Letter from the Chief Inspector of General Practice

OUTSTANDING

We carried out an announced comprehensive inspection at St Paul’s Way Medical Centre on 9 October 2017. Overall the practice is rated as outstanding.

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

• This was the first inspection of the practice since their relocation to new, improved premises earlier in the year.
• 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, visible clinical and managerial leadership and governance arrangements and used innovative and proactive methods to improve patient outcomes, working with four other network practices and local providers to share best practice and develop integrated care.
• In response to the significant clinical and social challenges the practice employ a higher than average ratio of GP's to patients (1:1700) and nurses.
• The practice helped to promote and manage many population specific services and health education events targeted at young mums, young adults and ethnic minority groups. It encouraged social prescribing and acted as a hub to various support groups, for example, helping patients with depression, promoting recognition and management of minor ailments to young and new patients. These services improved patient self management (which helped reduce waiting times and improve access to healthcare).
• The results showed good patient uptake, which in turn has provided positive feedback for the practice, especially in terms of patient trust in the practice.
• To benefit the whole practice population and bespoke to the practice, a patient Health Champion programme was developed. This involved the practice training patients to volunteer and support other patients to improve individual understanding and control over their healthcare needs and led to improved patient satisfaction. The practice offered a seven week training course and had trained 56 Health Champions of which 27 had attained a level 2 qualification in Understanding Health Improvement. This model of care goes beyond clinical outcomes and aimed to support patients in a more holistic way, addressing wider health determinants.
• The practice was proactive in obtaining patient feedback. This included feedback from regular ‘meet the manager’ events, their own surveys, Friends and Family Test (an average of 120 – 160 patient feedback per month), Patient Participation Group and Health Champions programme as well as the GP Patient Survey and NHS Choices. This enabled any issues, concerns or complaints to be raised, which were then systematically acted on. For example, improved patient access through online consultation.
• The practice had developed a leadership programme in 2016 and commissioned a facilitator to work with the leadership and wider practice team.
• The practice had good new facilities and was well equipped to treat patients and meet their needs. This included an area in reception where patients could self monitor their height, weight and blood pressure.
• 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 were accredited as a YOU’RE WELCOME’ pilot site. YOU’RE WELCOMEprovides a framework for delivering and planning young people’s health services and through participation, that young people will have a greater understanding of the services available. It aims to help practices improve access to health services for marginalised groups.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result, although details of the local NHS complaint advocacy organisation, NHS England and the Ombudsman were not consistently included in responses to patients.
• We found that two indicators representing completion by the practice, childhood immunisations recommended for children up to 2 years of age, had been below the local and national average although the practice were actively taking action and could demonstrate significant improvement as of March 2017.

We saw several areas of outstanding practice including:

• The practice were very proactive. They had developed a practice Health Champions programme which commenced in 2016 and aimed to benefit patients across all of the practice population groups. Health Champions were usually patients trained by the practice who then volunteer to support other patients to increase control over and improve the patients’ understanding of their health as well asthe services at the practice. Over 250 patients had benefitted from the service. The practice offered a seven week training course and had trained 56 Health Champions of which 27 had attained a level 2 qualification in Understanding Health Improvement.Once trained the patient Health Champion would: run a weekly stall in the waiting room area, support the practice in planning / running events, collect feedback from patients, signpost patients to local services, assist patients in the waiting area with using the self-arrival machines, Web GP IPads and using the surgery pod.

However there were areas of practice where the provider should make improvements:

• Review the policies and procedures for complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice