Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 21 October 2015. Overall the practice is rated as outstanding.

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.

• There was a holistic approach to assessing, planning and delivering care and treatment to people who used the services.The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• Staff actively engaged in activities to monitor and improve quality and outcomes. Opportunities to participate in benchmarking, peer review and accreditation were proactively pursued.

• The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care.

• Patients said they were treated with compassion, dignity and respect and staff went the extra mile when patients required extra support.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they were meeting the needs of their patients.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients, staff and from the Patient Participation Group (PPG).

• The practice had good facilities and was well equipped to treat patients and meet their needs. The building was designed to meet the needs of patients. The Patient Participation Group (PPG) was actively involved in the design of the building.

• Information about how to complain was available and easy to understand.

• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, monitored and regularly reviewed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• There was a high level of constructive engagement with staff and a high level of staff satisfaction.Staff were proud of the organisation as a place to work and spoke highly of the culture. Staff at all levels were actively encouraged to raise concerns and ideas.

• The leadership across the practice drove continuous improvement and staff were accountable for delivering change. There was a clear practice approach to seeking out and embedding new ways of providing care and treatment.

We saw several areas of outstanding practice including:

• The practice carried out annual Inflammatory Bowel Disease (IBD) testing. The term IBD is a group of inflammatory conditions of the colon and small intestine. One of the GPs was the IBD Clinical Champion for the CCG area and involved with the Gastroenterology team at the local acute hospital, to assess the possibility of using near patient testing to assess for IBD in primary care. The practice was the only GP practice in the country to do this and if the research is fruitful, this model may be rolled out to primary care nationwide.

• The practice worked collaboratively with the lead GP from a neighbouring practice to develop best practice mental health care plans which were then used for the care of patients across both practices. These plans advised clinicians on what they should be monitoring, questions they should ask patients about their condition and when they should refer patients to a consultant or acute care. We saw data that indicated the number of patients accessing mental health out patient’s services had decreased since the care plan had been put in place.

• The practice used a screening tool to reduce polypharmacy and the prescribing of medicines that may cause side effects in older people. We saw that there was a reduction in admissions of older people to acute services from the previous year.

• The practice, in collaboration with a neighbouring practice had developed Clinical Standards for the care delivered in the care homes they visited. The Standards set out what care the patient and staff in the homes should expect and how they would monitor their effectiveness.

• The practice developed a range of templates and guidance for staff in the management of patients not included in Quality Outcome Framework (QOF). Examples of these were the care of patients suffering from coeliac disease.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice