Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westwood Surgery on 21 September 2017. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. All opportunities for learning from internal and external incidents were maximised.

• The provider used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they were proactive in developing templates and protocols to assist in implementing best practice guidelines and they shared these with other practices.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. Staff were proactively supported to acquire new skills and share best practice.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Some patients said they did not always find it easy to make an appointment with a named GP but urgent appointments were available the same day. Systems had been put in place to improve consistency for patients and these were consistently reviewed. The practice guaranteed same day access for patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The provider 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. The provider had implemented their vision and strategy at the practice since they had taken over and all staff we spoke with said there had been significant improvements in all areas.

• The provider had strong and visible clinical and managerial leadership and governance arrangements. There was a clear leadership structure and staff felt supported by management.

• The provider proactively sought feedback from patients, which it acted on.

• There was a high level of constructive engagement with staff and a high level of staff satisfaction.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw several areas of outstanding practice:

• The provider had excellent systems to ensure learning from significant events was shared with the whole practice team and staff were involved in the analysis of significant events. These systems had been implemented at the practice since the provider takeover and were embedded. For example, staff had been fully appraised of their responsibilities in reporting and records showed a wide range of reporting including near miss incidents and reporting of positive practice. Significant events were discussed at meetings across the practice and this included a multidisciplinary meeting. A six monthly significant event newsletter was provided to all staff with a detailed list of the significant events and the action taken. An annual significant event meeting involving all staff was held. This involved staff taking part in mixed staff team workshops to analyse a number of significant events and review the actions taken to assess if any improvements in the process were required. Staff told us they found these meetings an excellent environment for learning and they felt involved in the improvements to the service.

• To support learning and improvement the provider had a complaints committee which investigated and reviewed all complaints, a mortality committee to regularly review patient deaths that were referred to the coroner and specific lead clinical staff reviewed cancer diagnoses against national guidance.

• There were excellent systems in place for sharing information about safeguarding concerns and identifying children at risk and these had been implemented at the practice and were embedded. These systems included early intervention multidisciplinary safeguarding meetings called “Think Family”. The provider had led on the pilot for these meetings and the format and principles had been rolled out to other practices in the Bassetlaw CCG area and shared with the wider community. The provider had also developed templates for assessing patients requesting contraception. These templates assisted staff to identify child sexual exploitation and to assess the patient’s competency to make decisions.

• There were excellent systems to ensure health and safety in the practice. For example, although NHS property services had completed health and safety risk assessments and implemented maintenance plans on behalf of the landlord, the provider had monitored and reviewed these and completed their own risk assessments to assure themselves the building was safe. On take over of the practice patients told us the provider had not used the building until they could be assured it was safe and had chosen to transport patients to their other sites on the first day.

• A programme of continuous clinical and internal audit was used to monitor quality and to make improvements. The provider had a detailed programme of clinical audit which included auditing some areas annually to ensure continued improvement in areas such as prescribing practice and they had made significant savings in this area. They took account of and monitored good practice developments through their extensive audit systems, developing templates and protocols to support and improve practice. The practice shared this learning and their developments with local practices.

• Care was provided by integrating the primary, secondary and social care workforces. Larwood and Bawtry were one of the fifteen test sites across England to have been chosen to develop and test a new enhanced primary care approach. The provider, Larwood Health Partnership, was part of the multidisciplinary team leading this project. The provider had implemented this multidisciplinary approach, (Primary Care Home Model), across all their sites.

The provider should make the following improvements:

• Improve patient experience of making an appointment.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice