We carried out an announced comprehensive inspection at Hickings Lane Medical Centre on 25 July 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 an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning were maximised.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. There was a very supportive approach to staff development to ensure they had appropriate skills and experience. The practice used clinical audit to improve patient care and drive quality improvement within the practice.

• The practice participated in the structured apprentice programme for young adults aspiring to work in primary care.

• The practice had systems in place to seek consent to summary care records from patients reaching their sixteenth birthday.

• The practice worked effectively with the wider multi-disciplinary team to plan and deliver integrated care that was responsive to the needs of patients.
• The practice used proactive methods to improve patient outcomes, working with other local providers to share best practice. This included teledermatology and tele-consultations with hospital consultants.
• The practice proactively reached out to the community and worked constructively with other organisations to promote patient education and a healthy lifestyle.
• Feedback from stakeholders and patients about their care, and interactions with all practice staff, was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice offered extended opening hours between 7.30am and 7pm Monday to Friday, with the exception of Thursday when the practice closed at 6.30pm. Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed with stakeholders and discussed with staff.
• There was a strong and proactive leadership structure within the practice, and staff felt well-supported by management.
• The leadership drove continuous learning and improvement at all levels, and staff were accountable for delivering change.

We saw several areas of outstanding practice:

The emotional and social needs for children and young people were seen as important as their physical needs. For example:

• As part of a community project, one of the GP partners had worked with local organisations, young people and children to promote anti-bullying. This included a theatrical production aimed to empower young people to explore anti-bullying issues and seek support when needed.

• The practice team championed the delivery of good quality care and a flexible service to young people residing in secure children’s home. Ofsted had positively recognised the input of the GPs and practice nurses (and other agencies) in the support provided to the children.

• The practice offered a range of extra services which provided care closer to patients' homes and reduced referrals and / or burden on hospital services. For example, ultrasound scanning for orthopaedic, musculosketal and dermatology conditions and detection of breech presentations in pregnant women. In addition, the daily extended hours enabled improved access to services for patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice