Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Limes Medical Centre on 21 March and 21 April 2016. The routine inspection was over two days to include a GP specialist advisor. Overall the practice is rated as good.

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

Feedback generally from patients was consistently positive about the care and services they received. The majority of patients said that they were treated with compassion, dignity and respect at all times, and were involved in decisions about their care and treatment.

Patients told us they were able to access care and treatment when they needed it, and most people said that they could access appointments or telephone consultations in a way, and at a time that suited them.

Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. People’s needs were central to the planning and delivery of services. The practice worked in partnership with other services to meet patients’ needs, and used innovative ways to improve outcomes for patients.

There was a proactive and innovative approach to seeking out and embedding new ways of working to ensure the services were effective.

The practice team was forward thinking and took part in national and local projects to develop the services. They had led a project, which enabled the practice to offer extended surgery hours on Saturday and Sunday.

The practice were also part of a national project designed to bring clinical pharmacists into the general practice workforce. The new way of working will help improve health outcomes for patients and workload pressures, to enable the GPs to focus their skills where they are most needed.

Comprehensive systems were generally in place to keep patients safe. Information about safety was used to promote learning and improvement, although r

ecords kept of safety alerts did not always show that all relevant issues had been actioned.

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

Staff had the skills, knowledge and experience to deliver effective care and treatment.

The culture and leadership promoted the delivery of high-quality, compassionate care. The practice had a highly motivated and cohesive staff team to enable them to deliver well-led services.

The commitment to learning and the development of staffs’ skills was recognised as essential to ensuring high quality care. The Limes Medical Centre was an established teaching practice and had an active role in training medical students and GP registrars.

A third GP had become a trainer to enable the practice to further expand their teaching role.

The practice sought the views of patients and staff, which it acted on to improve the services. Complaints were effectively managed and reviewed to ensure that appropriate learning and improvements had taken place.

We saw several areas of outstanding practice:

• The practice had a high number of patients with learning disabilities and had initiated and led various projects with involvement of other agencies, to improve care, inequalities and access to services for patients. This included a programme to improve the uptake of cancer screening, by ensuring patients were not excluded inappropriately. This had led to increased use of capacity and best interest assessments for patients, and improved access to screening. For example, 53% of eligible patients had attended breast screening, of which 67% had a capacity and best interest assessment completed (compared to the local screening rate of 43.5% and assessment rate of 48%). The programme had also led to improvements countywide.

• The practice also had a lead role in developing care pathways, templates and information for people with learning disabilities, including an annual health check

  with involvement of the learning disability team

  . T

  hese were available in picture and easy to read form that patients could understand. Various templates and information had been adopted for use by the CCG and countywide as good practice.

• The CCG had a higher prevalence of patients with asthma. To improve access and enable patients to see a health professional that best meets their needs, the practice had led an initiative with involvement of local pharmacies, to co-ordinate reviews and improve outcomes for patients with asthma. Local pharmacists carried out an annual review of patients who were well controlled. In the first 12 months of the project this had freed up 120 appointments, to enable the GPs to focus their skills where they are most needed, including patients whose asthma was poorly controlled.

The provider should make the following improvement:

• Monitor the system for recording and acting on safety alerts to ensure all relevant issues have been actioned to mitigate risks to patients.

​Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice