Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tanworth Lane Surgery, part of GPS Healthcare, Solihull on 18 May 2017. GPS Healthcare are a group of six practices in Solihull and includes two registered locations Tanworth Lane Surgery and Meadowside Family Health Centre and an additional four branches.

All of the practices share one practice list and have a central management team with shared policies, procedures and governance arrangements. We have produced two reports to reflect both locations registrations; however due to the structure of the provider organisation much of the detail included in the reports will be replicated.

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

• The practice had a clear vision which had safety, quality of care and staff involvement as its top priority. The strategy to deliver this vision had been produced with staff and stakeholders and was regularly reviewed and discussed with staff.
• A comprehensive understanding of the performance of the practice was maintained through the management board. Performance was managed centrally and managers could review achievement and compliance at each location and across the organisation. We saw evidence of quality improvement activity that had been implemented with case studies to demonstrate learning. The learning points were cascaded to staff and discussed at individual site and team meetings.
• The management team had a meeting structure in place which included a staff forum to ensure all staff had the opportunity to contribute to the practice vision and values.

• The provider had expanded the six practices with seven additional consultation rooms, through the local infrastructure investment scheme. This had enabled them to offer more services.

• The practice had an active patient participation group (PPG) and the provider also held a GPS Healthcare wide network PPG meeting was held on a regular basis. The practice implemented suggestions for improvements as a consequence of feedback from patients and from the patient participation group (PPG). For example the PPG were asked for suggestions and ideas on how to improve the patient information leaflet which was acted on. This included adding information on medicines waste and the leaflet being available in different formats to support vulnerable patients.

• A patient newsletter had been set up which was issued every three months. The newsletter promoted health awareness and updated patients on changes within the practices and the plans that had been implemented.
• 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, this included regular health awareness events.
• There was evidence of quality improvement including clinical audits. There had been 21 clinical audits undertaken in the last two years across all six sites and the learning shared with each practice. These were completed audits where the improvements made were implemented and monitored.
• The practice had set up a comprehensive health and safety system. This included a standard operating system that had been adapted at all sites and an annual event planner, so all sites were aware of when risk assessments, training and checks would be completed.

The outstanding feature at this practice was the leadership and this was demonstrated through:

• The practice had identified that talks from local charities was an opportunity to support patients and their families and had linked with local charities and services to do this. For example: Four events had taken place over 12 months and were advertised in the practices, on the website and in the practice newsletter. The four events included, a dementia friends event, a living well after a cancer diagnosis by MacMillan and Cancer Research UK, Age UK and Solihull Carers to offer support to all carers over the age of 13 years. The practice had an average of 10 patients and their families attend each event. The practice had set up a ‘Healthcare Hub’ in conjunction with the local library, to offer access to health advice and health awareness to the local population.
• The practice undertook the General Practice Improvement Programme, sponsored by NHS England. This was a program focused on the organisational efficiency that can be developed by making use of ‘lean’ process mapping. By identifying and removing differences between sites, the practice had developed a protocol for dealing with emergency situations. This included having exactly the same emergency grab bag (with identical contents, in specified pockets) in each location. The practice had an innovative use of technology with each department having a ‘Whats App’ program on their telephone to liaise with each other in the case of an emergency and to organise cover in the case of staff sickness.

There were areas of practice where the provider should make improvements:

• Continue exploring and establishing effective methods to identify carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at GPS Healthcare on 5 December 2018 as part of our inspection programme. In addition, we inspected four of the five branch sites on 11 and 12 December 2018.

At the last inspection in May 2017 we rated the practice as good overall.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm. Although systems and process to promote consistency across the organisation were in place, they were not always applied consistently in practice. Some areas such as the management of safety alerts, elements of performance monitoring and the system for monitoring patients on high risk medicines required embedding further.
• There was an open and transparent approach to safety and a system in place for recording, reporting and learning from significant events. The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse and for identifying and mitigating risks of health and safety.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines and best practice.
• Staff were encouraged and given opportunities to train or study for additional qualifications to enhance their roles.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. The practice considered innovative ways of providing appropriate care to vulnerable and hard to reach groups of patients.
• Patients could access care and treatment in a timely way during normal surgery hours or via the extended hours hub.
• There were clear responsibilities, roles and systems of accountability to support effective governance. Partners held specific roles as part of the executive board for which they were accountable.
• The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
• The vision of the organisation took into account the changing landscape of the local health and social economy.

Whilst we found no breaches of regulations, the provider should:

• Continue to embed new systems and processes in relation to the monitoring of patients on high risk medicines.
• Continue to monitor the process for receiving all safety alerts.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice