Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery, Great Lumley on 25 August 2016. Overall the practice is rated as outstanding.

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

• Kindness and compassion was fundamental to the practice ethos and we were told that patients were at the centre of what they did. This was corroborated by patient survey results, what we were told by patients on the day and via completed questionnaires.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example they had taken on the role of extended diabetes care for patients in the local area due to an identified need for the service; this included insulin initiation and had required extra staff training. GPs had also undertaken extra training in gynaecology, dermatology and cardiology following identification of a high number of their patients requiring this care. This increase in expertise showed a reduction in referrals to secondary care in these areas because of this.

• The practice funded care for pre-diabetic patients and performed reviews on these patients in order to prevent disease progression. They had provided this service for two years.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example they worked closely with local charities and the Carer’s Association, enabling their patients to benefit from services they had to offer.

• The practice had a clear vision which had quality and safety as its top priority. The strategy was regularly reviewed and discussed with staff. Staff told us that there was no hierarchy in the team and that they felt supported and valued.
• Following the loss of two key members of staff the practice had recognised that staff were unsettled due to the uncertainty and change and they had completed a team forming and building exercise. They had also introduced staff reward schemes.

• The practice had strong and visible clinical and managerial leadership and governance arrangements. Leadership was a priority at the practice and they were busy developing their new business plan, which was to be shared with staff. Continuous improvement was embedded into the culture of the practice. In response to the Patient Survey results, the practice had had a whole team effort focussing on shared decision making with patients. The results in this area had improved substantially following this.

We saw several areas of outstanding practice:

The practice had purchased equipment to provide near patient testing to patients. This ensured correct treatment with antibiotics was provided and had reduced antibiotic prescribing figures in line with national guidance.

The practice worked strongly with the local community and patients told us there was a strong family feel and sense of community spirit. The practice had implemented a scheme whereby patients in need were provided with hygiene packs made up by the Women’s Union if they were admitted to hospital. These included essential toiletries.

The leadership in the practice drove continuous improvement and staff were accountable for delivering change. Safe innovation was celebrated. There was a clear proactive approach to seeking out and embedding new ways of providing care and treatment. The practice had introduced the ‘Extra Mile’ and ‘Make a Difference’ schemes to incentivise and reward staff and recognise compassionate care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice