Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Somercotes Medical Centre on 1 November 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 significant events and near misses. All opportunities for learning from internal and external incidents were maximised and shared widely across all staffing groups.

• The practice had clearly defined and embedded systems to minimise risks to patient safety. This included arrangements for safeguarding and medicines management.

• Staff were aware of current evidence based guidance and had the skills and knowledge to deliver effective care and treatment.

• Nationally published data showed the majority of patient outcomes were above local and national averages.

• Clinical audits demonstrated improvement to patient outcomes.

• We observed a strong patient-centred culture and feedback from patients about their care was consistently positive. Patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• 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 staff, patients and the patient participation group.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• The provider was aware of the requirements of the duty of candour.

• The practice held the Royal College of General Practitioners research ready accreditation and was a level one research site practice with the Clinical Research Network. Research Ready is a quality assurance programme, for all research-active UK GP practices.

We saw several areas of outstanding practice including:

• The practice was committed to working with people whose circumstances might make them vulnerable. For example: the practice proactively engaged with vulnerable adult risk management (VARM) multi-agency meetings when this was required and positive outcomes were achieved for patients’. This included mitigating risks to patient’s home environment (for example hoarding and fire) and in some cases respecting their “unwise decisions” as defined by the Mental Capacity Act 2015.

• The practice demonstrated a responsive approach by taking account of the needs of their local population, and not just their registered patients. This enabled services to be delivered closer to home. For example, in response to a need to increase the support provided to carers, the practice staff and Derbyshire Carers Association (DCA) were instrumental in setting up a “carers’ clinic” in the Southern Derbyshire clinical commissioning group area. Carers received an assessment of their needs at any of the 18 participating GP practices and were involved in developing a support plan that focused on positive outcomes they wanted to achieve. Within three months of the project commencing in July 2015, the following measurable results were achieved: the rate of carer identification increased by 281%, the number of active carers on the practice’s register increased by 40% and the number of carers assessments completed with the locality increase by 800%. The British Medical Journal awarded the practice and DCA a commendation as finalists for the "primary care team of the year award" in 2016.

• The Derbyshire county council had awarded the practice the Derbyshire dignity campaign award (previously known as the silver award) in June 2015; in recognition of work undertaken to promote people’s dignity and respect. Somercotes Medical Centre was the first GP practice in the county to achieve the silver award, which is the highest level of dignity award currently available. These awards had been achieved following an assessment process which considered areas such as: patient and staff involvement; respecting people’s right to privacy; as well as listening and supporting people to express their needs and wants. Some of the evidence that led to these awards included the following: reception staff used text speech software to communicate with some patients with hearing impairments; and this enabled the voice of the receptionist to be converted into text of which the patient could read. Some patients with learning disabilities communicated with the practice staff via picture boards which have symbols to represent their views. The national GP patient survey results reinforced this aspect of care was maintained; as the results were above local and national averages.

• A free in-house acupuncture clinic for patients. Records reviewed showed along with the expertise within the practice in joint injections, the acupuncture service had helped keep referral rates for musculoskeletal problems low, reduced prescribing costs or the need for medicines. Patients were very complimentary of this service and the impact it had on reducing chronic pain for example.

  Professor Steve Field (CBE FRCP FFPH FRCGP)

  Chief Inspector of General Practice