This practice is rated as ‘Outstanding’ overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? - Good

We carried out an announced comprehensive inspection at Tideswell Surgery on 3 September 2018. This inspection was undertaken following the practice’s merger with Bakewell Medical Centre in 2017. The registered provider for regulated activities at these two locations is the Peak and Dales Medical Partnership.

The provider’s registration with the Care Quality Commission (CQC) was updated on 3 October 2017 to reflect the new arrangements. The inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• People were truly respected and valued as individuals and were empowered as partners in their care. We found compelling evidence to support that the service was centred towards the needs of patients and the delivery of first class care. This was supported by the 2018 national GP patient survey in which Tideswell Surgery performed higher on all 18 questions compared to local and national averages, in some cases by a significant margin. Eleven of the 18 questions scored either 99% or 100% satisfaction scores. This was further demonstrated by the feedback received in the 50 comments cards we received from patients on the day of the inspection, all of which provided highly positive patient experiences regarding the practice.
• Services were tailored to meet the needs of individual people and delivered in a way to ensure flexibility, choice, and continuity of care. Patients had on-the-day access to see a GP. A daily ‘drop-in’ clinic ensured that all patients got to see a GP if they wanted to see one. The access indicators used by the CQC in the accompanying evidence table show all measures are a positive or significantly positive variation to local and national averages
• The practice provided a weekly medicines delivery service to a ‘branch location’ at Taddington. This was maintained in recognition of the difficulties caused by rural isolation, which could often prove difficult for example, for those who worked in the farming community. An informal surgery was held between 12.30pm-1pm each week to ensure patients had access to a medical consultation and basic health checks if required. Any patients requiring follow up tests or investigations would be directed to the Tideswell site.
• The partnership had undertaken significant work to integrate elements of the two practices since the merger had taken place, and had invested in a project manager to support this process. They had ensured continuity in delivering quality services throughout this period. There had been a commitment to maintaining each practice’s own identity to reflect the needs of their own communities.
• Joined-up working with Bakewell Medical Centre meant there was greater flexibility and capacity for GP clinical sessions, and staff such as the practice-based pharmacist, offered more care options for patients.
• The practice strove to maintain integrated care for their patients within a rural location, and accommodated a number of visiting services and professionals including health visitors, midwives, podiatrists, physiotherapists, counsellors and the Citizens Advice Bureau.
• The provider had an achievement of 95% in the 2017-18 Quality and Outcomes Framework (QOF), which was a slight reduction from the previous year. These figures remained subject to external verification. We saw that the levels of exception reporting were below local and national averages showing that patients engaged well with the practice to monitor and improve their conditions.
• We found effective systems were in place to promote adult and child safeguarding.
• People were protected by an established safety system, supported by a focus on openness, transparency, and learning when things went wrong.
• Environmental risk assessments had been undertaken, including fire and Legionella.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines.
• Processes within the dispensary mostly kept patients safe. Medicines and patient safety alerts were managed effectively and there were processes in place to be assured of the competence of staff.
• The practice encouraged learning and improvement, and we saw that staff were mostly up to date with the practice’s training schedule. The practice was not able to easily demonstrate up-to-date evidence for GPs, although we were told this had been completed.

We found three areas of outstanding practice:

• Outcomes for people who use services were consistently better than expected when compared with other similar services. For example, in addition to the results in the GP patient survey, the practice performed above local and national averages in relation to cancer screening and child immunisation rates. There were lower attendance rates for Accident and Emergency attendance (the third lowest of 50 practices across the two local CCGs), and emergency hospital admissions (the sixth lowest of the 50). This demonstrated a strong commitment to working in partnership with their patients.
• The practice participated in a local project called ‘Train the Trainer’ to improve the quality and impact of health reviews through effective information sharing between appropriate health care professionals. They were able to provide examples to demonstrate the effectiveness of this. For example, a patient was intending to stop their medicines and explained their reasons for this. This led to an urgent referral for the consultant to review the patient and advise them accordingly.

• Further to a project on health in rural communities, a health check facility had been arranged at a nearby agricultural centre to encourage opportunistic health screening and advice. A GP partner had been involved in the recruitment of a nurse to deliver this service.

There were also some areas where the provider should make improvements:

• Fridge temperature monitoring in the dispensary should be completed daily in line with the practice’s own standard operating procedure.
• The practice should review their training log to consider incorporating a summary of GP training, in particular mandatory training attendance, as identified within the partnership’s training policy.
• Review templates for significant events and errors to ensure these are signed off with a record of the actions taken, including dates of completion.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.