Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hannage Brook Medical Centre on 16 November 2016. Overall the practice is rated as outstanding.

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

• There was an open and transparent approach to safety and a system in place for managing significant events. Opportunities to learn from internal and external safety events were maximised and used to drive improvement.
• The practice had clearly defined and embedded systems to keep patients safe and safeguarded from abuse.
• Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.
• Staff were aware of current evidence based guidance and clinical audits demonstrated quality improvement.

• The practice took a holistic approach to assessing, planning and delivering care and treatment to meet patient’s needs. Staff worked collaboratively to understand and meet the range and complexity of people’s needs.

• The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care.

• We observed a strong patient-centred culture and feedback from patients about their care was consistently positive. Patients said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• The national GP patient survey results showed patients rated the practice higher than others for all aspects of care including interactions with staff and access to the service.
• Patients found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice worked closely with other organisations and with the local community in planning and delivering services that met patients’ needs.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• There was 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 and discussed with staff.

We saw several areas of outstanding practice including:

The whole team was engaged in reviewing and improving safety and safeguarding systems. Learning was shared widely with other health and social care professionals. For example:

• Following an unexpected death, one of the GP partners had facilitated a clinical commissioning group (CCG) event which was attended by a wide range of professionals including GPs, school nursing staff and social care workers from the multi-agency team. The event was attended by 86 people and focused on strengthening the arrangements in place for working with young people using drugs, and clinicians being aware of the safeguarding thresholds and early referral pathways. The GP had also facilitated a question and answer session on drug misuse on two occasions at a local secondary school to promote awareness of the risks and services available for the young people to access. The sessions were delivered to year 11 and 12 students with 25 pupils in each group.

• The practice was consistent in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health; with support from the patient participation group (PPG). For example, the practice had supported patients in setting up self-help groups for people with a diagnosis of atrial fibrillation and diabetes with patient education being a focus area at the regular meetings. The PPG has also been running an informal self-help group [Wirksworth in support of health (WISH)] for people experiencing poor mental health including depression and anxiety since October 2015. Benefits to patient care included emotional support, reduced isolation and befriending. In addition, the Quality Outcomes Framework data for atrial fibrillation, diabetes, mental health and depression were above local and national averages indicating positive clinical outcomes were also achieved for patients.

• The practice and PPG had organised a men’s health event as part of a health promotion campaign. About 120 people attended the event which was held at the local cricket club. The practice had audited the number of appointments requested by men prior to and after the event. The results showed the number of appointments had increased by 2.5% and some men had booked appointments specifically to discuss health issues such as erectile dysfunction.

• Benchmarking data showed the practice’s rate for emergency admissions and accident and emergency (A&E) attendances were significantly below the local and national averages. Contributory factors included good access to clinicians, effective systems in place for care planning and a strong emphasis on multi-disciplinary working to improve patient outcomes. In addition, the national GP patient survey results showed the practice performed above local and national averages in all areas relating to accessing the service and availability of GP appointments. For example, 86% of patients described their experience of making an appointment as good compared with the CCG average of 72% and the national average of 73%. Patient feedback was also overwhelmingly positive about the ease of making an appointment at a time that was convenient for them.

The areas where the provider should make improvement are:

• Consider ways to increase the uptake rate of the meningitis C and pneumococcal conjugate vaccine (PCV) booster in children aged two years and under.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice