Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

The practice had been previously inspected on 22 September 2015 when it was rated as Good overall, with one domain being rated Requires Improvement for the provision of responsive services.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Lupset Health Centre on 15 November 2017. The inspection was carried out as part of our inspection programme and was also used to follow up areas where at the time of the last inspection, on 22 September 2015, the provider was informed they should take action to improve some areas in respect of the provision of responsive services. This included improving access to the practice for patients with a disability, improving the ease of patients contacting the practice by telephone, and the need to provide patients with access to information about how to make a complaint. We noted at the 15 November 2017 inspection that the practice had taken action to improve these service areas.

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.

• A number of higher level services were provided within the practice which would otherwise be usually delivered in secondary care settings.

• The practice showed better than average performance in relation to the prescribing of antibiotic items.

• The practice offered home visits from 9am, which supported provision of earlier interventions, and prevented deterioration and possible admission to secondary care services. Urgent care was also prioritised with appointments being available for these patients on the day of presentation.

• Staff discussed treatment options with patients, and we were told by carers and patients that they were treated with compassion, kindness, dignity and respect by all the staff in the practice.

• The practice provided services to patients who were assessed as being potentially violent and had been excluded from mainstream GP services.

• Public engagement was positive and active. The practice sought patient feedback via a number of routes, such as carrying out individual surveys and engagement with the established Patient Participation Group. The practice was responsive to patient feedback and had implemented improvements to the practice telephone system in light of previous low patient satisfaction.

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

We saw two areas of outstanding practice:

• The practice recognised there was high local patient demand for mental health services (including those for dementia). In response to this it had employed a mental health nurse and delivered a number of dedicated services to meet these needs.

• The practice provided services to patients who had been assessed as being potentially violent, and had therefore been excluded from accessing services provided by their own GP practice. As well as having delivered care to these patients, over time Lupset Health Centre had supported a significant number to return to other mainstream GP services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lupset Health Centre on 22 September 2015. Overall the practice is rated as good.

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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 although complaints information was not openly visible in the practice.
• Urgent appointments were available the same day and early morning and late evening appointments were also available. Although the practice had recognised that patients were dissatisfied with access to the practice by telephone and to appointments with GPs of their choice and had made changes, these changes had achieved a limited impact on patient satisfaction.
• The practice had good facilities and was well equipped to treat patients and meet their needs. However, these were not always used effectively to support patients with a disability.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• There was an active patient participation group.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• Performance for mental health related indicators was 100% with a 6.2% exception rate, well above the CCG and national average of 94.2% and 90.4%. The practice had employed a mental health nurse as part of an external funding arrangement due to the high prevalence of mental health problems experienced by their patient group. This had been so successful the practice had continued the nurse’s employment when the funding had ended. This service ensured patients received timely care and support at the practice, reducing the need for referrals to secondary care services. The mental health nurse held hour-long appointments once a week for patients living with dementia and their carers. The nurse had developed their consulting room to ensure a comfortable and welcoming space for patients.

The areas where the provider should make improvement are:

• Ensure disabled patients are able to use the facilities provided such as the lowered reception desk and the electronic check in system.
• Improve access for patients in wheelchairs and pushchairs through the reception doors.
• Improve access to the practice by telephone.
• Ensure patients can easily access complaints information in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice