Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Street Lane Practice on 14 July 2015. Overall the practice is rated as goodgood.

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.
• The practice adopted up to date computer systems to improve communication internally and externally which also improved the patient experience by transferring all paper patient notes to a scanned easy access system.
• Patients (currently 21%) were being introduced to an online access system allowing them to view their medical records at home, re-order prescriptions, book or cancel appointments and add data to their medical records such as blood pressure results and asthma monitoring.
• The practice used innovative and proactive methods to improve patient outcomes, working with local nursing homes in a pilot scheme to order prescriptions, share medical records and care plans electronically. The system was especially effective in promoting communication when a patient was discharged from hospital to a participating care home.
• Clinical audits were wide ranging and fully completed with learning shared across the clinical team.
• The practice operateda separate business (embedded within the facilities at Street Lane

  Street Lane Services which provided specialist NHS community clinics, purchased by the CCG. These brought hospital consultants and nurse specialists into the practice. These specialists worked in partnership with lead GP partners in areas of dermatology, cardiology, minor surgery and paediatrics. They were accessed by registered patients as well as the wider community through a referral system and reduced the burden on hospital services.

• 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 and they were encouraged to adopt text message and online services to increase efficiency around appointments, medication and understanding their diagnosis.
• The practice had an active patient reference group, which had 42 members on its communication list with a core attendance of 10-15 members.
• The practice had a clear vision which had care, quality, efficiency 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.
• The practice had invested in a 12 week practice improvement programme with an external provider to evaluate the management of the practice across patient delivery and consistency of approach.
• The practice had a very good skill mix which included an advanced nurse practitioner (ANP) practice nurses and a health care assistant (HCA). Two part-time Patient Liaison workers were an integral and valued part of the team. The HCA was undergoing training in enhanced skills to provide extra hours of clinical time to undertake tasks previously assigned to the registered practice nurses following a clinical duties audit.

We saw several areas of outstanding practice including:

• An innovative Patient Liaison Service was launched to support patients to identify local services and opportunities to enhance social well-being and reduce dependency on GP services that may not be as appropriate. Over 200 patients had benefitted since its introduction in 2014 and the CCG is commissioning other local practices to adopt this type of service.
• An Echocardiography machine (which assists in the diagnosis of heart conditions) was available for use within the practice as part of the specialised cardiac service provided by Street Lane Services. The machine was used in 90% of new patient referrals to this clinic.

• Office space, freed up by the removal of paper medical records had been transformed into a multi-disciplinary hub, where doctors, nurses and patient liaison workers worked side by side in an open plan and collaborative way- breaking down professional barriers and improving efficiency and team work.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Street Lane Practice 8 February 2019 as part of our inspection programme.

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 and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• In addition to general practices services, the practice provided additional specialist NHS community clinics under a separate contract with NHS Leeds Clinical Commissioning Group. The clinics could be accessed by patients registered with the practice; along with the local patient population.
• The practice had an in-house patient liaison service which provided support to all patients for both clinical and non-clinical needs.
• The practice had been involved in developing the ‘Healthy Minds Service’ which provided virtual support for patients with low level mental health issues; signposting to other services and a range of techniques and tools to improve resilience.
• The practice had implemented an ‘outcomes’ computer template on the clinical system for clinicians to complete following patient consultation. This clearly outlined the management plan and what the next steps for the individual patient were.

We saw areas of outstanding practice:

• The practice had worked with patients to improve access through the development of the eReception system. This enabled patients to contact the practice via a link on the website and reduce the need to contact the practice by telephone. This service was available 24 hours a day and the practice responded to any patient requests via this method within 30 minutes during working hours.
• The practice had obtained funding from the Yorkshire and Humber Academic Science Network to test eReception and had shared the system with 25 practices across Leeds.

Whilst we found no breaches of regulations, the provider should:

• Continue to identify and manage risks to patients through risk assessments of the premises. Specifically, the risk assessments for fire and infection prevention and control should be improved and updated.
• Continue to liaise with their cleaning company regarding the improving of infection, prevention and control processes.
• Review their exception reporting rates for patients living with diabetes to assure themselves that these patients are receiving the care, treatment and support that they need.

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 Primary Medical Services and Integrated Care