We carried out an announced comprehensive inspection at OHP- Dr Prem Jhittay on 5 March 2019 as part of our inspection programme.

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

• What we found when we inspected
• Information from our on-going 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 effective services because;

• The practice had a proactive approach to childhood immunisations, which supported them to consistently achieve above the World Health Organisation (WHO) targets of 95% across all the childhood immunisation indicators. For immunisations for one-year old, the practice achieved 100% for the uptake.
• The practice demonstrated that they had facilitated an increase in the number of patients at the end of their life who were able to die in their preferred place. In 2017 five patients were on the Gold Standard Framework (GSF) register and there was little data around those persons preferred place of death. Data provided by practice showed an increase from four to ten patients who had their preferred place of death recorded and from one to six in the number of patients who died in their preferred place of death between 2017 and 2018.
• The practice’s flu vaccination achievement was second highest in the Clinical Commissioning Group (CCG). The practice achieved this by hosting Saturday and Sunday flu clinics and conducting home visits for those patients who were housebound. The practice proactively communicated with patients to ensure that they knew about the importance of flu vaccinations. Posters were placed in the waiting room, letters were sent and the practice called and texted patients where necessary. The practice demonstrated a high flu vaccination uptake for ‘at risk’ patients (92% of patients over 65 and 75% of those under 75 that were at risk).

We rated the practice as outstanding for providing caring services because;

• Patient satisfaction results in the National GP patient survey were significantly higher than local and national averages in a number of areas relating to patient involvement in care and treatment. For example, 100% of patients had confidence and trust in the healthcare professional they last saw or spoke with. The number of patients who felt that the professional they last saw or spoke with understood their mental health needs was 100%. The practice achieved scores above 94% in all other responses relevant to the caring key question.
• Patient satisfaction expressed in other ways, for example, the NHS Choices website and CQC comment cards were almost entirely positive about the practice in relation to the caring nature of the practice and the care provided.
• The practice achieved these scores that were above local and national averages and above the scores of practices with similar patient demographics and local challenges.
• The practice also demonstrated that it had developed a policy to regularly call homeless patients as a well-being check and to establish if they had migrated out of the area. We saw an example of this being used.

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

• The practice demonstrated that services were tailored to meet the needs of individual people and were delivered in a way that ensured flexibility, choice and continuity of care. For example, the practice offered standard 20 minute doctor appointments, 30 minute nurse appointments and 45 minute review appointments, including for long term conditions. This was complimented by a follow-up card system that ensured the reception team could make top correct appointment at the right time before the patient left after consultation.
• The practice had a triage system that allowed patients to speak to a doctor and be directed to the appropriate service and allowed the practice to appropriately plan clinical service delivery. The practice had inbuilt over capacity of staff to comprehensively provide for patient need, be this expected or unexpected.
• Staff at the practice consistently went over and above their duty to ensure that care and treatment was provided for patients in a timely and accessible way.

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

• The practice demonstrated innovation, a dedication to continual improvement and clear and decisive leadership in many areas, particularly in relation to patient centred inclusive care.
• The practice QoF achievements were generally above local and national averages in in all areas were above practices that shared similar demographic challenges, including deprivation, languages barriers, illiteracy and cultural considerations. This was further highlighted by the low levels of exception reporting the practice achieved, ensuring that meaningful numbers of patients were able to access and benefit from care and treatment provided by the practice.
• Patient satisfaction in general was higher than local and national averages but the practice continued to review and analyse to innovate new ways to continue to improve in line with their mission statement.
• Leaders at the practice rigorously inspired staff to follow their example, who spoke openly and enthusiastically, when asked, about their roles and the contributions they were able to make.
• The practice took a systematic approach to working with other organisations to improve care outcomes, tackle health inequalities.

We also rated the practice as good for providing safe services because:

• The practice demonstrated well embedded and effective systems to safeguard patients from abuse and provide safe treatment to patients in line with guidance. Patients on medicines were comprehensively reviewed to ensure treatment remained safe and appropriate.

We saw an area of outstanding practice including:

• The practice demonstrated that access for patients was at an almost unrivalled level even though the practice faced challenges that would typically result in access to care and treatment being lower than local and national averages. For example, high levels of deprivation, language and literacy barriers, cultural concerns around some health interventions and high patient expectations. Longer appointments as standard, inbuilt overstaffing and a dedicated focus on building a trusting relationship with the practice population all contributed to overcoming these challenges.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care