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his practice is rated as Outstanding overall. (Previous rating October 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at Thornfield Medical Group on 3 October 2018. This was as part of our ongoing 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 and improved their processes.
• There was a truly holistic approach to assessing, planning and delivering care and treatment to people who used the service. Quality improvement was at the heart of any changes made by the practice. New evidence based techniques were used to support the delivery of high quality care.
• They ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff were committed to working collaboratively, people who had complex needs were supported to receive coordinated care and there were innovative and effective ways to deliver more joined up care to patients.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Staff were consistent in supporting patients to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health, and every contact with patients was used to do so.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice had helped to make links with patients who may be most vulnerable of being excluded from good access to primary medical services.
• The practice took a systematic approach to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money.
• The practice planned for a sustainable future, and innovated to support sustainability and provision of good quality care. Leaders were not afraid of safe innovation and strove to continually improve the health outcomes for patients. There were strong governance arrangements which supported safe innovation and continual improvement.

We saw areas of outstanding practice:

• Leaders were not afraid of safe innovation and strove to continually improve the health outcomes for patients. They were proactive in responding to the needs of the patients to help reduce health inequalities. They understood the challenges faced by patients in a very deprived area and put in place strategies to support improved outcomes for patients. For example, staff were consistent in supporting people to live healthier lives through a targeted proactive approach to health promotion and prevention of ill health. They had reduced non-elective admissions to hospital for patients with chronic obstructive pulmonary disease (COPD) by 12.5%. They had captured the individualised needs of patients who had undergone gender reassignment, experienced gender dysphoria or identified as non-binary, including future health screening needs. The practice had linked with people who were most vulnerable of exclusion from good access to primary medical services. They had supported patients to become familiar with the practice and how primary care works with a visit by young people with autism and participating in a national children’s TV programme.

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

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thornfield Medical Group on 20 October 2015. 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 significant events. The process for recording significant events centrally required review.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment, however, some gaps in training were identified during the inspection.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They also told us the practice was clean.
• Patients told us that it was sometimes difficult to make an appointment, particularly with a preferred GP. However, they also said they found it easy to make urgent appointments.
• Information about services and how to complain was available and easy to understand. The practice took action following complaints.
• 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 and there was an open culture. The practice proactively sought feedback from staff and patients, which staff acted on.
• The practice worked well with their patient participation group. The group told us staff communicated regularly with them and had acted on their suggestions.

The areas where the provider should make improvements are:

• Review arrangements for recording significant events. Make sure all events are logged collectively and analysed by the team as a whole.

• Review the process for accessing the staff area of reception to maintain their safety.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The majority of patients we spoke with were satisfied staff at the practice listened to their views, showed them respect and involved them in decisions about their care and treatment. One patient told us, “The doctors and nurses are lovely. They look after me well. They treat me well. They respect and understand me. It’s just what I think a doctor’s practice should be about.” Another patient said, “The doctors have all been really nice….she always listens to what is wrong rather than making assumptions.”

Most patients told us they experienced care, treatment and support which met their needs. One patient said, “My doctor bends over backwards to listen to me. I have a long-standing health problem which my doctor understands. My doctor involves me in everything and I feel a part of every decision made.” However, we found most patients we spoke with were unhappy with the appointments system. Our inspection found the practice was taking action to address this concern.

Patients who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The premises were clean, hygienic and patients were protected from the risk of infection.

Effective staff recruitment and selection processes were in place. We found steps had been taken to make sure only suitable staff were employed at the practice.