Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingskerswell and Ipplepen Medical Practice (Kingskerswell Health centre), Devon on Wednesday 13 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. The practice carried out a thorough analysis of the significant events and arranged for their learning to be shared with other practices and the NHS England quality and safety team. Learning from other practices was also shared with practice staff using the significant event audit learning sharing document.

• Risks to patients were assessed and well managed.
• The practice promoted the SAM (Sepsis Assessment and Management) guidelines giving a checklist and traffic light approach for parents to monitor their children during illness and reinforce their knowledge of when to call for advice from health care staff in the practice or in the hospital.

• There were appropriate arrangements for the efficient management of medicines.

• 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.
• Staff held roles within the wider community. For example; one of the GPs was the clinical lead for patient safety and quality for South Devon and Torbay CCG. The IT lead had been appointed by the CCG as their SystmOne, patient record system, Champion.

• Data from Public Health England showed the practice had a higher incidence of patients with long term conditions and dementia. We saw evidence to show that despite this the practice was consistently rated as one of the top practices locally and nationally. For example,Quality and Outcomes Framework (QOF) scores, GP national patient survey, ratings on NHS choices, local surveys, friends and family test results, dispensing service quality scheme and CCG monitoring.

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

• The staff often went above and beyond their normal roles to impact on patients within the wider community. For example, one of the GPs had helped set up and volunteered at the local memory café and two others had undertaken a bicycle ride to raise charitable funds for a local hospice which patients benefitted from accessing where their health needs dictated.

• The practice worked jointly with the Teignbridge homeless charity giving out food parcels.

• Relationships with patients was highly valued by all staff and promoted by leaders. We were given examples where staff had worked effectively to build and maintain relationships. For example, patients of a newborn child were sent a letter of congratulations.

• 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 further developed the complaints process by seeking an independent GP to review patient care following complaints and complete an independent report. The report confirmed effective complaints management and patient care.
• 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.

• The practice had a proactive system for identifying carers lead. The practice had identified 4.9% of the practice population as carers. The ongoing support included links to local services and referral to the Devon Carers Network.

• There were failsafe systems in place to ensure patients were offered screening. This had resulted in rates for cervical and bowel cancer screening being higher than CCG and national averages.

• There were good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice was organised and had effective governance structures in place.
• 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.

We saw a number of areas of outstanding practice. These included:

The practice had standardised their use of the computer system (SystmOne) through the development of templates which included care plans, patient leaflets, preferences, protocols, prompts and alerts to improve patient safety and care. For example, the IT lead had developed a frailty template, for use as part of a local frailty project, which had a very positive impact on the practices in the project, by improving the processes and working through a series of prompts to ensure all relevant data is recorded. This template in some instances has been shared nationally as a result of direct requests from other practices. This had resulted in the member of staff receiving a SystmOne (practice computer system) Champion of the Year award (usually given to GPs), primarily for their work in leading a group of nine SystmOne GP practices sharing learning and developing the very best use of the computer system in support of patient care.

Leaders have an inspiring shared purpose and strive to deliver and motivate staff to succeed. The GPs and leadership team had invested in their staff over a long period of time. This had led to a happy, loyal workforce with low staff turnover. Staff were supported both financially and with protected time to develop both personally and professionally in addition to the required updates. For example; the practice manager had started at the practice as a sixth form school leaver. They had started in the administration team and was sponsored to obtain a dispensary qualification, followed by a national vocational qualification (NVQ) in business and administration and level 4 management NVQ. The practice then funded her foundation degree in Management and Leadership prior to promoting her to practice manager. Two additional staff had been supported to obtain NVQ’s in management. One of the practice nurses had been funded to do a prescribing course. Another practice nurse had been funded and supported to do a nursing degree and prescribing qualification. Other staff had been sponsored to become health care assistants and dispensers. Existing partners had worked at the practice as GP trainees. Ex members of staff had been encouraged to develop and pursue promotion and roles outside of the practice. For example, one of the partners now worked for the CCG as chief executive officer. Present staff were also supported to have roles within the wider community. For example, one of the GPs was the Clinical Lead for Patient safety and quality for the local CCG and the IT lead had been appointed by the CCG as their SystmOne Champion, working closely with the chief clinical information officer.

The continuing development of staff skills, roles, competence and knowledge was recognised as integral to ensuring high-quality care. Staff were encouraged to attend advanced training, develop systems, lead pilots and suggest ideas to ensure high quality care and achievement. For example, we saw examples of detailed, multi-layered systems and structures which had good outcomes for patients. These systems were detailed and monitored to ensure the information was effective and in the best interest of patients. For example, including an independent review in the complaints process, development of a quality significant event reporting system, sharing the developed templates and processes with the CCG and promoting the SAM (Sepsis Assessment and Management) guidelines resulting in earlier referrals to paediatrics. Systems, audits and processes were performed with a high level of detail resulting in positive impact for patients and cost savings to the practice and CCG.

There were failsafe systems in place to ensure patients were offered screening and results were followed up as appropriate. As a result, cervical and bowel cancer screening rates were higher than the clinical commissioning group (CCG) and national averages

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice