Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Larwood Surgery on 26 and 27 July 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice was proactive in developing templates and protocols to assist in implementing best practice guidelines and they shared these with other practices.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice was leading on a pilot for a “primary care home” model of multidisciplinary care.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, they had changed the telephone access system in response to the outcomes of the National GP patient survey.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they a

  were managed and responded to, and made improvements as a result.

• The practice had 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. The practice had been awarded the Royal College of General Practitioners (RCGP) quality practice award in 2012.

We saw several areas of outstanding practice including:

• The practice had excellent systems to ensure learning from significant events was shared with the whole practice team and staff were involved in the analysis of significant events. For example, records showed significant events were discussed at meetings across the practice and this included a multidisciplinary meeting. A six monthly significant event newsletter was provided to all staff with a detailed list of the significant events and the action taken. An annual significant event meeting involving all staff was held. This involved staff taking part in mixed staff team workshops to analyse a number of significant events and review the actions taken to assess if any improvements in the process were required. Staff told us they found these meetings an excellent environment for learning and they felt involved in the in improvements to the service.

• There were excellent systems in place for sharing information about safeguarding concerns and identifying children at risk. These included early intervention multidisciplinary safeguarding meetings called “Think Family”. The practice had led on the pilot for these meetings and the format and principles had been rolled out to other practices in the Bassetlaw CCG area and shared with the wider community. The practice had also developed templates for assessing patients requesting contraception. These templates assisted staff to identify child sexual exploitation and to assess the patients competency to make decisions.

• A programme of continuous clinical and internal audit was used to monitor quality and to make improvements. The practice had a detailed programme of clinical audit which included auditing some areas annually to ensure continued improvement in areas such as prescribing practice and they had made significant savings in this area. They took account of and monitored good practice developments through their extensive audit systems, developing templates and protocols to support and improve practice. The practice shared this learning and their developments with local practices.

• The practice had excellent systems to manage staff training ensuring staff completed the required training. The practice had supported staff to obtain a wide range of clinical and management qualifications relevant to their role. 

• The Bassetlaw District General Hospital was situated very close to the main site Larwood Surgery (5 minutes’ walk) and the practice had identified this as a cause for their patients high attendance figures at the accident and emergency (A and E) department. In response to this, the practice had developed an urgent care walk in service at the main site in 2010. This service was popular with patients and 20 - 24,000 patients had been seen annually since implementation. Records showed patient A and E attendance had steadily reduced (despite the practice list size increasing). A patient survey showed the majority of patients rated the service as very good or excellent and 50% of the patients said they would use this service rather than go to A and E. Data showed the patients waiting times at the service were usually below 15 minutes and we observed patients were seen promptly. Patients told us they liked the service because they knew they could be seen the same day. Due to the success of the service this model had been extended to one of the other practice sites in 2013.

• Care was provided by integrating the primary, secondary and social care workforces. Larwood and Bawtry was one of the fifteen test sites across England to have been chosen to develop and test a new enhanced primary care approach. The provider Larwood and Village Surgeries were part of the multidisciplinary team leading this project. The pilots had a combined focus on the personalisation of care and providing better coordinated care that is closer to home. Almost 70 networks of GPs, health and social care staff had submitted expressions of interest to be the first sites for the development of this model outlining their innovative ideas for transforming local health and community services. The successful 15 sites were chosen following a rigorous process, involving key health and social care partners, patient representatives and an evaluation workshop attended by all shortlisted applicants.

There were areas of practice where the provider should make improvements:

• Review the security and storage arrangements for the vaccines held in the fridge at Lakeside surgery.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice