Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N Chandra and Partners on 21 April 2016. Overall the practice is rated as outstanding.

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

• All staff were open, transparent and fully committed to reporting incidents and near misses. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning and personal reflection from internal and external incidents were maximised.
• The whole team was engaged in reviewing and improving safety and safeguarding systems. They used the Care Quality Commission fundamental standards to measure standards of care and signed up to the NHS England Sign up to Safety campaign.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they developed practice specific protocols to safeguard patients, identify patients at risk of exploitation and assess patient need.
• Feedback from patients about their care was consistently and strongly positive.
• The practice carried out regular patient engagement and surveys, including surveys for children for whom they introduced specific survey forms.
• 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 and reduced inequalities. For example, they worked with the local community support workers to create new practice specific literature in Urdu and European languages.
• Comprehensive information about the practice and services was made available to patients including a patients’ charter and quarterly practice and patient group newsletter..
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from external stakeholders, patients and from the patient participation group. For example, the practice reserved child only appointments after school and increased the availability of urgent appointments as a result of PPG discussions.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was active review of complaints and how they were managed and responded to, and improvements are made as a result. People who use services were involved in the review. The practice had a mission statement and 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. Staff, patients and external stakeholders were encouraged to contribute to the practice strategy to deliver this vision.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice:

• The practice was very responsive to the needs of minorities. They engaged with the local community to co-produce practice specific information in their own language, for example, Urdu, Hungarian and Polish and introduced specific survey forms for children. Hungarian patients had a 21% fail to attend (FTA) rate for new patient appointments. They worked with local community support workers to create new practice specific literature in these languages. After the introduction of these resources the FTA rate decreased significantly.
• The practice recognised problems locally with human trafficking. They consulted local authorities and national guidance. The information was discussed with staff to raise awareness and identify indicators of modern slavery. Bespoke protocols were developed to assess these patients upon registration and at subsequent appointments or if they failed to attend for appointments.
• Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, they invited dementia patients and family members to suggest how services could be improved, which they acted upon.
• The practice made significant efforts to identify and support carers. There was a named carers champion who worked with local organisations to support carers and attended local carers champion meetings and events. We saw a dedicated carers corner in the waiting area with up to date information and saw examples of the support offered to patients, carers and their families. Carers were given a direct practice telephone number to ring for support. A local carer support organisation had acknowledged the practice’s proactive approach to carers. The practice was featured in the Carers Count newsletter shortly after the inspection. The practice had significantly increased the proportion of carers on their register as a result of this activity.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice