Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lovemead Group Practice on 5 May 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. The practice had introduced the role of a patient liaison officer to support the practice’s vulnerable patients in admission avoidance. The role involved liaising with the community team and care coordinator and other service providers to ensure care packages were in place for these patients and also for patients post discharge from hospital. It also provided a single point of contact within the practice for patients and their relatives.
• 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. The practice had developed plans for an emergency care practitioner (ECP) role. The practice then worked with other local practices, to secure funding from the clinical commissioning group through the Transferring Care of Older People scheme to employ an ECP. The ECP worked across all local practices, visited acutely ill elderly patients promptly to prevent hospital admissions and identified and assessed elderly frail patients at risk of hospital admission.
• 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, the practice had purchased raised chairs and a perch stool for the waiting room to make it easier for patients with mobility problems.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result. An annual audit of complaints was undertaken to identify any trends.
• 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.

We saw several areas of outstanding practice including:

• The practice ran a young person’s sexual health clinic called “No Worries”. The young person did not need to be registered with the practice to be able to be seen within this scheme. A young person with a sexual health need would always be seen on the same day. The proactive engagement of the practice with this service had contributed to the overall teenage pregnancy rate for the Trowbridge area being reduced by 50% since the service began 10 years ago.
• Patients who were carers were fully supported by the practice. Regular meetings were held at the practice for carers and attended by other support agencies. The practice was flexible with appointment scheduling. Carers were given a password to quote when calling for an appointment which alerted receptionists to the need to accommodate carers as a priority. Carers were invited for twice yearly health checks which included a clinical health check and a wellbeing health check with a member of Wiltshire carer support.
• A GP within the practice, who had a special interest in dermatology (skin conditions) and had undergone additional training, ran a dermatology clinic within the practice. The successful decrease in dermatology referrals to secondary care and patient satisfaction with the service has led to a successful application for future funding of the clinic by NHS England from April 2016. A second GP had recently undertaken additional training in order to accommodate the expansion of the service and triaging all secondary care referrals. The practice has plans for further expansion, enabling other practices in the area to refer their patients into the service.
• The practice had been awarded the Primary Care respiratory award by the Primary Care Respiratory Society, a national organisation, as a result of high quality care and the good practices it delivered to respiratory patients.
• The practice had been accredited with a gold award by Wiltshire Public Health for its achievements in their stop smoking targets. The latest results demonstrated that the practice was highest in the percentage of patients who had stopped smoking, for the whole of Wiltshire with a stop smoking rate of 82%.
• There was a truly holistic approach to assessing, planning and delivering care and treatment to patients who used the service. The nurses who managed patients with chronic diseases, worked with a patients’ emotional wellbeing initially in order to engage patients in being proactive and motivated to manage their own conditions before discussing problem solving with the patient. This had led to good outcomes for patients. For example, a patient on medicines to treat high blood pressure had not engaged with the benefits of lifestyle changes. The nurse applied this model of care and within a year the patient had lost weight, stopped smoking and was taking exercise which had led to the patient no longer requiring medicines to maintain blood pressure within normal limits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice