Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Langridge and partners on 5 April 2016. Overall the practice is rated as outstanding.

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

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example the practice had been involved in the design, delivery and implementation of the community gynaecology and dermatology services.

• The practice used innovative and proactive methods to improve patient outcomes, and worked with other local providers to share best practice. For example GPs could access the Nottingham clinical navigator service which enabled them to obtain specialist advice regarding a patient’s specific health condition from an appropriate consultant based at the Nottingham University Hospital (NUH) Trust.

• The patient participation group proactively reached out to the community and worked constructively with other organisations to improve patient outcomes. This included health promotion, patient education and supporting the emotional needs of the patient population.

• There was an open and transparent approach to safety and an effective system in place for reporting, recording and investigating significant events. Risks to patients were assessed and well managed.

• Staff had the skills, knowledge and experience to deliver effective care and treatment. Some clinical staff had undertaken additional training to enhance their skills and had developed areas of special interest to support them in taking lead roles within the practice.

• Feedback from patients about their care was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.

  We saw several areas of outstanding practice including:

• The practice demonstrated innovative patient participation group (PPG) working to help support the emotional needs of its patient population. The practice had empowered and supported the PPG in setting up a bereavement self-help group. This group was open to the whole community and meetings were held monthly in the Keyworth primary care centre.PPG members we spoke with and records reviewed showed the bereavement group had made a positive impact on patients’ mental wellbeing.

• The practice team actively engaged with other health organisations including the Nottingham University Hospitals NHS Trust to develop and provide community based services which reduced the use and burden on hospital services. The benefits to patient care included: care being delivered closer to home; reduced hospital attendances and admissions; as well as early supported discharges. For example:

• The practice was involved in the design and provision of specialist community services in surgical dermatology (for the greater Nottingham health district) and gynaecology (for Rushcliffe residents).

• The senior GP partner had worked with four local GPs and a community matron in the design and provision of the hospital in reach service (into the health care of older people wards) service at Nottingham University Hospital. This service aims to manage admissions to the older people wards and ensure timely and safe discharges for patients

• The practice proactively reached out to the community and worked constructively with other organisations to improve patient outcomes. For example, the practice held an annual flu day on the first Saturday of October and records reviewed showed over 2000 patients were vaccinated on the day. A total of 4233 patients were invited for flu vaccinations in 2015 and 3513 (83%) patients had received them.

However there was an area of practice where the provider should make improvements:

• Ensure robust processes are implemented in the checking of single use medical consumables to ensure they are in date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with seven people who used the service and ten staff. Most of the people we met had been attending the practice for many years, along with most of the other members of their family. They said they were involved in making decisions about their care and treatment and they were happy with the service as a whole. One patient said, "I've never had a single problem in all the years I've been coming here."

We saw that good records of consultations were kept with details of the care, treatment and support provided to patients. A further analysis of the arrangements to check that chronic disease patient registers were adequately monitored and to evidence that patients were being contacted in a timely way to offer them a review would provide additional safeguards to some patients.

There were suitable systems in place for the management of medicines and the people we spoke with were happy with the service they received.

The practice had arrangements in place to support staff to gain suitable skills to meet the requirements of their role. There were processes in place for the regular supervision and appraisal of staff and new systems had been introduced to manage the organisation of staff training needs.

People were aware of the complaints systems and were satisfied that their concerns would be taken seriously. Complaints and incidents were recorded and investigated however, the processes in place to implement learning from these events required more thought.