Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Christiana Hartley Medical Practice on 29 September 2017. Overall the practice is rated as outstanding. The practice is rated as outstanding for providing responsive services for older people, vulnerable people and those experiencing poor mental health; and well led services for all population groups and good for providing safe, effective and caring services.

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

• Safety was a key priority for the practice and comprehensive risk assessments and audits covering a range of issues were regularly conducted. The practice additionally utilised external auditors to ensure the safety of the practice systems and premises.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. There were systems to manage safety alerts. Learning from any incidents was discussed at internal and external meetings with other healthcare professionals to promote shared learning.
• The practice had invested in modernising the premises. The environment was pristine yet welcoming with plenty of information available for patients.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The practice sought additional training materials for staff. For example, comprehensive guides for infection control.
• Patients we spoke with and Care Quality Commission (CQC) comment cards reviewed indicated that patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had updated its telephone system to improve access. Patients we spoke with said they found it easy to make an appointment. Urgent appointments were available the same day.
• There was a strong and clear leadership structure and staff felt supported by management.
• Communications with staff had been well considered to ensure information was easily accessible and that staff carried out their roles effectively. For example, there was a communications noticeboard for staff to review two policies a week.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour.

We saw areas of outstanding practice:

The practice implemented a series of measures to help provide equitable access and health care provision for their patients. For example:

• The practice had set up a programme to review all their patients who were in care homes and nursing homes. These reviews took place every 12-15 weeks to ensure patients were receiving correct medicines and timely referrals when necessary. The reviews involved family, carers and staff from the homes attending the practice to co-ordinate care and provide holistic care for the patient. This was in addition to the GPs and nursing staff attending the homes. Patients on antipsychotic medicines were checked to ensure they were under the care of a psychiatrist .The structured reviews had resulted in a 6% reduction in the prescribing of antipsychotic medicines and a 2% reduction in emergency hospital admissions over the past 12 months for these patients.
• Accessible Information standards had been well considered. For example, the practice had conducted a telephone survey for visually impaired patients to improve their experience of the service provided. This had resulted in these patients being made more aware of the facilities available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice