was rated as good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at The Lakes Medical Practice on 5 April 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, involved all staff, shared the information internally and externally, and improved their processes.

•The practice proactively reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. We were able to see the positive impacts on patient care and outcomes. Innovation was valued and actively encouraged, and we saw where, for instance, changes to clinics had resulted in improved access for patients. Treating patients holistically was seen as a cornerstone to good results.

•Staff involved and treated patients with compassion, kindness, dignity and respect. Patient feedback was positive.

•Patients found the appointment system easy to use and reported that they were able to access care when they needed it. Telephone triage allowed GP advice within two hours, or one hour for children, and direction to the most appropriate member of staff.

•There was a strong focus on continuous learning, improvement and innovation at all levels of the organisation. Staff were heavily invested in their roles and were empowered to develop their skills.

We saw areas of outstanding practice:

•The Infection Prevention Control (IPC) lead had initiated a series of weekly ‘Soapbox’ emails, which she used to communicate any infection control updates and best practice to all staff, or to communicate good news stories.

•The practice had proactively reduced opiate and benzodiazepine prescribing as part of a programme with input from the Patient Participation Group (PPG). The practice were the lowest prescribers for hypnotics in the area, reducing the numbers of patients prescribed these drugs from 180 to 20. We saw further evidence of the success of this programme through decreasing opiate usage, for instance a 30% reduction in codeine use, and a 42% reduction in Tramadol usage. The practice had shared their learning from this with others at Clinical Commissioning Group (CCG) learning events.

•Staff innovation and suggestions were valued and encouraged and we saw patient outcomes had improved as a result, for instance improving rates for asthma review clinics after a telephone consultation option was offered.

•The practice had developed an in-house service to offer extra support, psychotherapy, advice and signposting to patients who had undergone a termination of pregnancy. The practice proactively contacted these patients.

•Patients could receive additional holistic support  from an in-house Emotional Wellbeing Practitioner who provided psychotherapy. The practice could demonstrate this had significantly improved patients well-being scores and also reduced the frequency of GP contacts from people suffering poor mental health.

•The practice were committed to supporting their staff. Staff were invited to complete a Professional Quality of Life Questionnaire to help them reflect on their roles and stress. Staff could access extra support including a two hour Personal Development session where they could discuss issues such as stress and burn out.

•Staff were given high levels of support and access to training, and were encouraged and empowered to develop specialisms and skill sets. Practice staff had developed specialist interest areas, including for women’s health and sexual health services. As a result of this the practice offered a same day appointment or call back service for sexual health, contraception or menopause advice, ensuring fast access for patients. The service generally dealt with over 100 call backs each month. The specialist staff member was given protected time and additional support to facilitate this service.

•Staff meeting minutes were mapped to CQC domains of safe, effective, caring, responsive and well led to provide structure and clear direction, to ensure not only legislative compliance but also to encourage continuous improvement.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of The Lakes Medical Practice on 26 November 2014.

We have rated the practice overall as good.

Our key findings were as follows:

• Patients we spoke with told us they were satisfied with the care provided by the practice and said their dignity and privacy was respected. Patients positively commented that they recognised the practice was always trying to improve the service provided.

• CQC comment cards were completed by patients prior to the inspection and comments were overwhelmingly positive.

• Staff told us they felt involved and engaged in the practice to improve outcomes for both staff and patients. They said they were proud to work there and felt that communication between the various teams within the practice was a strong point.

• There was a range of qualified staff to meet patients’ needs and keep them safe.

• There was good leadership and a strong learning culture and the staff had a clear vision, with quality and safety as their top priority. Staff responded to change and were encouraged to bring suggestions for improvement. We saw a high level of constructive staff engagement and staff satisfaction. Staff had received resilience training, this involved them reflecting on what they did, how they supported each other and how they moved forward together as a team.

We saw two areas of outstanding practice including:

• The practice had recently introduced a home blood pressure monitoring system for patients. The patients take their own blood pressure at home and then text their reading to the surgery where it is monitored by the healthcare assistant. There were at the time of our visit 109 patients who were using this service.

• The practice had a holistic approach to managing long-term medical conditions and patients received reviews which looked at their overall needs rather than having to attend specific clinics for each condition.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice