Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Baslow Health Centre on 21 June 2016. Overall the practice is rated as outstanding.

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

• The practice team were committed to deliver high quality and responsive patient-centred care. We found many examples where staff had provided exceptional care to support the individual needs of patients.
• Feedback from patients was overwhelming positive with regards to the care they had received. Patients said they were treated with compassion, dignity and respect and they were actively involved in decisions about their treatment. Results from the latest national GP survey showed that the practice scored higher than the local and national averages in all 23 questions patients were asked. This included a 100% positive response rate in terms of patient confidence and trust in both the GP and nurse. Patients we spoke to on the day reinforced these results.
• The practice provided excellent access to care and we observed a well organised, flexible and effective appointment system, which accommodated the needs of patients. Patients said they were able to access care and treatment when they needed to, and had a positive experience when making an appointment. This was complemented by a responsive approach to home visit requests, recognising the needs of their predominantly older patient profile.
• Risks to patients were regularly assessed and reviewed in conjunction with the wider multi-disciplinary team, which met on a weekly basis. We spoke to community based staff who worked with this surgery, and all provided extremely positive accounts of their interactions with the practice. They told us that GPs were approachable and accessible; that their views were respected; and that any requests were acted upon without delay.
• There were processes in place to safeguard children and adults, and staff had received appropriate training and knew how to report concerns.

• The practice team had the skills, knowledge and experience to deliver high quality care and effective treatment, and were supported to develop their roles via an established appraisal process. Staff had been supported to undertake training to enhance their skills and some had developed areas of special interest to support them in taking lead roles within the practice.
• There was an open approach to safety with a system in place for the reporting and recording of significant events, although the number of reported incidents was low. We observed examples where learning had been applied from events to enhance the delivery of safe care to patients.
• The practice dispensary provided medicines to 86% of registered patients. This service enabled a responsive and personal service for the supply of medicines, including the delivery of medicines to frail and housebound patients. However, some areas for improvement were identified within the operation of the dispensary, which the practice immediately rectified.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audit was used to drive quality improvement within the practice.
• Information about services and how to complain was available and easy to understand, although some details required an update to reflect current guidance. Improvements were made to the quality of care as a result of complaints and concerns.
• The premises were clean and tidy with good facilities. The practice was well-equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff told us that they felt extremely well-supported by management. There was strong leadership and governance arrangements were generally robust.
• The practice analysed and responded to feedback received from patients to review and improve service provision.
• The patient participation group (PPG) influenced practice developments. For example, some amendments had been made to the appointment system further to a survey undertaken by the PPG.

We saw several examples of outstanding practice:

• The delivery of first class patient-centred care on the individual needs of patients was evident in all aspects of the practice’s work. The high level of compassion and respect provided was highlighted in the national GP patient survey, comment cards, and from patients we spoke with on the day of the inspection. For example, the GP survey showed 100% of patients who responded had confidence and trust in the last GP they saw. GPs provided personal contact details for community nursing staff and sometimes directly to families to support excellent end of life care. They would visit patients at weekends and bank holidays to ensure patients received continuity of care and rapid intervention to reduce the need for hospital admission. Data for emergency hospital admissions demonstrated this was half the CCG rate, despite the practice having 31% of their patients aged 65 and over.
• The practice had initiated a service that supported patients with a terminal illness to remain in their own homes and to die at home if this was their preference. This service had evolved into an independent charity and became available to all practices across the CCG area. Practice data showed that 97% of patients had died within their preferred place as a consequence of the planning and support offered by the practice working in conjunction with the wider health and social care teams.
• The practice used innovative and proactive methods to improve patient outcomes, and worked with their Clinical Commissioning Group (CCG). The practice was dedicated to supporting new ways of working, and some projects had been rolled-out across other local practices. For example, they had initially developed a system to ensure that patients at the end of their life had rapid access to medicines they may require if their symptoms were to deteriorate. This had developed into the ‘just in case’ medicine boxes now widely used for palliative care patients across the CCG.

The areas where the provider should make improvement are:

• Ensure a procedure is in place to monitor and action any uncollected prescriptions, especially when higher risk medicines have been prescribed.
• Undertake a risk assessment for the delivery of medicines to patients’ home addresses by the driver and volunteers from the PPG.
• Review and risk assess the use of a white board display of patients’ names with complex needs to raise staff awareness of those requiring care prioritisation.
• The practice should ensure that cleaning schedules are signed and dated.  

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice