We carried out an announced comprehensive inspection of Cestria Health Centre on 10 November 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care and prescribing as a result of this.
• Feedback from patients about the care they received was better than local and national averages. Patients reported that they were treated with compassion, dignity and respect. Patient feedback in relation to access was higher than local clinical commissioning group and national averages.
• Patients were able to access same day appointments. Pre-bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice had proactively sought feedback from patients and implemented suggestions for improvement and made changes to the way they delivered services in response to feedback. Patient participation group members had been invited to attend a practice away day to decide on a new model of appointment system.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved an overall result which was comparable with the local average and higher than the national average.
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed.

We saw area’s of outstanding practice, including:

• The practice held a monthly multi-disciplinary meeting at their linked care home which was attended by a mental health practitioner. This enabled early identification and treatment of mental health related issues in the elderly and ensured residents were supported appropriately by care home staff. This, together with a ward round approach to visiting residents in the home and effective emergency health care planning had led to a reduction in the number of unplanned admissions to hospital and A&E attendances for older patients.
• The practice had a dedicated nurse practitioner who carried out regular home visits to review patients’ care plans and contacted patients on discharge from hospital to ensure they were receiving appropriate support and their needs were being met. This had also contributed to a reduction in the number of unplanned admissions to hospital and A&E attendances. A further nurse practitioner had been appointed to extend this area of work.

• The practice had been instrumental in developing and providing staff and facilities to provide a weekend service for frail, elderly and vulnerable patients. This had resulted in fewer admissions to hospital over weekends and generally for this patient group.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice