Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Caythorpe & Ancaster Medical Practice on 21 April 2016. Overall the practice is rated as outstanding.

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

• At the inspection we found that patients were protected by a strong comprehensive safety system and a focus on openness, transparency and learning when things go wrong. The practice had comprehensive systems in place to keep people safe which took into account current best practice.

• There was an open and transparent approach to safety and an effective system in place for the reporting, recording, investigating and monitoring of significant events.

• Information about safety was highly valued and was used to promote learning and improvement. Risk management was comprehensive and well embedded.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice employed a qualified nurse as a care co-ordinator who liaised with other agencies in the care of older people.
• Feedback from people who use the service and stakeholders was consistently and strongly positive.93 patients expressed high levels of satisfaction about all aspects of the care and treatment they received. The feedback from comments cards we reviewed said they are treated with care, compassion, dignity and respect. Staff went the extra mile.
• Data from the January 2016 national GP survey was also consistently high.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, a Neighbourhood team. The team identified those most at risk of health and social care problems and decided how best to manage their needs.

• Services were tailored to meet the needs of the patients and were delivered in a way to ensure flexibility, choice and continuity of care. 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

• The practice had good facilities at both sites 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 a number of areas of outstanding practice including:

• The practice ensured that the patients were protected by a strong comprehensive safety system with a focus on openness, transparency and learning when things went wrong. The level and quality of incident reporting demonstrated that all staff were open and fully committed to reporting incidents and near misses.

• A GP partner, with the support of Lincolnshire County Council, introduced a “Bicycles for exercise programme” The practice purchased 13 electric bicycles and these were loaned to identified“at-risk” patients, for example, those with cardiovascular disease, to encourage them to become more physically active. The practice used their medicine delivery service to deliver these to patients. The feedback from this project was very favourable and encouraged patients to go on to continue to cycle and become physically fitter.

• A GP partner, with support from local agencies, had helped to develop local walking groups.These were initially surgery based but had now become autonomous and self-sustaining under the “Walk for Life” scheme. They now had active weekly walking groups based in both Caythorpe and Ancaster surgeries. Independent research by Sheffield Hallam University (The value of walking – an ethnographic study of a Walking for Health group, Gordon Grant April 2015) had validated the success of this programme. These groups were promoted through the practice website, information in the waiting rooms and through Patient Group newsletters.

The areas where the provider should make improvement are:

• Ensure the safeguarding register is current and up to date

• Have a system to record safeguarding and gold standard framework palliative care meetings.

• Ensure that guidance received within the practice is checked and interpreted correctly to ensure patient safety. For example, in relation to repeat prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice