Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bakewell Medical Centre on 12 May 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing safe, effective, caring and responsive services. It was outstanding for well led and for providing services for all the population groups we inspected.

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 proactive methods to improve patient outcomes, working with other local providers to share best practice. This included work related to hospital admission avoidance and end of life care.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information was provided to help patients understand the care available to them.

• 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).

• 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. Succession planning was in place, 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:

• Patients were protected by a strong safety focus and robust systems were in place to safeguard patients from abuse. For example, the practice had used the Manchester Patient Safety Framework (MaPSaF) as a basis for developing their error reporting protocol. This had promoted a genuinely open culture in which all safety concerns were highly valued and integral to learning and improvement. The MaPSaF helps healthcare organisations to reflect on their progress in developing a mature safety culture.
• The practice had an established and embedded process for multi-disciplinary working to deliver integrated care that was centred around the patients’ needs and experience. As a result, robust systems were in place for effective care planning and on-going reviews of patient’s individual health needs and medicines.
• Outcomes for patients were consistently higher when compared with other similar services and the national average. his included: lower rates for emergency admissions, out of hours usage and attendance of Accident and emergency (A&E) services which were below local and national averages.
• The admissions avoidance work had a strong focus on improving outcomes for patients at most risk of unplanned admissions to hospital and preventative care arrangements were in place. This ensured patients could continue being cared for in the community. The practice had identified 4% of the patients at most risk which was above the contractual requirement of 2%.

• One of the GP partners had led innovations across the CCG area to drive improvements in respect of end of life care. This showed the GP had a strong commitment to improving the outcomes for patients in the wider locality. The practice showed a high level of commitment to the needs of patients receiving palliative care and recognised that many of them wanted to receive the highest quality of care and support to enable them to die with dignity in their own home or care home. Effective and robust systems were in place to ensure they received their end of life care in line with their expressed preferences.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should

• Ensure clinical audits in respect of contraceptive implants and minor surgery are undertaken regularly in line with best practice guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice