Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wellway Medical Group on 25 February 2016. Overall the practice is rated as outstanding.

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 used innovative and proactive methods to improve patient outcomes. Clinical audits had been triggered by new guidance and from learning from significant events.

• Data showed that the practice was performing highly when compared to practices nationally and in the Clinical Commissioning Group. The latest publicly available data from 2014/15 showed the practice had achieved 99.7% (England average 94.8%) of the total number of points available to them, with a clinical exception reporting rate of 4.6% (England average 9.2%).
• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• There was a clear leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.

• Staff throughout the practice worked well together as a team.

We saw several of outstanding practice which included:

• The practice had all-encompassing systems and processes in place to ensure that patients received high quality care and treatment. These included learning from significant events, triggering clinical audits and then changes in clinical practise which improved patient care.

• The practice introduced ‘LEAN’ processes for all their pathways including systems focussed on improving access to their services. Using the LEAN system removed unnecessary tasks to ensure a faster and more efficient process. Patient access was improved following critical feedback from patients in the GP National Patient Survey in 2013 when only 25% of patients said it was easy to get through on the telephone. After introduction of a new LEAN appointment system the January 2016 score had improved to 92%. The CCG gave also feedback that attendances of their patients, at the local access centres, had reduced significantly, noting that in 2013, 1070 patients attended while in 2015, 261 attended which was a reduction of 73% over that two year period.

• The practice had an excellent learning culture. They took quality improvement very seriously. The practice had a very evident culture of improvement across all staff groups, led by the Quality & Performance Team. There was a clear and proactive approach to seeking out and embedding new ways of providing care and treatment. For example, the practice had recently recruited a paediatric advanced nurse practitioner to improve services for children. We saw this had led to higher than average performance across a number of patient outcome indicators and they had been rated as a higher achieving practice within the General Practice Outcome Standards (GPOS).

• The practice took the needs of carers very seriously by appointing a carer’s champion whose role was to promote the needs of carers and liaise with the local carer’s organisation. We saw they maintained information for carers boards in each of the waiting areas of the surgeries which contained a wealth of information. Information for carers was also posted on their social media pages. This included support available at home, mobility aids and transport support. The practice had information setting out what their goal was as a practice to support carers. The local carer’s organisation had provided carer awareness training for staff. They also featured the work the practice were doing for carers on their website. The practice’s computer system alerted GPs if a patient was a carer. There were 367 patients on their carer’s register which was 2% of the practice population. The practice offered annual health checks for carers in the carers birthday month.

• The practice took the needs of vulnerable patients seriously. A lead nurse role had been nominated vulnerable groups which included patients with learning disabilities, epilepsy and sensory impairment. The practice maintained a register of patients with a learning disability. They were offered a yearly review with the lead nurse. Health action plans with personalised goals had been designed for the patients, including easy read health action plans for patients with a learning disability. The practice nurse had liaised with a local specialised nurse for advice and was seeking feedback from patients regarding the service the patients received. The practice provided GP and practice nurse services to a local hospital forensic mental health unit for patients who had been referred by the courts for assessment or who had been declared as not criminally responsible or unfit to stand trial by the Criminal Justice System.

• The practice had introduced a programme to reduce unplanned admissions to hospital. This ‘high risk patient pathway’ focussed on frail elderly patients, those on their palliative care and mental health register and some high risk patients who had chronic obstructive pulmonary disease (COPD). A care plan had been introduced for each patient. A multidisciplinary, high risk patient pathway meeting was held monthly. As a result of this the practice’s emergency admissions to hospital for the over 65s had reduced from 15.68 per 1,000 patient population to 11.73 from quarter 1 of 2015/16 to quarter 2 of 2015/16.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice