Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northbrook Group Practice on 28 April 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing effective and responsive services and good for providing safe, caring and well led services. It was also outstanding for providing services for people with long term conditions and those experiencing poor mental health and good for providing services for families, children and young people,  working age people, older people and people in vulnerable groups.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s 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 (PPG).
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.
• The practice had robust systems for the safe management of controlled medicines which included recording of safe receipt and disposal.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• 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.

We saw several areas of outstanding practice :

• The practice had conducted an education event regarding diabetes for members of the practice population. This included a consultant diabetologist as a guest speaker and representation from other specialists linked to diabetes such as a dietician, ophthalmology, podiatry and representatives from Diabetes UK. Approximately 200 people attended this event and feedback received was positive. Following this event, the practice reviewed and reorganised their diabetic clinics to further improve services provided.

• The practice had a health trainer to support weight management, alcohol reduction and smoking cessation and could demonstrate this had a positive impact for patients using this service.
• Letters were sent in large format to those patients who had recorded sight problems. 
• Opportunistic screening was undertaken for dementia during flu clinics and during routine screening of patients assessed with a long term condition.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northbrook Group Practice on 20 November 2018 as part of our inspection programme. At the previous inspection in April 2015 the practice was rated as outstanding overall and specifically in effective and responsive. Features included:

• A diabetes education event where guest speakers included a consultant diabetologist and there was representation from other specialists linked to diabetes such as a dietician, an ophthalmologist podiatry and representatives from Diabetes UK. Positive feedback was received form the 200 patients who attended and as a result the practice reviewed and organised diabetes clinics to improve services to patients.
• The practice health trainer supported weight management, alcohol reduction and smoking cessation and could demonstrate positive impacts for patients.
• Patients recorded as having sight impairment were sent information in large print.
• Opportunistic dementia screening was carried out during flu clinics and long term condition reviews.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as outstanding overall.

We rated the practice as outstanding for providing responsive services because:

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
• There were innovative approaches to providing integrated person-centred care.
• The practice had identified areas where there were gaps in provision locally and had taken steps to address them.

We rated the practice as outstanding for providing well-led services because:

• The culture of the practice and the way it was led and managed drove the delivery and improvement of high-quality, person-centred care.

We have rated the population groups as good with the exception of the older people, families, children and young people population groups which we have rated as outstanding.

• The practice held seasonal patient wellbeing promotions including winter wellness and stay well, stay safe events held at the practice. The winter wellness events included music and singalong for attendees and care hampers were given to patients which contained a blanket, a first aid kit, thermometer and treats. Due to the high uptake, two sessions were held on the same day. Those invited included 50 patients and their carers, some of whom were socially isolated including those recently bereaved and those who were part of the poly-pharmacy scheme.
• An event was organised for older patients to attend the practice to learn how to use mobile devices to access online services. The practice saw an uptake of all 35 patients who attended this event and were continuing to use the online facility.
• The practice held a ‘Nasal Flu Party’ hosted by the practice mascot a large green and white newt, to improve uptake in two and three year olds.
• All patients attending were treated to refreshments, helium balloons and balloon animals. They also created bravery certificates for the children to colour in and handed out stickers.
• Feedback received from parents was very positive and comments included it was easier to bring their child for a nasal spray on a Saturday and the flu party was not only a positive experience but a less stressful one for both parent and child.
• Uptake for nasal flu improved from a total of 173 given in the previous year compared to 279 up to December 2018 with 52 declined either due to parents not consenting or children already given at school for those in at risk groups.
• A mother and baby education event had been held at the practice and included life support training and promoted the importance of immunisation. Pregnant and new mums were invited to attend. Talks were given on childhood illnesses, pharmacy and breast feeding. New mum packs put together by the practice were distributed.

We also rated the practice as good for providing, safe, effective, caring and well-led services because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines and best practice.
• There were comprehensive policies and procedures to support best practice.
• There was an open and transparent approach to safety and a system in place for recording, reporting and learning from significant events. 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.
• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse and for identifying and mitigating risks of health and safety.
• There were clear responsibilities, roles and systems of accountability to support effective governance.
• Patients received effective care and treatment that met their needs.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice