Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hope Citadel Healthcare Community Interest Company on 5 April 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.
• 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 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and patients who had difficulties understanding were encouraged to complain verbally and were supported in the process.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• All staff employed by the practice had received a disclosure and barring check (DBS check). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place , was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Locally the practice is known as Middleton Health Centre and is part of a larger not for profit organisation called Hope Citadel Healthcare.

We saw several areas of outstanding practice including:

• The practice had increased the flexibility and length of its appointments to 13 minutes instead of 10 and could demonstrate the impact of this by reduced use of the accident and emergency services and positive results from clinical audits.
• The practice had a good skill mix of staff which included a nurse prescriber, counsellors and focussed care workers who organised a wide variety of health and social care related support in order to manage and improve the health and lives of patients in need of this. They were able to demonstrate the positive impact for this group of patients. For example some patients asked to speak to us and told us of their different personal experiences of how the practice had made a positive difference to their lives. These examples resulted in a reduction of inappropriate attendance at other services such as accident and emergency. We also saw evidence, through audit, of households becoming substance free and 65% of patients had better compliance with their medication.
• The focussed care team organised social activities such as weekly coffee mornings and craft classes for female patients, open days and boogie babies. They did this to build relationships with the patient population, reduce social isolation, help patients learn new skills whilst keeping informal contact with the practice and reduce inappropriate attendance at other acute services such as walk in centres or accident and emergency departments. Audit showed that families accessing focussed care presented 57% less often in the year following the support provided.
• All staff undertook 360 degree feedback and appraisals that identified learning needs from which action plans were documented. Our interviews with staff confirmed that the practice was proactive in providing training and funding for relevant courses to enhance individual development and skills for the benefit of patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice