Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at East Leake Health Centre on 4 February 2015. Overall the practice is rated as Outstanding.

We found the practice to be outstanding for providing, responsive services and for being well led and good for providing safe, effective and caring services. It was also outstanding for providing services for the population groups, of people experiencing poor mental health (including people with dementia) and families, children and young people.

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

• The practice worked with other local providers to share best practice to improve patient outcomes.
• Patients told us they very happy and satisfied with the care and treatment they received. They said they were treated with compassion, dignity and respect by all staff.

• Patients felt involved in their care and able to make informed decisions about their treatment.
• The practice actively sought feedback from patients using a variety of methods and acted on suggestions for improvements and made changes to the way it delivered services based on this feedback. The practice had an active Patient Participation Group (PPG), who worked in partnership with the practice to further improve services for patients.

• The practice was accessible to all patients and was well equipped to treat patients and meet their needs.
• Patients were able to access care and treatment when they needed it. They described their experience of making an appointment as good, with urgent appointments usually available the same day.
• The culture and leadership empowered staff to carry out lead roles and innovative ways of working to meet needs, and drive continuous improvements.
• The practice had a clear vision which had quality and safety as its top priority. Systems were in place to keep patients safe and minimise risk of harm. When things went wrong the practice had an open culture which ensured lessons were learnt and improvements made.
• The management and governance of the practice assured the delivery of high-quality person-centred care.
• Staff were actively supported to continually develop their knowledge and skills to ensure the delivery of high quality care. The practice had a highly motivated and committed staff team with extensive experience and skills, to enable them to deliver well-led services.
• The practice had a very good skill mix which included advanced nurse practitioners (ANPs) who were able to see a broader range of patients than the practice nurses. This had enabled greater access to appointments for patients and freed up time for training and development for all staff. There was a preceptorship, mentoring and support programme in place to support new ANPs to the practice.
• GP's gave their personal phone numbers to families and carers of patients receiving end of life care to ensure they could be contacted if needed. Following bereavement a personal letter of condolence was sent by the GP who knew the patient best. This was followed up with welfare calls.
• The practice had instigated a ‘Red Dot’ system to identify patients with multiple long term conditions and ensure they were allocated longer single appointments to have health checks for each of their conditions, This had reduced the number of appointments required for these patients, ensured greater continuity of care and increased access to appointments for other patients .
• The practice provided a dispensary service for patients at a branch surgery to ensure they had ease of access to medicines.

We saw several areas of outstanding practice including:

• The practice worked with a voluntary partner to develop a strategy to support young people in crisis and at risk of suicide. The programme had been adopted across the county.
• Staff were supported to a very high standard and had access to training funded by the practice to help develop their skills. For example a nurse was supported to undertake a diabetes merit course which enabled them to run joint diabetes clinics which increased access to and effectiveness of care. The practice had been recognised by the CCG and Nottingham University as a particularly supportive placement for students and GP registrars.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection February 2015 – Outstanding)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at East Leake Medical Group on 16 and 21 March 2018 as part of our inspection programme.

At this inspection we found:

• There were safety policies including adult and child safeguarding policies in place and staff were familiar with these. Staff received safety information as part of their induction and refresher training and knew how to raise concerns.

• The practice identified vulnerable patients and worked with other agencies to support and protect them from neglect and abuse.

• Care records gave the information needed to deliver safe care and treatment and were accessible to relevant staff in an accessible way, including for extended hours appointments.

• Arrangements for the storage of medicines and the operation of the dispensary kept patients safe.

• Patients participated in national screening programmes and health initiatives with encouragement and support from the practice.

• The most recent published QOF results were 100% of the total number of points available compared with the clinical commissioning group (CCG) average of 99% and national average of 96%. The overall exception reporting rate was 6% compared with a CCG and national average of 10%.

• Patients could access services in ways that were convenient to them, including using online services and accessing routine appointments with GPs and nurses outside of usual surgery hours.

• The practice collaborated with stakeholders and played a key role in developing services across the whole CCG area.

• Staff were respected and valued. They felt proud to work for the practice.

• The patient participation group (PPG) played an active role in representing patient views and developing services.

• The practice was open to innovation and developed new ways to improve services for patients.

We saw areas of outstanding practice:

• The practice had initiated, piloted and participated in the development of an innovative and comprehensive electronic system to guide clinicians along appropriate care pathways and aid their decision making. This was known as ‘F12 Pathfinder’ and meant clinicians pressed one key to access all the templates and protocols they needed when considering the health needs of patients. The F12 Pathfinder system was built into the electronic record system and templates were automatically pre-populated with individual information from patient records. There were templates for a broad range of health issues including for example, heart failure and cancer, which meant clinicians were confident they were following relevant up to date guidance and pathways and had support for their decision making. In each case, the template guided clinicians through the relevant pathway, ensuring accurate information was gathered, basic investigations completed, tests carried out and referrals made. The templates were personalised to the Rushcliffe area and reflected the services that were available to the practice, for example giving details of local clinics and their referral criteria.

• The practice collaborated with stakeholders and played a key role in developing services in the practice and across the whole CCG area, including the ‘Let’s Live Well in Rushcliffe’ scheme and the extended hours service. They had developed a programme to identify patients with undiagnosed atrial fibrillation (AF) and this had been successful in increasing the numbers of patients identified and treated for this long term condition. Their development of a multi-agency CCG wide model of enhanced care home support for older people had improved care for these patients and resulted in a reduced number of emergency admissions to hospital. The practice were active in the GP Federation and GPs from East Leake Medical Group took lead roles in the development of services across the local health community.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice