Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heathgate Medical Practice on 11 January 2017. 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 the practice had systems in place for reporting and recording significant events. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients who used services were assessed and well managed.
• The practice was proactive and responsive to patients’ needs.
• Patient safety alerts were logged, shared and initial searches were completed and the changes effected.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice had undertaken 411 NHS health checks last year.
• Results from the national GP patient survey showed patients responded positively to all questions in the survey. All results were above the local and national averages. For example; 95% of patients said they could get through easily to the practice by phone compared to the CCG average of 70% and the national average of 73%.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice gathered feedback from patients and it had a very engaged and proactive patient reference group (PRG), who liaised closely with staff and influenced practice development. Changes were made to the way it delivered services as a consequence of feedback from patients and the PRG.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs. For example; the practice had a room available which included a baby weighing facility for parents to use.
• There was a clear strong leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make an improvement was:

• Develop a system to proactively identify carers.

We saw areas of outstanding practice including:

• The practice had encouraged the Clinical Commissioning group (CCG) to look at commissioning a local enhanced service with Practices across the CCG to engage in the monitoring of patients with eating disorders, based on monitoring submitted by the practice. A new local enhanced service was commissioned and two partners at the practice formalised a practice protocol for the process. The adoption of the monitoring principles were outlined in a guide prepared by Kings College London.
• The practice offered an “options” letter and questionnaire for patients due an asthma review. The letter gave four options of how to book their review and ensured patients were involved and included in decisions about their care. All responses were overseen by the respiratory lead.
• The practice used a “passport to health” which gave patients information and reminders of ongoing and new conditions and what treatments or regular tests were needed.
• The practice created a pull up banner to promote ‘lost clinical time’ due to patients who did not attend for clinical appointments in the practice. We saw evidence of the Norfolk CCG’s support campaigns which followed and the practice’s banner and poster designs were made available to other practices within the CCGs. The banner included lost hours and appointment data for the practice each month. The practice provided data which showed the amount of patients who had missed an appointment each month, excluding the flu vaccination clinics, had declined immediately following the campaign.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice