Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jessop Medical Practice on 21 October 2016. Overall, the practice is rated as outstanding.

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

• There was an effective system in place for the reporting and recording of significant events. Significant events were investigated and learning outcomes were shared with the practice team to enhance the delivery of safe care to patients.
• The practice had systems in place to safeguard children and vulnerable adults.

• Clinicians kept themselves updated on new and revised guidance and discussed this at clinical meetings.
• We saw evidence of an active programme of clinical audit that reviewed care and ensured actions were implemented to enhance outcomes for patients.
• Patients told us they were treated with compassion, dignity and respect. They also said they were involved in their care and decisions about their treatment. This was corroborated bythe outcomes of the latest national GP patient survey and CQC comment cards.
• The practice planned and co-ordinated patient care with the wider health and social care multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe. Fortnightly multi-disciplinary meetings took place to discuss and review patients’ needs.
• The practice had an effective appraisal system in place and supported staff training and development.
• The practice team had the skills, knowledge and experience to deliver high quality care and treatment.
• Arrangements were in place to assess and manage risk effectively.
• Feedback from patients we spoke with on the day, and from CQC comment cards, demonstrated that some people had encountered difficulties with regards access to GP appointment. The practice were very aware of this issue and were keeping this under constant review to enhance patient experience on access.
• The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were accessible for patients with impaired mobility.
• There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of quality care. Regular practice meetings occurred, and staff said that GPs and managers were approachable and always had time to talk with them.
• The partnership had a comprehensive three-year business plan and associated action plan, and the practice proactively engaged with other practices and their Clinical Commissioning Group (CCG).
• The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received.
• The practice had a patient participation group (PPG) which met on a bi-monthly basis.

We saw a number of areas of outstanding practice including:

• The partners led an innovative and committed team, and promoted a strong inclusive culture with a focus on continuous quality improvement. As a large practice, the partners recognised the importance to prioritise time to build effective relationships and communication within the team, and achieved this through daily ‘catch-up’ and weekly breakfast meetings to enhance their formal operational and governance frameworks.
• Significant events were thoroughly investigated and some of these were shared with the national reporting and learning system (NRLS). The NRLS ensures the learning gained from the experience of a patient in one part of the country is used to reduce the risk of something similar occurring elsewhere. Incidents were also used as a method of selecting appropriate clinical audit topics within the practice.
• We saw that a full cycle audit had been undertaken to review the practice’s efficacy of coding for child safeguarding. The outcomes had been to improve the accuracy of coding, and assistance from the information technology department had ranked entries on the safeguarding register in date order to enable easier access to a list of the most recent cases where concerns had been identified. A second audit in May 2016 had highlighted that when a code was used to identify domestic violence, this needed to automatically generate a child safeguarding alert and add them to the practice’s safeguarding register.
• 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 patient’s homes. For example, a GP provided a vasectomy service for all patients within their CCG. Access to carers’ clinics and counselling services for younger people were available to people outside of the practice. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with five patients during our inspection and a further 15 patients by telephone. We did this to help us to understand the outcomes and experiences of patients who used the practice. On the whole, patients told us that they were happy with the care and treatment they received. Some patients however, did raise concerns about difficulties accessing appointments and the telephony system in place at the practice. Their comments included, “I have no complaints about the doctors, they are all excellent whoever you see” and “I believe they have started same day appointments now but you don’t have a choice of who you see.”

We found that patients were involved in their care and treatment which was provided in a way intended to ensure their safety and welfare.

Patients who used the service were protected from the risk of abuse. Patients we spoke with told us they trusted the GPs and nurses caring for them and felt safe receiving support from all of the staff at the practice. Staff received appropriate professional development which included an annual appraisal and training relevant to their role.

The practice had effective systems in place to protect the health, safety and welfare of patients. There was a Patient Participation Group (PPG) at the practice and they were involved in assessing the quality of care patients received. A PPG is made up of practice staff and patients that are representative of the practice population.