Letter from the Chief Inspector of General Practice

We conducted a comprehensive announced inspection on 14th July 2015.

The overall rating for this practice is outstanding.

We found that the practice was outstanding in relation to being effective, well led and responsive to patients’ needs. They provided a safe, effective, caring, responsive and well led service.

They were outstanding for being well led, effective and responsive in providing services for people living in vulnerable circumstances. They were outstanding for well led and responsive to families, children and young people. The practice was outstanding in their effectiveness and responsiveness in providing services to older people and they were outstanding in their effectiveness for people with long term conditions. They were good for working age people (including those recently retired and students), and people experiencing poor mental health (including people with dementia).

Our key findings 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, addressed and shared with staff during meetings.

• Risks to patients and staff were assessed and managed. There were risk management plans which included areas such as premises, medicines handling and administration, infection control and safeguarding vulnerable adults and children.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff had received training appropriate to their roles. Staff were supervised and supported and any further training needs had been identified and planned for.

• Patients were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They told us that access to appointments with GPs and nurses was good and that they were happy with the treatments they had received.

• Information about services and how to complain was readily available and easy to understand. Complaints were handled and responded to in line with relevant guidelines.

• 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 sought feedback from staff and patients, which it acted on.

We saw a number of areas of outstanding practice.

• The practice had written two policies which the local Clinical Commissioning Group (CCG) had adopted and distributed to the other Norfolk practices. These were a transgender policy, which was a response to an identified need within the practice and local CCG and an adoption policy created from working with National Adoption Advisors. They had identified the need for the policy within their CCG and were currently using both.

• The GPs worked closely with drug dependence teams to support vulnerable patients such as those with a drug and alcohol addiction or those with poor mental health. They received referrals from and made referrals to the Norfolk Recovery Partnership which was a Norfolk wide initiative. The practice independently built a relationship with the East Coast Recovery service to forge a stronger and wider impact to assist vulnerable patients. They worked closely with the Norwich Admiral Nurse for dementia care. Admiral Nurses are specialist dementia nurses who give practical and emotional support to family carers, as well as the person with dementia.

• The practice organised external disability awareness and visual awareness training and changes were made to the way the practice accommodated these patients. For example, help was offered to patients with check-in and registration and a lower area of the reception desk was installed after consultation with patients about the design so that staff could greet patients with mobility problems at their level.

• The practice had a specialist prescribing nurse who was dedicated to palliative care, at risk patients, elderly dependant patients, housebound patients, out of hours’ referrals and clinics at the care homes that were supported by the practice. The work of the specialist nurse had cut the risk of a repeat admission by over half to the statistical expectation.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice