Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leyburn Medical Practice on 4 October 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.
• Risks to patients were assessed and well managed.
• The practice had recognised the challenges that they faced with regard to the rurality of the practice and had provided services closer to home.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• 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. Diabetes management was highly regarded by the practice and there were high levels of symptom control and low levels of hospital admissions. The practice participated in insulin initiation.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 good facilities and was well equipped to treat patients and meet their needs. There was a minor injuries service supported by a community Paramedic Practitioner as the nearest accident and emergency service was 18 miles away.

• The practice provided a dermatology service. They had invested in a dermoscope and one of the GPs had undertaken extra training.

• There was a clear leadership structure and staff felt supported by the management team. 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 several areas of outstanding practice:

The leadership in the practice drove continuous improvement and staff were motivated and accountable for delivering change. Safe innovation and learning was celebrated. There was a clear proactive approach to seeking out and embedding new ways of providing care and treatment. The practice had introduced a bonus scheme to incentivise and reward staff and recognise effective care.

The practice demonstrated innovative improvement and practice within a rural area which they shared this with other organisations. The practice had a Paramedic Practitioner; we were told that this was the first example of this service in the country due to the locality of the practice.

The practice had taken over the governance of another local practice that needed support and were transferring learning and leadership skills.

The practice had worked closely with the district nursing team and hospital to develop a leg ulcer protocol and with the hospital to develop a deep vein thrombosis care (DVT) protocol. These had been adopted in the local area and provided this care closer to home with a smooth and patient centred process. The practice also provided an ultrasound service and a vasectomy service. This was economically beneficial to the local health economy as well as offering a convenient service to patients from the local community.

The practice had devised and implemented pre-appointment questionnaires that were sent out to patients suffering from asthma and coronary heart disease as they had recognised that there was a high proportion of these patients who did not attend for reviews. This system allowed the practice to reach out to these patients, be updated on their condition and to detect and call in those who needed additional treatment. They were able to demonstrate a year on year increase in asthma reviews.

The areas where the provider should make improve are:

Ensure that systems are in place to monitor prescriptions through the practice in line with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Leyburn Medical Practice on 14 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.