This practice is rated as outstanding overall. (Previous rating March 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at Lion Health on 2 July 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access same day care when they needed it. However, patient feedback on telephone access was generally negative.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The practice had a dedicated advanced nurse practitioner (ANP) for patients in care homes and acutely unwell patients.

• The practice had adopted an ‘assertive outreach’ strategy to improve the uptake of long-term condition clinics. This involved proactively reaching out to patients based on clinical need; for example, online monitoring for working age people.

• When patients were assessed to be at risk of suicide or self-harm the practice had arrangements in place to help them to remain safe. The practice took a proactive approach to reduce suicide cases by holding an educational event with an external speaker and had internally reviewed cases to identify any learning.

• There was an extensive programme of governance meetings that included all staff and extended to a wide range of healthcare professionals. The programme of multidisciplinary team meetings (MDT) included dedicated time set aside from the main MDT meeting to discuss and review the care and treatment for palliative patients, patients with poor mental health and patients with respiratory conditions. As an example of good practice, the local CCG shared learning from this practice model with other practices within the CCG and had been used as a demonstrator site for other CCGs.

• The practice had developed their approach for managing patients with long-term conditions with the introduction of a dedicated administrative team and a patient centred approach to improving attendances for reviews. The non-attendance rate and the average attendance rate had both halved since 2016 and 80% of patients with a long-term condition had all components reviewed at one appointment. The percentage of patients on each long-term register who had received at least annual reviews was consistently high. The practice had written their own protocols for long-term condition management that provided comprehensive and effective treatment and care.

The areas where the provider should make improvements are:

• Ensure that the new telephone system improves access for patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Letter from the Chief Inspector of General Practice

Lion Health has a practice population of approximately 24700 patients within the Dudley area.

We carried out a comprehensive inspection on 14 January 2015.

We have rated each section of our findings for each key area. The practice provided a safe, effective, caring, responsive and well led service for the population it served. The overall rating was good and this was because the practice staff consistently provided good standards of care for patients.

Our key findings were as follows:

• Practice staff worked together as a team to ensure patients received the standards of care they needed.

• There were safe systems in place for ensuring patients received appropriate treatments and prescribed medicines were regularly reviewed to check they were still needed.

• Patients were protected against the unnecessary risks of infections because staff adhered to appropriate hygiene practices and regular checks were carried out.

• The practice was able to demonstrate a good track record for safety. Effective systems were in place for reporting safety incidents. Untoward incidents were investigated and where possible improvements made to prevent similar occurrences.

• Patients were treated with respect and their privacy was maintained. Patients informed us they were very satisfied with the care they received. The feedback we received from patients was without exception positive.

We saw several areas of outstanding practice including:

• The main role of an advanced nurse practitioner is the provision of care for older people including those aged 75+ years. Home visits are also carried out to ensure care for older people meets their needs.

• The main role of a mental health advanced nurse practitioner is the provision of care for patients with mental health illnesses. Home visits are also carried out. This service helps in provision of effective care and preventing escalation of patient’s mental health conditions.

• Practice staff have introduced a system for patients with hypertension where they email their blood pressure recordings to the practice. Recording equipment is supplied by the practice. Staff responds accordingly by email and provide advice so that patients receive appropriate and timely care.

• For patients above a specific weight clinical staff offer them a nutrition and exercise course to promote healthy lifestyles. The practice website gave guidance about various ways of healthy living including diet, exercises and promotion of women’s health.

• Clinical staff visited two local schools and provided pupils with advice about sexual health and contraception.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice