Letter from the Chief Inspector of General Practice

We inspected this service on 9 April 2015 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found the practice to be good for providing safe, effective, caring, responsive and well-led services. The practice was good for providing services for older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All opportunities for learning from incidents were maximised.

• Risks to patients were assessed and well managed.

• Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand.

• Patients said that there was continuity of care, with urgent appointments available the same day although routine appointments were not always easy to book. However, the practice had made some changes to try and improve access.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice had an open culture that was effective and encouraged staff to share their views through staff meetings and significant event meetings.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. For example, the practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients and from the Patient Participation Group (PPG).

We saw several areas of outstanding practice including:

• The practice had regularly produced a poster for patients in an easy to read format and user-friendly way with pictures and statistics. The information it gave patients included things such as: the amount of patients who had failed to arrive for an appointment together with the cost; the number of patients attending A & E; number of complaints received by the practice and the number of safety audits the practice had completed. Feedback from patients was consistently positive. It had helped to foster a more open relationship with patients as they now had a better understanding of how things were prioritised and the impact patients had on the practice.

• The practice had been awarded the Lesbian & Gay Foundation GOLD Pride in Practice award for delivering fully inclusive healthcare services to their patients. The practice had been required to meet strict criteria to be awarded the highest “Gold” level award. A number of changes at the practice had taken place to achieve this such as forging strong links with relevant support services to increase access and modifying the new patient questionnaire to capture data on sexuality. This resulted in doctors being aware when they saw patients and allowing targeted signposting to services where appropriate.

• The practice had previously reached out to patients at risk of falls by holding an event on falls prevention. The practice had now built on this area of interest and was collaborating with Warwick University on a falls research project for older people. Appropriate patients had been offered a one hour face-to-face assessment by nurses at the practice who had undergone further training. Patients had then been referred to either community physiotherapy, occupational health or to the GP as required. The project had allowed patients to become more educated about falls prevention and had been offered early interventions where relevant. A review of the collaboration project around the impact achieved had been scheduled for March 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Outstanding overall. At the previous inspection in September 2015 the practice were rated as good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Good

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Hobs Moat Medical Centre on 15 January 2019 as part of our inspection programme.

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 concluded that:

• Patients were able to access care and treatment in a timely way.
• Quality Outcomes Framework data was generally in line, or above, local and national averages. Exception reporting data was generally lower than both the CCG and England averages in indicators such as long term conditions.
• Staff we spoke with were positive about working at the practice and the leadership and management team.
• We found several areas of continuous improvement and innovation undertaken by the practice and found the practice were always willing to participate in pilot studies and trials.
• The practice assessed and responded to the needs of their population groups.
• Patients with spoke with and the Patient Reference Group were positive about the practice, the services offered and the care and treatment delivered at the practice.

We rated the practice as good for providing safe, effective and responsive services.

We rated the practice as outstanding for providing caring services because:

• Patient satisfaction through the National GP Patient Survey was higher than both the CCG and England averages across all indicators relating to caring.
• Patient feedback through comment cards, reviews on NHS Choices and patient consultations on the day of the inspection were very positive about the caring nature of the practice.
• The practice completed a number of patient surveys, in partnership with their Patient Reference Group, to understand their patient population and work to find new initiatives and innovations to meet those patient needs.
• The practice had proactively identified and supported 485 carers, approximately 4.4% of the practice population. Patients identified as carers were eligible for a number of enhanced services such as tailored flu vaccination invitations, a carer’s support advisor held a monthly clinic at the practice and there was literature in the practice waiting room of local support groups and networks.

We rated the practice as outstanding for providing well-led services because:

• The practice demonstrated a strong leadership team with clear roles, responsibilities, lead areas and values. Staff we spoke with commented on how the strong leadership team provided clear direction and guidance and impacted on a positive working environment.
• The practice worked proactively with the Patient Reference Group (PRG) to undertake a number of surveys and responded to patient need with a number of innovative services.
• The practice had a strong culture of learning and development and encouraged staff to undertake further learning and training to increase the skill mix within the practice and provide enhanced services to patients.
• The practice leadership team continually assessed and responded to patients’ needs within their population group. For example, the practice improved staff awareness and response in relation to suicide awareness and prevention following a higher than normal prevalence. In addition to this, the practice had purchased software for their website which enabled visually impaired patients to listen to the text and information on the website.
• The practice worked to achieve a number of accreditations such as; Military Veteran Aware Accreditation, autism friendly, dementia friendly and Lesbian & Gay Foundation GOLD Pride in Practice to improve the quality of care for patients.

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