Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cape Hill Medical Centre on 9 January 2017. Overall the practice is rated as outstanding.

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

• 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. There was visible clinical and managerial leadership and effective governance arrangements.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. The practice was proactive in the management of safeguarding children and vulnerable adults.

• The practice used innovative and proactive methods to improve patient outcomes. Clinical audits had been triggered by new guidance and from learning from significant events.

• Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect. For example: 97% of respondents had confidence and trust in the last GP they saw or spoke to.

• 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, a new telephone system with the initial greeting in five languages and the ability to book an appointment with the GP of choice.

We saw several areas of outstanding practice including:

• The practice was one of only 17 practices nationally to receive the Gold Standards Framework award for end of life care. The End of Life Care programme considered all care parameters using NICE guidance as the basis and demonstrated improvements in every aspect care. This included documentation of advanced planning, patient preferences, bereavement support, holistic assessment of care, plus seven other elements. One key factor was having a single clinical lead who examined all clinical notes, they co-ordinated the practice to meet the targets it had set in the aspiration for End of Life Care. Learning points showed a clear appreciation of the advantage of having a single person take the lead, with whole team buy in and continuous review and ongoing education and reflection in the regular clinical meetings.

• The practice had developed detailed holistic care plans that included reviews of physical and social care, plus patient education. They provide a holistic approach to reduce co-morbidities and reduce unplanned admissions. For example, the inclusion of social aspects of care, falls prevention and self-management education for the patients. We saw detailed evidence that demonstrated multiagency working to support isolated and patients who were housebound. The nurses attend weekly meetings with the community nursing team to enable concerns about patients to be acted upon immediately to improve unplanned admissions

• The clinical leads at Cape Hill Medical Centre believed that the ‘standard’ model of a short consultation with a single health professional was not well-adapted to serve the needs of their patient population. To meet the population needs and following a review of the patient experience the practice developed a wellbeing hub, this involved a work coach, link worker, chaplain and a mental health team practitioner working side by side. The aim of these roles was to provide high quality care, support and guidance to patients.

However there were areas of practice where the provider should make improvements:

• The practice should consider how to further promote national screening for bowel cancer in order to address the lower than average uptake.
• The practice should continue to monitor the measures taken to improve patient satisfaction rates in relation to access and appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice