Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Andrews Health Centre on 14 September 2016. The practice provides NHS primary care services to registered patients and a GP-led walk-in centre (WIC) for non-registered patients. 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.
• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• There was evidence of quality improvement including clinical audit. We saw that the practice had put in place a comprehensive audit programme which was driven by the needs of the practice population in order to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Registered and non-registered patients said they could get an appointment with urgent appointments available the same day. 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 modern facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. The provider was aware of and complied with the requirements of the duty of candour.
• Leaders had an inspiring shared purpose and 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. Staff felt supported by management.
• There was a strong focus on continuous learning and improvement at all levels. The practice took pride in its role as a teaching and training practice and we saw that a learning and reflection culture was embedded in the organisation.

We saw several areas of outstanding practice:

• The practice had empowered its patients to help them self-manage their health in partnership with the practice through a free tele-health ‘app’. Approximately 100 patients with high blood pressure (one sixth of the hypertension register) were home-monitoring their blood pressure and using the technology to submit readings to their doctor. The practice shared several case studies and positive patient outcome data from a pilot study which was presented at the Royal College of General Practitioners Annual Conference in 2016.
• The practice embraced social prescribing recognising that many patients attending the surgery had non-medical conditions and linked patients with sources of support in the community. Over 200 patients had been referred of which approximately 84% had engaged with a service, such as, the Young Carers Project, English language classes, craft groups, walking clubs, bereavement support group. We saw several case studies of very positive outcomes and improved wellbeing for patients.
• The practice had developed and piloted, as part of the Bromley by Bow Health Partnership, the educational programme ‘DIY Health’ for parents to improve their skills, knowledge and confidence in managing minor health concerns in children under the age of five. The 12-week programme covered topics such as fever, feeding, gastroenteritis, cold and flu and ear pain. One of the practice GPs had run an event for parents of children with eczema and created an illustrative book ‘Sharing Stories with Itchysaurus’. Children had an opportunity to bathe a toy dinosaur in emollients, practice applying bandages and created posters which the practice had displayed in the surgery.
• The practice, as part of its Well Community initiative had started the social group ‘Chatter Natter’ which offered support for older and potentially isolated people to meet and have some refreshments and friendly conversation.

The areas where the provider should make improvement are:

• Consider implementing a system to advise patients when consultations were running late.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice