Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lighthouse Medical Practice on 21 June 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 incidents and near misses and were actively encouraged to do so. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were constantly assessed and were well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients said they found it easy to make an appointment, but not always with a named GP and there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about services and how to complain was available and easy to understand. The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result. Complaints were discussed at significant events meetings if appropriate and reviewed annually.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• 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 forum (patient participation group). For example they had introduced an automated telephone booking system to help improve access to appointments.

• 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.

• Feedback from patients about their care was consistently positive.

We saw several areas of outstanding practice:

• External stakeholders such as patients, nursing home staff and members of the wider multi-disciplinary team were invited to attend the section of significant events meetings that they were involved in, ensuring transparency throughout the process.

• Multi-disciplinary team (MDT) meetings included local voluntary support agencies.

• The practice lead GP in information technology (IT) and the practice clinical governance lead had devised a robust system of ‘spiral audit’ whereby areas of clinical activity could be examined, reviewed and acted on on a continuous basis. This was a highly reactive system allowing the practice to immediately input the latest National Institute for Health and Care Excellence (NICE) or Medicines and Health Products Regulatory Agency (MHRA) guidelines and therefore identify and review patients that may be at risk. This meant that patient outcomes were continuously reviewed and improved.

• The practice had identified a high proportion of carers (4.4%) amongst their patients and had both a practice carers’ lead and a patient forum carers’ lead as well as a patients’ lead. They worked together with the practice team to identify and support carers. The practice was pro-active in identifying young carers. An extensive carers’ protocol was available on the website.

• There was a chaplain attached to the practice who could be contacted by people of all and no religion, faith or belief.

• The practice business manager was also the managing partner and as a consequence was committed to driving forward new initiatives.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice