This practice is rated as Good overall.

The key questions are rated as:

• Are services safe? – Good
• Are services effective? – Outstanding
• Are services caring? – Good
• Are services responsive? – Good
• 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 – Good
• Families, children and young people – Good
• Working age people (including those recently retired and students – Good
• People whose circumstances may make them vulnerable – Good
• People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Three Chequers Medical Practice on 17 April 2018. This is our first inspection of Three Chequers Medical Practice, which we carried out as the practice is a newly registered service. The practice was formed in 2017, by the merger of Endless Street Doctors Surgery, Three Swans Surgery and St Ann Street Surgery (all based in Salisbury city centre). The practice now operates across five sites, three of which have a dispensary.

At this inspection we found:

• The recent merger of three practices to create Three Chequers Medical Practice had caused some disruption to services. However, the practice was aware of the issues and we saw numerous examples of a clear and structured approach to resolving them. The strategy and supporting objectives were stretching, challenging and innovative, while remaining achievable.
• The practice had a clear and strong management structure. GP partners at the practice had a long history of initiating and developing new ways of working prior to the merger and we saw evidence this was continuing. For example, they had recently introduced a computerised workflow system to manage medical correspondence.
• The practice had 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. However, we found that routine checks recommended to reduce the risk of Legionella infection had not been carried out since February 2017.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect. There was evidence staff went ‘that extra mile’ to support patients when necessary.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw a number of areas of outstanding practice:

• The practice ran a specialist service to deliver annual health checks to people with a learning disability. The service included a GP, a consultant in learning disabilities and a learning disability specialist nurse. Patients with the most complex care needs were reviewed by the GP and Consultant in joint consultations.
• The practice ran a service that aimed to improve the care provided to older people and reduce unplanned admissions to hospital for people aged 75 or over. There was evidence that while the rate of unplanned admissions for this group of patients had gone up nationally, the practice rate had remained the same.
• The practice led a Community Heart Failure project in partnership with other local practices. It was a pilot project designed to establish the need for a community service and to set up such a service if the evidence showed it to be a practical and cost effective service model. In the three months up to December 2017, 322 new patients had been referred to the service, all had been seen within 14 days, with an average waiting time of 6 days, and 34 patients had been cared for at home who might otherwise have needed hospitalisation.
• The practice had developed a service for patients with mental health and substance misuse problems, and who frequently used health services, such as the accident and emergency department. The service was led by a GP with an interest in mental health and a psychiatric nurse. Patients where offered a more intensive service and we saw evidence it was helping patients achieve more stability and positive outcomes.

The areas where the provider should make improvements are:

• Review their systems to allow the practice to confirm that all learning points from complaints and significant events had been shared with all appropriate staff.
• Review their systems to allow the practice to confirm that all patients who make a complaint are given information about the escalation process if they are not satisfied with the practice response.
• Review their systems to ensure the appropriate checks are carried out for the prevention of legionella.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice