Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bradford on Avon and Melksham Health Partnership on 18 August 2016. Overall the practice is rated as outstanding.

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

• The leadership and culture of the practice was used to drive improvements and deliver high quality person centred care. The practice undertook a systematic approach to work effectively as a whole practice team, involve the patients and the community and other organisations to deliver the best outcomes and deliver the care within the community wherever possible.

• 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. For example the practice had introduced a wide range of initiatives over the past two years to support people; The ‘Leg Club’, a Memory Café, a balance and falls class, and set up a social hub in the local community.

• The practice used opportunities to improve outcomes where possible for example, during the flu clinic they checked patients over 65 for an irregular pulse and identified 24 new patients with atrial fibrillation (an irregular heart beat which led to identification of patients who may be have an increased risk of stroke and needed advice and/or medication).

• Feedback from patients about their care was consistently positive.

• 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 (PPG). For example the PPG had contributed to producing a directory of self-care support groups, raised awareness of key public health messages, conducting surveys and submitting proposals for improvements. The PPG had recently been involved in discussions on recruitment for new staff, including GPs.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

The practice provided a ‘Leg Club’, an innovative primary care led service to deliver research based wound management in a friendly social environment, provide staff development and learning, provide continuity of care and coordinated care, promote health and wellbeing and achieve outcomes and peer support. This service had improved outcomes for patients including reduced healing times, reduced recurrence rates (from 75% to 25%), improved social isolation, reduced house-bound contacts by 26% and reduced referrals to secondary care.

The practice employed an integrated team to drive forward the Transforming Care for Older People Team (TCOP) work programme who worked together to integrate the information technology systems to improve information sharing, break down barriers to effective communication and improve discharge planning and reduce admissions . The team undertook urgent home visits to enable a rapid service to those who may be at risk of an admission, the care coordinator visited patients in hospital prior to their discharge to facilitate their discharge and ensure the correct care was in place.

The practice offered seven day nurse support for local Nursing and Care homes, education support for staff in local Nursing and Care homes and access to wound care at the weekends in the local community.

The practice had responded to some concerns relating to delays accessing some mental health services for children and recognised that some needs were not fully met. The practice implemented regular meetings with the Health Visitors, introduced a mental health resource file for each consultation room with self-help material an assessment and support pack, and and created a mental health representative post to provide a contact for mental health patients (or their families) that need assistance.

The practice had an active patient participation group (PPG), they were very engaged in how the practice was run and had delivered health promotion sessions, contributed to producing a directory of self-care support groups and run volunteer support services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice