This practice is rated as Outstanding overall.

(Previous inspection January 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Outstanding

Families, children and young people – Good

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people living with dementia) - Good

We carried out an announced comprehensive inspection at The Scott Practice on 21 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was always delivered according to evidence- based guidelines. 
• Those whose circumstances made them vulnerable, frail older people and those with multiple long term conditions were well supported by the practice who employed a pro-active care team.
• Staff involved and treated patients with compassion, kindness, dignity and respect.The practice was above average for its satisfaction scores on consultations with GPs and nurses.
• Recent improvements had been made to the telephone system and patients found it easy to use the appointment system and reported that they were able to access care when they needed it.
• There was innovation and service development and improvement was a priority among staff and leaders.

• At the core of the practices ethos, was learning and development across all staff groups.

We saw areas of outstanding practice:

• The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice. In October 2016 the practice linked with six neighbouring practices to hold quarterly meetings with the wider multidisciplinary team which included a respiratory nurse, community geriatrician, a representative from the local social prescribing initiative, palliative care nurses, district nurses, heart failure nurse, social services and the falls team. This provided the opportunity to review those patients considered most at risk and a forum for sharing best practice and learning through review of case studies.
• The practice ensured that patients with complex needs, including those with life-limiting progressive conditions, were supported to receive coordinated care in innovative and efficient ways.The practice employed a care co-ordinator nurse to review and implement care plans for those patients whose circumstances may make them vulnerable. Initially, patients were assessed using a risk stratification tool which included review of patients living with dementia, learning difficulties, frailty, at risk of hospital admission, housebound, residing in care home or those with multiple long term conditions. The care co-ordinator had identified 255 patients at risk and 89% of these patients had agreed care plans in place.

• There was compassionate, inclusive and effective leadership at all levels. All leaders demonstrated high levels of experience, capacity and capability needed to deliver excellent and sustainable care.

• There was a demonstrated commitment to best practice performance and risk management systems and processes. The practice reviewed how they functioned to 

  ensure that staff at all levels have the skills and knowledge to use those systems and processes effectively. Problems were identified and addressed quickly and openly.

The areas where the provider

should

make improvements are:

• Review monthly checks of emergency medicines and consider completing a risk assessment in the absence of keeping a stock of Atropine, a medicine to treat slow heart beat.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Scott Practice on 14 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also rated as good for providing services for all population groups.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice:

• Monthly multi-disciplinary meetings with a Geriatrician in attendance were held to review the care needs of older people and they offered rapid access appointments for those with complex needs.

• The practice provided excellent care to those patients with palliative care needs.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should

• Take action to improve immunisation rates for children as figures were below national average for all standard childhood immunisations.

• Ensure that patient access to the practice by telephone is improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice