We carried out an announced comprehensive inspection at The Thornton Practice on 25 October 2018 as part of our inspection programme. Our inspection team was led by a CQC inspector and included a GP specialist advisor.

At the last inspection in December 2014 we rated the practice as good overall.

Our judgement of the quality of care at this service is based 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 rated this practice as outstanding overall.

This means that:

• Patients were protected from avoidable harm and abuse and that legal requirements were met.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.

We rated the practice as outstanding for providing responsive services because:

• Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.

• The practice had identified areas where there were gaps in provision locally and had taken steps to address them.

We rated the practice as outstanding for providing well-led services because:

• Leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care.
• The practice led local initiatives to improve care and shared their best practice to the benefit of the neighbourhood.
• Staff, patients and the patient participation group (PPG) had been involved by the practice leaders in the planning and delivery of care.
• The practice had developed a vision to deliver high levels of care, staff reported high levels of motivation, work satisfaction and involvement achieving the practice vision.

We saw several areas of outstanding practice including:

• Services were tailored to meet the needs of individual people are were delivered in a way to ensure flexibility, choice and continuity of care. The practice had identified areas where there were gaps in service provision locally and had taken steps to address these, by creating new roles and processes to better meet needs. Feedback received from patients and other stakeholders on the changes made was positive. We noted increased levels of staff and patient satisfaction.
• The practice looked at demand for appointments after a long-term audit of appointment availability and use, analysing capacity and patient demand. The results were used to ensure sufficient urgent and routine appointments were provided each day, linked to demand. The impact had been a significant reduction in the volume and unpredictability of unscheduled work. The practice linked this to less pressure for staff and patients by the positive survey results. We noted that staff and patients had provided positive feedback around this area.
• The PPG which had been established three years previously had, with the support and financial backing of the practice, led and completed several successful initiatives and projects to promote patient wellbeing and care, for example the “Healthy Heroes” and “BioBlitz” initiatives they had been recognised locally and nationally as an exemplar.
• There were high levels of engagement with external partners agencies to deliver care and lifestyle improvements to patients, for example, the “Fleetwood Town community trust.” and multi-agency flu clinics.
• The practice used social media innovatively to engage with patients both at the practice and in the locality.

There were areas where the provider should make improvements are:

• Record all safety alerts and action taken in response to them.
• Include declarations in recruitment information held.
• Document a risk assessment of content and location of emergency medicines.
• Check and update entries in staff training matrix against certificates of training.

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

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

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Thornton Medical Practice.

We undertook a comprehensive inspection on 3 December 2014. We spoke with patients, staff and the practice management team. The inspection took place at the same time as other inspections of GP practices across the Fylde and Wyre Clinical Commissioning Group.

The practice is rated as good.

Our key findings were:

• All staff understand and fulfil their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal incidents were maximised to support improvement. 
• The practice was using proactive methods to improve patient outcomes it links with the Clinical Commissioning Group and other local providers to enhance services and share best practice.
• Patients told us they were treated with compassion, dignity and respect and they were involved in care and treatment decisions. Accessible information was provided to help patients understand the care available to them. Feedback from patients was positive about their care, treatment and communication with the practice staff.
• Complaints were sensitively handled and patients are kept informed of the outcome of their comments and complaints. The appointment system was sensitive to the needs of the population groups the practice served. The practice was actively involved in new initiatives to enhance and support the care they delivered to their patients.
• The practice had a clear vision which had quality and safety as priority.

We saw several areas of outstanding practice including:

• All members of the practice staff had either completed or were working towards becoming Dementia friends.
• All practice patients could be seen by a GP on the same day under their Guaranteed Advanced Access process. This was not always with their named GP but was with one GP within the practice.
• Patients could directly access, appointments the Help Direct Service from the practice to assist them with their personal needs for example debt management. The service held twice weekly clinics within the practice.
• The practice supported patients to access the electronic Big White Wall Scheme where they could be supported with their mental health and counselling needs at a time to suit their lifestyle. This could be accessed 24 hours a day and patients were signposted to this service appropriately.
• Inter-practice referrals were seen to be effective in addressing patients’ needs for specialist advice. Appointments were available under this service within the day or the next 24 hours.
• The practice worked as part of the Rapid Response Team for the area, this ensured patients needing immediate intensive nursing or social support who did not require hospitalisation could be treated in their own home.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke to a number of people about the service. We spoke with patients either before or after their treatment, five GP’s, the practice manager, nursing staff, and administration/reception staff. We also spoke to the commissioning department of NHS England. This was in order to gain a balanced overview of what patients experienced using this practice.

Patients spoke highly of the way they were treated by staff and were happy with the treatment and support shown to them. Comments from patients included, "I have no complaints. The staff, nurses and doctors have all been great".

The practice ensured patients were respected and involved in their treatment. Patients we spoke with felt they were given enough information about treatment options. One patient said, "The doctor was really good with me and explained everything.”

Care and treatment was planned and delivered in a way that ensured patient's safety and welfare. We spoke with the doctors and nursing staff regarding the assessment of patients and looked at systems used. Patients confirmed that they felt confident that the doctors and nursing staff understood their condition.

The service had effective safeguarding practices in place. Staff had a good understanding of what actions to take place should they have any concerns about safeguarding patients at the practice.

The provider had a range of audits and systems in place to monitor the quality of the service being provided.