We carried out an announced comprehensive inspection at Arch Healthcare on 28 January 2019 as part of our inspection programme. This was a first rated inspection for the service that was registered with CQC in February 2017.

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

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

• A proactive approach to anticipating and managing risks to people who use services is embedded and is recognised as the responsibility of all staff. A risk management model had been devised to identify which care pathway within the integrated service was most appropriate for each patient.
• There was evidence of learning from significant events that was shared outside of the practice to improve safety and reductions in harm.

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

• Multidisciplinary working was at the forefront of the model of care for the service. Collaborative working across the integrated service meant that patient outcomes had improved and there was evidence of reduced accident and emergency attendance, and a 32% reduction in unplanned admissions and a 42% reduction in re-admissions to hospital.
• There was a collaborative and holistic approach to transitioning patients to other GP practices when they were more stable and able to work.

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

• Feedback from patients was consistently positive and was higher than local and national averages in some areas.
• There is a strong, visible person-centred culture. Staff are highly motivated and inspired to offer care that is kind and promotes people’s dignity.

The practice coordinated an annual memorial service for patients, staff and the public to commemorate the lives of homeless patients who had died.

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

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care, particularly for patients who were vulnerable and those with poor mental health.
• There were innovative approaches to providing integrated person-centred care that increased access to services for patients, including clinicians visiting patients in the community at hostels, drop-in centres and on the streets in order to meet their needs.

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

• Strategies and plans are fully aligned with plans in the wider health economy, and there is a demonstrated commitment to system-wide collaboration and leadership.
• Leaders have an inspiring shared purpose, and strive to deliver and motivate staff to succeed. There is strong collaboration, team-working and support across all functions and a common focus on improving the quality and sustainability of care and people’s experiences.
• Governance arrangements are proactively reviewed and reflect best practice. A systematic approach is taken to working with other organisations to improve care outcomes.

These outstanding areas benefitted all population groups and so we rated all population groups as outstanding.

We saw several areas of outstanding practice including:

• A risk management framework was in use across the integrated service. This included clear referral criteria and case management responsibilities for patients based on the assessment of risk.
• The practice monitored key performance indicators and measured performance using a range of metrics. This included measuring the impact of interventions and care and treatment on a reduction in access to secondary care.
• Services were developed based on evidence based treatment and care and the practice participated in research to improve health outcomes, including the development of outreach services to treat patients with hepatitis C.
• GPs provided homelessness healthcare leadership across the city, including to other GP practices in supporting patients to transition from homelessness primary care services into mainstream primary care services.
• Clinicians provided education to increase the skills of other clinicians and frontline workers across the integrated care service and beyond, in order to improve treatment and care for homeless patients across the city.

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