Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bedlingtonshire Medical Group on 2 February 2016. Overall the practice is rated as outstanding.

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

• People were protected by a strong comprehensive safety system and a focus on openness, transparency and learning when things go wrong.
• 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, working with other local providers to share best practice.
• Feedback from patients about their care was consistently and strongly positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, they had implemented a change to the telephone system which allowed patients who could not press buttons (such as those with arthritis) to speak to a receptionist quicker than they could previously.
• The practice was well equipped to treat patients and meet their needs. 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. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw several areas of outstanding practice including:

• The practice had implemented a number of initiatives as part of their High Risk pathway, which was designed to manage patients at risk of unplanned hospital admissions. These included a review of prescribing which had reduced unnecessary repeat prescriptions by 16%, and the development of their own evidence-based care plans to allow patients with respiratory conditions to manage them at home. Since implementing these measures the practice had reduced unplanned hospital admissions for their patients from 239 in 2013/14 to 99 in 2015/16. Some of these iniatives had been adopted by the local clinical commissioning group (CCG) and extended to practices across the region.

• The practice manager had designed and implemented an evidence-based system for reporting and analysing significant events. This had created a culture which prioritised safety and learning in the practice, and resulted in an increase from 11 significant events reported in 2013 to 54 in 2015, driving a number of improvements at the practice. Where the practice did not achieve 100% of the Quality and Outcomes Framework points available for a particular domain a significant event analysis was performed to learn what could be improved. All staff, adminisitrative and clinical, were included in this process, and patients were invited to be involved to suggest ways to improve.
• A practice nurse with experience of minor illness care had been employed to implement a minor illness clinic at the practice. They created an evidence-based minor illness triage pathway developed for receptionists, and any patients who fit the criteria on the list could be given an appointment with the nurse instead of a GP. Minor illness appointments were blocked out for these patients, creating on average 25 additional GP appointments per day.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice