Dr Alagu Rajkumar NewApproachComprehensive …...Contents Summaryofthisinspection Page...

This report describes our judgement of the quality of care at this service. It is based on a combination of what we foundwhen we inspected, information from our ongoing monitoring of data about services and information given to us fromthe provider, patients, the public and other organisations.

Ratings

Overall rating for this service Good –––

Are services safe? Good –––

Are services effective? Good –––

Are services caring? Good –––

Are services responsive to people’s needs? Outstanding –

Are services well-led? Good –––

DrDr AlaguAlagu RRajkajkumarumarQuality Report

Orford Jubilee ParkJubilee WayWarringtonTel: 01925 843883Website: ericmoorepartnership.co.uk

Date of inspection visit: 19/04/2016Date of publication: 06/07/2016

1 Dr Alagu Rajkumar Quality Report 06/07/2016

Contents

PageSummary of this inspectionOverall summary 2

The five questions we ask and what we found 4

The six population groups and what we found 7

What people who use the service say 11

Outstanding practice 12

Detailed findings from this inspectionOur inspection team 13

Background to Dr Alagu Rajkumar 13

Why we carried out this inspection 13

How we carried out this inspection 13

Detailed findings 15

Overall summaryLetter from the Chief Inspector of GeneralPracticeWe carried out an announced comprehensive inspectionat Dr Alagu Rajkumar on 19 April 2016. Overall thepractice is rated as good.

Our key findings across all the areas we inspected were asfollows:

• Staff understood and fulfilled their responsibilities toraise concerns and report incidents and near misses.Significant events had been investigated and actionhad been taken as a result of the learning from events.

• Systems were in place to deal with medicalemergencies and all staff were trained in basic lifesupport.

• There were systems in place to reduce risks to patientsafety. For example, infection control practices weregood and there were regular checks on theenvironment and on equipment used.

• Staff assessed patients’ needs and delivered care inline with current evidence based guidance.

• Data showed that outcomes for patients at thispractice were similar to outcomes for patients locallyand nationally.

• Staff had the skills, knowledge and experience todeliver effective care and treatment.

• Staff felt well supported in their roles and were kept upto date with appropriate training.

• Feedback from patients about the care andtreatment they received was very positive.

• Patients said they were treated with dignity andrespect and they were involved in decisions abouttheir care and treatment.

• Patients told us they found it easy to get anappointment. This included urgent and routineappointments.

• The practice had good facilities, including disabledaccess. It was well equipped to treat patients and meettheir needs.

• Information about services and how to complain wasavailable. Complaints had been investigated andresponded to in a timely manner.

• The practice had a clear vision to provide a safe andhigh quality service.

• There was a clear leadership and staffing structure andstaff understood their roles and responsibilities.

Summary of findings


• The practice provided a range of enhanced services tomeet the needs of the local population.

• The practice sought patient views aboutimprovements that could be made to the service. Thisincluded the practice having and consulting with apatient participation group (PPG).

We saw areas of outstanding practice including:

• Nurse practitioners visited patients in a large nursinghome on a daily basis to provide clinical oversight ofthe residents. This was supported by regular GP visitsand oversight. This resulted in a decrease inunplanned hospital admissions for the residents.Nurse practitioners had also provided training tostaff to enable them to support residents with someof their health related needs.

• The practice provided primary care to homelesspeople in central Warrington. An ‘outreach nurse’and other designated leads (including a lead GP)were designated to support homeless patients. Thiswork was set up following engagement with

homeless people and some of the local agenciessupporting homeless people. The practice workedalongside other agencies to provide the servicewhich had resulted in greater uptake of screeningand treatment for these vulnerable patientsand avoidance of attendance at A&E.

• A patient co-ordinator made regular contact witholder or housebound patients who had not had anyother form of contact with the practice. They used ascreening tool as part of this to establish if there wasany cause for concern for the patient’s health.

• The practice had established a group of Polish andKurdish speaking volunteers to support new patientsin response to an increase in patients from EasternEurope. They had also established a working groupwith the Clinincal Commissioning Group (CCG) andLocal Authority with an aim to address socialisolation amongst this group.

Professor Steve Field CBE FRCP FFPH FRCGPChiefInspector of General Practice

Summary of findings


The five questions we ask and what we foundWe always ask the following five questions of services.

Are services safe?The practice is rated as good for providing safe services.

• Staff understood and fulfilled their responsibilities to raiseconcerns and report incidents and near misses. The practicecould clearly demonstrate that significant events had beeninvestigated and any learning from these had been sharedacross the practice.

• The practice had clearly defined and embedded systems,processes and practices in place to keep people safe andsafeguarded them from abuse.

• Staff had been trained in safeguarding and they were aware oftheir responsibilities to report safeguarding concerns.Information to support them to do this was widely availablethroughout the practice.

• Infection control practices were carried out appropriately andin line with best practice guidance.

• Health and safety related tests were carried out on thepremises and on equipment on a regular basis.

• The practice had a large staff team. Staff recruitment checkshad been carried out appropriately.

• Systems were in place for managing medicines safely and thepractice was equipped with a supply of medicines to supportpeople in a medical emergency.

Good –––

Are services effective?The practice is rated as good for providing effective services.

• Patients’ needs were assessed and care was planned anddelivered in line with best practice guidance.

• The practice monitored its performance data and had systemsin place to improve outcomes for patients. Data showed thatoutcomes for patients were comparable to or higher than localand national averages. For example; the percentage of patientswith diabetes, on the register, who had had an influenzaimmunisation in the preceding 12 months was 98.34%compared to a national average of 94.45%.

• The practice worked in conjunction with other practices in thelocality to improve outcomes for patients.

• Staff worked with a range of professionals to understand andmeet the range and complexity of patients’ needs.

Good –––

Summary of findings


• A programme of regular meetings were held to review thequality of the service and the care and treatment provided topatients.

• Clinical audits were carried out to drive improvement inoutcomes for patients.

• Staff felt well supported and they had the training, skills,knowledge and experience to deliver effective care andtreatment.

• A system of staff appraisals was in place and all staff hadundergone an up to date appraisal of their work.

Are services caring?The practice is rated as good for providing caring services.

• The practice had acted upon patients’ feedback about theirexperiences of the care provided.

• Patients told us they were treated with dignity and respect andthey were involved in decisions about their care and treatment.They gave us very positive feedback about the caring nature ofstaff.

• We saw that staff treated patients with kindness and respect,and maintained confidentiality.

• A patient co-ordinator had regular contact with older orhousebound patients who had not had any other form ofcontact with the practice. They also supported patients whohad been discharged from hospital.

• Information for patients about the services available to themwas readily accessible.

• The practice maintained a register of patients who were carersin order to tailor the service provided. The practice identifiedcarers through a range of means such as new patient checksand during checks on people who required chronic diseasemanagement.

Good –––

Are services responsive to people’s needs?The practice is rated as outstanding for providing responsiveservices.

• The practice reviewed the needs of the local population andworked in collaboration with partner agencies to secureimprovements to services where these were identified and toimprove outcomes for patients.

• The appointment system was flexible and responsive topatients’ needs. Patients felt they received timely care andtreatment when they needed it.

Outstanding –

Summary of findings


• The practice responded to the needs of specific groups ofpatients including those who were older people in care settingsand homeless people who were supported by other services inthe local community.

• The practice had identified a group of Polish and Kurdishspeaking volunteers to support new patients in response to anincrease in patients from Eastern Europe. They had alsoestablished a working group with the Clinical CommissioningGroup (CCG) and Local Authority with an aim to address socialisolation amongst this group.

• The practice had good facilities and was well equipped to treatpatients and meet their needs.

• Information about how to make a complaint was available andthe practice responded quickly to issues raised. Complaintswere investigated and any learning from complaints was sharedacross the practice.

Are services well-led?The practice is rated as good for being well-led.

• The practice had a clear vision and strategy to deliver highquality care and promote good outcomes for patients. Staffwere clear about the vision and their responsibilities in relationto this.

• There was a clear leadership structure and staff felt supportedby management.

• There were systems in place to govern the practice and supportthe provision of good quality care. This included arrangementsto identify risks and monitor and improve quality.

• The practice proactively sought feedback from staff andpatients and acted upon this. The practice had an establishedand well engaged patient participation group (PPG) who wereconsulted with and the practice acted upon their feedback.

• There was a clear focus on continuous learning, developmentand improvement linked to outcomes for patients.

• The provider was well aware of the challenges to the serviceand worked to meet these. The future developments of thepractice had been considered and some were in progress.

Good –––

Summary of findings


The six population groups and what we foundWe always inspect the quality of care for these six population groups.

Older peopleThe practice is rated as outstanding for the care of older people.

• The practice offered proactive, personalised care and treatmentto meet the needs of the older people in its population. Thepractice kept up to date registers of patients with a range ofhealth conditions (including conditions common in olderpeople) and used this information to plan reviews of healthcare and to offer services such as vaccinations for flu.

• Nationally reported data showed that outcomes for patientswith conditions commonly found in older people were similarto or better than local and national averages. For example, thepercentage of patients with chronic obstructive pulmonarydisease (COPD) who had a review undertaken including anassessment of breathlessness was 91.36% compared to anational average of 89.9%.

• All patients over the age of 75 had a named GP. A careco-ordinator contacted patients over the age of 75, and thosewho were housebound, on a regular (quarterly) basis if theyhad not had contact with the practice. They used a screeningtool as part of this to establish if there was any cause forconcern for the patient’s health.

• Nurse practitioners carried out a daily visit to a local care hometo assess and review patients’ needs and to prevent unplannedhospital admissions. GPs also provided regular visits to theservice and were available to support clinical decisions. Thenursing team had provided training to staff at the care home toenable them to better understand and respond to aspects ofpeoples’ healthcare needs.

• Home visits and urgent appointments were provided forpatients with enhanced needs and patients told us the practiceprovided home visits readily if they required these.

• The practice used the ‘Gold Standard Framework’ (this is asystematic evidence based approach to improving the supportand palliative care of patients nearing the end of their life) toensure patients received appropriate care. Feedback frompatients about the quality of end of life care provided by thepractice was very positive.

Outstanding –

People with long term conditionsThe practice is rated as good for the care of people with long-termconditions.

Good –––

Summary of findings


• The practice held information about the prevalence of specificlong term conditions within its patient population. Thisincluded conditions such as diabetes, chronic obstructivepulmonary disease (COPD), cardio vascular disease andhypertension. The information was used to target serviceprovision, for example to ensure patients who requiredimmunisations received these.

• The clinical team provided regular, structured reviews ofpatients’ health. Patients with several long term conditionswere offered a single, longer appointment to avoid multiplevisits to the surgery.

• Data from 2014 to 2015 showed that the practice hadperformed comparably to practices nationally for the care andtreatment of people with chronic health conditions. Forexample, the percentage of patients with asthma, on theregister, who had had an asthma review in the preceding 12months was 75.18% compared to a national average of 75.35%.

• A care co-ordinator contacted patients following discharge fromhospital to check if they required any services from the practice.

• The practice held regular multi-disciplinary meetings to discusspatients with complex needs and patients receiving end of lifecare.

Families, children and young peopleThe practice is rated as good for the care of families, children andyoung people.

• There were systems in place to identify and follow up childrenliving in disadvantaged circumstances and those who were atrisk, for example, children and young people who had a highnumber of A&E attendances. A GP was the designated lead forsafeguarding.

• Staff we spoke with had appropriate knowledge about childprotection and they had ready access to safeguarding policiesand procedures and the information they required to raise anysafeguarding concerns or alerts.

• Child surveillance clinics were provided for 6-8 week olds andimmunisation rates were comparable to the national averagefor all standard childhood immunisations. The practicemonitored non-attendance of babies and children atvaccination clinics and staff told us they would report anyconcerns appropriately. Immunisations could be providedwithout a pre-booked appointment to encourage uptake.

• The practice could offer appointments with an advancedpaediatric nurse practitioner who had specialist training andexperience in the diagnosis, care and treatment of ill children.

Good –––

Summary of findings


This was provided as part of a locally agreed pilot with the CCG.The pilot also included the services of a family nursepractitioner who role was to support families with health needsin the community.

• Appointments were available outside of school hours andchildren were given an appointment as priority.

• The premises were suitable for children and babies and babychanging facilities were available.

Working age people (including those recently retired andstudents)The practice is rated as good for the care of working-age people(including those recently retired and students).

• The needs of the working age population, those recently retiredand students had been identified and the practice had adjustedthe services it offered to ensure these were accessible, flexibleand offered continuity of care.

• The practice was open from 8am to 8pm Monday to Friday and8am to 1pm on Saturdays. Patients we spoke with told us thiswas very convenient for them.

• The practice provided telephone consultations for thosepatients who preferred or required these. This meant patientsdid not always have to attend the practice in person.

• The practice provided a range of health promotion andscreening that reflected the needs of this age group.

• The practice was proactive in offering online services includingthe booking of appointments and request for repeatprescriptions. Electronic prescribing was also provided. The useof an electronic prescription service enabled patients to collectmedication in the most convenient location.

Good –––

People whose circumstances may make them vulnerableThe practice is rated as outstanding for the care of people whosecircumstances may make them vulnerable.

• The practice held a register of patients living in vulnerablecircumstances in order to provide the services patientsrequired. For example, a register of people who had a learningdisability was maintained to ensure patients were providedwith an annual health check and to ensure longerappointments were provided for patients who required these.

• Staff were aware of their responsibilities regarding adultsafeguarding. For example, information sharing,

Outstanding –

Summary of findings


documentation of safeguarding concerns and how to contactrelevant agencies in normal working hours and out of hours.They provided a recent example of when they had raised asafeguarding alert.

• Staff had been provided with learning disability awarenesstraining.

• The practice responded to the needs of specific groups ofpatients including those who were older people living in a caresetting and homeless people who were supported by otherservices in the local community.

• The practice was accessible to people who required disabledaccess and facilities and services such as a hearing loop system(used to support patients who wear a hearing aid) andtranslation services were available.

• Information and advice was available about how to access arange of support groups and voluntary organisations.

• The practice hosted regular Citizens Advice Bureau sessions.

People experiencing poor mental health (including peoplewith dementia)The practice is rated as good for the care of people experiencingpoor mental health (including people with dementia).

• Data about how people with mental health needs weresupported showed that outcomes for patients using thispractice were comparable to national averages. For example,data showed that 79.17% of patients diagnosed with dementiahad had their care reviewed in a face to face meeting in thepreceding 12 months. This compared to a national average of84.01%.

• The practice provided an enhanced service to offerassessments to patients at risk of dementia and to improve thequality and effectiveness of care provided to patients withdementia.

• The practice provided primary care to patients living at a securemental health service.

• Processes were in place to prompt patients for medicinesreviews at intervals suitable to the medication they took.

• Patients experiencing poor mental health were informed abouthow to access various support groups and voluntaryorganisations.

Good –––

Summary of findings


What people who use the service sayThe results of the national GP patient survey publishedon 7January 2016 showed the practice was performingsimilar to other practices for patients’ experiences ofmaking an appointment. However, the practice scoredlower than local and national averages for questionsabout patients’ experiences during consultations withGPs. The patient survey contained aggregated datacollected between January - March 2015 and July -September 2015.

As part of the survey 399 survey forms were distributedand 106 were returned which equates to a 26.6%response rate. The response represents approximately1.2% of the practice population.

The practice received scores that were lower than theClinical Commissioning group (CCG) and national averagescores from patients for matters relating to consultationswith GPs such as: feeling listened, being given goodexplanations about tests and treatments, being involvedin decisions about their treatment and being treated withcare and concern.

For example:

• The percentage of respondents to the GP patientsurvey who stated that the last time they saw orspoke to a GP, the GP was good or very good atinvolving them in decisions about their care was63.92% compared to a CCG average of 82.72% and anational average of81.61%.

• 69.79% stated that the last time they saw or spoke toa GP, the GP was good or very good at treating themwith care and concern (CCG average 87%, nationalaverage 85.34%).

• 81.9% of respondents said the last GP they saw orspoke to was good at listening to them (CCG average90.6%, national average of 88.6%).

• 79.6% said the last GP they saw gave them enoughtime (CCG average 89.2%, national average 86.6%).

Patients’ scores for nursing staff were comparable to localand national averages. For example:

• 91.9% said the last nurse they saw or spoke to wasgood at giving them enough time compared to a CCGaverage of 94.3% and a national average of 91.9%.

• 89.7% said the last nurse they spoke to was good atlistening to them (CCG average 92.6% nationalaverage 91%).

• 89.4% said the last nurse they saw or spoke to wasgood at explaining tests and treatments (CCGaverage 90.8%, national average 89.6%).

The practice scored comparable to or higher than theCCG and national averages for questions about accessand patients’ experiences of making an appointment. Forexample:

• 63.6% of respondents gave a positive answer to thequestion 'Generally, how easy is it to get through tosomeone at your GP surgery on the phone?',compared to a CCG average of 60.54 and a nationalaverage of 73.26%.

• 76.9% described their experience of making anappointment as good (CCG average of 68.1%,national average 73.3%).

• 75.25% were fairly or very satisfied with the surgery'sopening hours (CCG average 73.72%, nationalaverage 78.3%).

• 84.5% found the receptionists at the surgery helpful(CCG average 84.4%, national average 86.8%).

Whilst respondents were overall more positive thanaverage about their experience of access andappointments the practice scored lower than average forpatients being able to see or speak to their preferred GP.The practice score for this was 17.08% compared to a CCGaverage of 30.19% and a national average of 36%.

A similar to average percentage of patients, 83.28%,described their overall experience of the surgery as goodor fairly good. This compared to a CCG average of 82.15%and a national average of 85.5%.

We spoke with ten patients during the course of theinspection visit and they told us the care and treatment

Summary of findings


they received was very good. They told us they feltlistened to, well informed about their health andtreatment options and that they were treated with careand concern by staff in all roles.

As part of our inspection process, we also asked for CQCcomment cards to be completed by patients prior to ourinspection. We received 75 comment cards. All of these

were positive about the standard of care and treatmentpatients received. Staff in all roles received highly positivefeedback. Staff were described as ‘professional’,‘respectful’, ‘excellent’, ‘friendly, ‘attentive’, ‘kind’,‘empathetic’ and ‘caring’. Patient’s comments included; ‘Itfeels a well organised and efficient practice’ and ‘They gobeyond expectation’.

Outstanding practiceAreas of outstanding practice included:

• Nurse practitioners visited patients in a large nursinghome on a daily basis to provide clinical oversight ofthe residents. This was supported by regular GP visitsand oversight. This had resulted in a decrease inunplanned hospital admissions for the residents.Nurse practitioners had also provided training tostaff to enable them to support residents with someof their health related needs.

• The practice provided primary care to homelesspeople in central Warrington. An ‘outreach nurse’and other designated leads (including a lead GP)were designated to support homeless patients. Thiswork was set up following engagement withhomeless people and some of the local agenciessupporting homeless people. The practice worked

alongside other agencies to provide the servicewhich had resulted in greater uptake of screeningand treatment for these vulnerable patients andlower rates of attendance at A&E.

• A patient co-ordinator made regular contact witholder or housebound patients who had not had anyother form of contact with the practice. They used ascreening tool as part of this to establish if there wasany cause for concern for the patient’s health.

• The practice had established a group of Polish andKurdish speaking volunteers to support new patientsin response to an increase in patients from EasternEurope. They had also established a working groupwith the Clinincal Commissioning Group (CCG) andLocal Authority with an aim to address socialisolation amongst this group.

Summary of findings


Our inspection teamOur inspection team was led by:

Our inspection team was led by a CQC Lead Inspector.The team included a GP specialist advisor, a practicemanager specialist advisor and an expert by experience.An expert by experience is a person who has personalexperience of using or caring for someone who uses thistype of service.

Background to Dr AlaguRajkumarDr Alagu Rajkumar is located in Orford Jubilee Park, JubileeWay, Warrington, Cheshire WA2 8HE. The practice wasproviding a service to approximately 8,800 patients at thetime of our inspection. The practice is situated in an areawith high levels of deprivation when compared to otherpractices nationally. The percentage of patients with a longstanding health conditions is similar to local and nationalaverages.

The practice is run by one GP. There are an additional threesalaried GPs (3 male and 1 female). There are five practicenurses, three of whom are nurse practitioners, a health careassistant, a practice manager and a team of reception/administration staff. The practice is open from 8am to 8pmMonday to Friday and 8am to 1pm on Saturdays. Thepractice has a branch surgery located at 74 Bewsey Street,Bewsey, Warrington, WA2 7JE. We visited the branchsurgery as part of our inspection. The Bewsey Surgery isopen from 9am to 5.30 Monday to Friday. Outside ofpractice hours patients can access the Bridgewater Trustfor primary medical services.

The practice has a Personal Medical Services (PMS)contract. The practice provides a range of enhancedservices, for example: childhood vaccination andimmunisation schemes, online access to GP practiceinformation systems for booking of appointments, bookingof repeat prescriptions and for registering patients, andavoiding unplanned hospital admissions.

Why we carried out thisinspectionWe carried out a comprehensive inspection of this serviceunder Section 60 of the Health and Social Care Act 2008 aspart of our regulatory functions. The inspection wasplanned to check whether the provider is meeting the legalrequirements and regulations associated with the Healthand Social Care Act 2008, to look at the overall quality ofthe service, and to provide a rating for the service under theCare Act 2014.

How we carried out thisinspectionBefore visiting, we reviewed a range of information that wehold about the practice and asked other organisations toshare what they knew. We carried out an announced visiton 19 April 2016. During our visit we:

• Spoke with a range of staff including GPs, practicenurses, the practice manager, deputy practice manager,reception and administrative staff.

• Spoke with patients who used the service and met withmembers of the patient participation group (PPG).

• Observed how staff interacted with patients face to faceand when speaking with people on the telephone.

DrDr AlaguAlagu RRajkajkumarumarDetailed findings


• Reviewed CQC comment cards which included feedbackfrom patients about their experiences of the service.

• Looked at the systems in place for the running of theservice.

• Viewed a sample key policies and procedures.

To get to the heart of patients’ experiences of care andtreatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

We also looked at how well services are provided forspecific groups of people and what good care looks likefor them. The population groups are:

• Older people

• People with long-term conditions

• Families, children and young people

• Working age people (including those recently retiredand students)

• People whose circumstances may make themvulnerable

• People experiencing poor mental health (includingpeople with dementia)

Please note that when referring to information throughoutthis report, for example any reference to the Quality andOutcomes Framework data, this relates to the most recentinformation available to the CQC at that time.

Detailed findings


Our findingsSafe track record and learning

There was an effective system in place for reporting andrecording significant events. Staff told us they would informthe practice manager of any incidents and there was also aform for recording these available on the practice’scomputer system. The practice carried out a thoroughanalysis of significant events. Significant events andmatters about patient safety were discussed at regularpractice meetings and we were assured that learning fromevents had been disseminated and implemented intopractice to prevent a re-occurrence. The practice alsoshared the learning from events with partner agencies andreported events locally and through the national reportingsystem. The records to demonstrate the actions taken inresponse to events were clear and informative. If asignificant event warranted immediate learning andsharing the provider arranged a meeting to discuss thedetails of this and ensure prompt action was taken.

Overview of safety systems and processes

The practice had clearly defined and embedded systems,processes and practices in place to keep people safe andsafeguarded them from abuse, which included:

• Arrangements were in place to safeguard children andvulnerable adults that reflected relevant legislation andlocal requirements and safeguarding policies wereaccessible to all staff. The policies clearly outlined whoto contact for further guidance if staff had concernsabout a patient’s welfare. Contact details and processflowcharts for reporting concerns were displayed in theclinical areas. Alerts were recorded on the electronicpatient records system to identify if a child or adult wasat risk. The registered provider was the lead member ofstaff for safeguarding. The GPs provided safeguardingreports where necessary for other agencies. All staff hadreceived safeguarding training relevant to their role. Forexample the GPs were trained to Safeguarding level 3.Staff demonstrated they understood theirresponsibilities to report safeguarding. Thesafeguarding lead provided a recent example of howthey had recognised and raised a safeguarding alertpromptly.

• Staff were available to act as chaperones if required. (Achaperone is a person who acts as a safeguard and

witness for a patient and health care professional duringa medical examination or procedure). Staff who acted aschaperones were trained for the role and had received adisclosure and barring service check (DBS check). (DBSchecks identify whether a person has a criminal recordor is on an official list of people barred from working inroles where they may have contact with children oradults who may be vulnerable).

• The practice maintained appropriate standards ofcleanliness and hygiene. We observed the premises tobe clean and tidy. There was an infection controlprotocol in place and staff had received up to datetraining. A nurse practitioner was the infection controllead. They were responsible to liaise with the localinfection prevention team and they carried out regularinfection control audits. The practice had achieved highscores in the audits.

• The arrangements for managing medicines, includingemergency drugs and vaccinations were appropriateand safe. Patient Group Directions had been adopted bythe practice to allow nurses to administer medicines inline with legislation. There was a system to ensure thesafe issue of repeat prescriptions. Patients who wereprescribed potentially harmful drugs were monitoredregularly and appropriate action was taken if test resultswere abnormal. Regular audits were undertaken tomonitor medicines prescribing practices. Prescribingdata for the practice was comparable to nationalprescribing data. Staff attended regular meetings withthe Clinical Commissioning Group (CCG) to look atprescribing issues across the locality and how thesecould be improved.

• We reviewed a sample of staff personnel files in order toassess the staff recruitment practices. Our findingsshowed that appropriate recruitment checks had beenundertaken prior to employment. For example, proof ofidentification, references, proof of qualifications, proofof registration with the appropriate professional bodiesand checks through the Disclosure and Barring Service.

Monitoring risks to patients

There were procedures in place for monitoring andmanaging risks to patient and staff safety.

• There was a health and safety policy available. Thepractice had an up to date fire risk assessment. Allelectrical equipment was checked to ensure the

Are services safe?

Good –––


equipment was safe to use and clinical equipment waschecked to ensure it was working properly. The practicealso had a variety of other risk assessments in place tomonitor safety of the premises such as control ofsubstances hazardous to health and infection controland legionella.

• Arrangements were in place for planning andmonitoring the number of staff and mix of staff neededto meet patients’ needs. There was a rota system inplace for the different staffing groups to ensure thatenough staff were on duty at all times.

Arrangements to deal with emergencies and majorincidents

The practice had arrangements in place to respond toemergencies and major incidents.

• There was an instant messaging system on thecomputers in all the consultation and treatment roomswhich alerted staff to any emergency.

• All staff had received annual basic life supporttraining.The practice had emergency medicinesavailable.These were readily accessible to staff in asecure area of the practice and staff knew of theirlocation. There was a robust system in place to ensurethe medicines were in date and fit for use. The practicehad a defibrillator (used to attempt to restart a person’sheart in an emergency) available on the premises andoxygen with adult and children’s masks.

• Systems were in place to record accidents andincidents.

• A system was in place for responding to patient safetyalerts to ensure the information was disseminated tostaff who needed to know.

The practice had a business continuity plan in place formajor incidents such as power failure or building damage.

Are services safe?

Good –––


Our findingsEffective needs assessment

The clinicians assessed patients’ needs and delivered carein line with relevant and current evidence based guidanceand standards, including National Institute for Health andCare Excellence (NICE) best practice guidelines. NICEprovides evidence-based information for healthprofessionals.

Staff had ready access to guidelines from NICE and usedthis information to deliver care and treatment that metpeoples’ needs. GPs clearly demonstrated that theyfollowed treatment pathways and provided treatment inline with the guidelines for people with specific healthconditions. They also demonstrated how they usednational standards for the referral of patients to secondarycare, for example the referral of patients with suspectedcancers.

The practice monitored the implementation of bestpractice guidelines through a series of meetings, peerreview and staff appraisal.

The practice used a system of coding and alerts within theclinical record system to ensure that patients with specificneeds were highlighted to staff on opening their clinicalrecord.

Management, monitoring and improving outcomes forpeople

The practice used information collected for the QualityOutcomes Framework (QOF) and performance againstnational screening programmes to monitor outcomes forpatients. QOF is a system intended to improve the qualityof general practice and reward good practice. The mostrecent published results showed that the practice hadachieved 100% of the total number of points available withan overall exception reporting rate of 16.9% which is higherthan the national average of 5.5%. Exception reporting isthe removal of patients from QOF calculations where, forexample, the patients are unable to attend a reviewmeeting or certain medicines cannot be prescribedbecause of side effects. This practice was not an outlier forany QOF (or other national) clinical targets. Data from 01/04/2014 to 31/03/2015 showed;

• Performance for diabetes related indicators werecomparable to or in some cases higher than the Clinical

Commissioning Group (CCG) and national average. Forexample, the percentage of patients on the diabetesregister, with a record of a foot examination and riskclassification within the preceding 12 months was91.92% % compared to a CCG average of 82.26% and anational average of 88.3%.

• The percentage of patients with chronic obstructivepulmonary disease (COPD) who had a reviewundertaken including an assessment of breathlessnessin the preceding 12 months was 91.36% compared to aCCG average of 91.3% and a national average of 89.9%.

• The performance for mental health related indicatorswas comparable to or in some cases higher than thenational average. For example, the percentage ofpatients diagnosed with dementia whose care had beenreviewed in a face-to-face review in the preceding 12months was 91.36% compared to a CCG average of91.36% a national average of 89.9%.

• The percentage of patients with schizophrenia, bipolaraffective disorder and other psychoses who had acomprehensive, agreed care plan in the preceding 12months was 91.78% compared to a CCG average of92.58% and a national average of 88.47%. We noted thatexception reporting for mental health indicators washigher than the national average.

We looked at the processes in place for clinical audit.Clinical audit is a way to find out if the care and treatmentbeing provided is in line with best practice and it enablesproviders to know if the service is doing well and wherethey could make improvements. The aim is to promoteimprovements to the quality of outcomes for patients. Wefound there had been a number of clinical auditscompleted in the last two years. One of these was acompleted two cycle audit with regards to the prescribingof opiates for chronic pain relief. This had improvedprescribing practices and ensured a greater number ofpatients had access to alternative medicines for painmanagement.

A range of meetings were held to share information andreview outcomes for patients. A rolling programme ofweekly meetings included; a review of mortality, a review ofreferrals, a review of medicines and prescribing practises, a

Are services effective?(for example, treatment is effective)

Good –––


review of significant events and the learning from these.Some of the meetings included multi-disciplinaryprofessionals such as community matrons, health visitors,midwives and McMillan nurses from across the locality.

Effective staffing

Staff had the skills, knowledge and experience to delivereffective care and treatment.

• The practice had an induction programme for newlyappointed members of staff. The head of nursing haddeveloped a comprehensive induction programme forthe induction of practice nurses.

• Staff told us they felt well trained and sufficientlyexperienced to meet the roles and responsibilities oftheir work. Staff had been provided with training in coretopics including: safeguarding, fire procedures, basic lifesupport and information governance awareness.

• Staff had been provided with role-specific training. Forexample, staff who provided care and treatment topatients with long-term conditions had been providedwith training in the relevant topics such as diabetes,podiatry and spirometry. Other role specific trainingincluded training in topics such as administeringvaccinations and taking samples for the cervicalscreening programme.

• Clinical staff were kept up to date with relevant training,accreditation and revalidation. There was a system inplace for annual appraisal of staff and this included arange of review meetings. Appraisals provide staff withthe opportunity to review/evaluate their performanceand plan for their training and professionaldevelopment. The practice had a system in place forpeer review and used a range of meetings as a means toassess the clinical care and treatment provided by theclinical team.

• Clinical staff held lead roles in a range of areasincluding: respiratory, diabetes, immunisations, childhealth, mental health, prescribing,safeguarding andclinical governance.

• The practice had a designated head of nursing. They lednursing led services such as the daily visits to a largenursing home and this include supporting and trainingstaff at the facility. Two of the nurses were trained to anadvanced practice level of training for diabetes andrespiratory. The practice was working alongside a local

education provider to start receiving pre-registerednurses on a primary care placement. They were alsoworking to become a placement for post registrationspecilist nurse practitioner students in the near future.

• Staff attended a range of internal and external meetings.GPs attended meetings with the CCG and worked acrossa federation of practices and a cluster of practices.Practice nurses attended local practice nurse forums.The practice was closed for one half day per month toallow for ‘protected learning time’ which enabled staffto attend meetings and undertake training andprofessional development opportunities.

Coordinating patient care and information sharing

The information needed to plan and deliver care andtreatment was available to relevant staff in a timely andaccessible way through the practice’s patient record systemand intranet system. This included care plans, medicalrecords, investigations and test results. Information such asNHS patient information leaflets were also available. Thepractice shared relevant information with other services ina timely way, for example when referring people to otherservices.

The practice reviewed hospital admissions data on aregular basis. GPs used national standards for the referralof patients with suspected cancers to be referred and seenwithin two weeks. Systems were in place to ensure referralsto secondary care and results were followed up.

Staff worked together and with other health and social careprofessionals to understand and meet the range andcomplexity of patients’ needs and to assess and planongoing care and treatment. This included when peoplemoved between services, including when they werereferred, or after they were discharged from hospital. Wesaw evidence that multi-disciplinary meetings took placeon a regular basis for information sharing and serviceplanning purposes.

The practice used the ‘Gold Standard Framework’ (this is asystematic evidence based approach to improving thesupport and palliative care of patients nearing the end oftheir life) to ensure patients received appropriate care. GoldStandard Framework meetings were held withmultidisciplinary professionals on a regular basis.

Nurse practitioners visited a local care home on a dailybasis to provide clinical oversight of the residents. This was


Good –––


supported by regular GP visits and oversight. This hadresulted in a decrease in unplanned hospital admissionsfor the residents. Nurse clinicians had also providedtraining to staff to enable them to support residents withtheir health related needs and further training wasplanned.

The practice took part in an enhanced service to supportpatients to avoid an unplanned admission to hospital. Thisis aimed at reducing admissions to Accident andEmergency departments by treating patients within thecommunity or at home. As part of this the practice haddeveloped care plans with patients to prevent unplannedadmissions to hospital and they monitored unplannedadmissions.

Consent to care and treatment

Staff sought patients’ consent to care and treatment in linewith legislation and guidance.

• Staff understood the relevant consent anddecision-making requirements of legislation andguidance, including the Mental Capacity Act 2005.

• When providing care and treatment for children andyoung people, staff were aware of their responsibility tocarry out assessments of capacity to consent in line withrelevant guidance.

• Where a patient’s mental capacity to consent to care ortreatment was unclear the GP or practice nurseassessed the patient’s capacity and, where appropriate,recorded the outcome of the assessment.

Health promotion and prevention

The practice identified patients in need of extra support.These included patients in the last 12 months of their lives,patients with conditions such as heart failure,hypertension, epilepsy, depression, kidney disease andthose at risk of developing a long-term condition. Patientswith these conditions or at risk of developing them werereferred to or signposted for lifestyle advice such as dietaryadvice or smoking cessation.

Information and advice was available about how patientscould access a range of support groups and voluntaryorganisations.

The practice encouraged patients to attend nationalscreening programmes. The practice’s uptake for thecervical screening programme was 81.26%, which wascomparable with the national average of 81.83%. However,bowel cancer screening and breast cancer screeninguptake rates were lower than the national average.

Childhood immunisation rates for the vaccinations givenwere comparable to local averages. For example, childhoodimmunisation rates for the vaccinations given to under twoyear olds ranged from 89.8% to 94.1%. This wascomparable to CCG averages.

Patients had access to appropriate health assessments andchecks. These included health checks for new patients andNHS health checks for people aged 40–74. Appropriatefollow-ups on the outcomes of health assessments andchecks were made, where abnormalities or risk factorswere identified.


Good –––


Our findingsRespect, dignity, compassion and empathy

We observed that members of staff were courteous andhelpful to patients and treated them with dignity andrespect. Curtains were provided in consulting rooms tomaintain patients’ privacy and dignity during examinations,investigations and treatments. We noted that consultationand treatment room doors were closed duringconsultations and that conversations taking place in theserooms could not be overheard. Reception staff knew thatthey could offer patients a private area for discussionswhen patients wanted to discuss sensitive issues or if theyappeared uncomfortable or distressed.

We made patient comment cards available at the practiceprior to our inspection visit. We received 75 comment cardsall of which were positive and complimentary about thecaring nature of the service provided by the practice.Patients told us in the comment cards that they felt thepractice offered an ‘excellent’ service and staff were helpfuland treated them with dignity and respect. Patients’feedback described staff as; ‘‘professional’, ‘respectful’,‘friendly, ‘attentive’, ‘kind’, ‘empathetic’ and ‘caring’.Patient’s comments included; ‘They go beyondexpectation’, ‘I would give staff a ten’ and ‘they take time tospeak with patients’.

During our discussions with staff that they consistentlydemonstrated a caring and patient centred approach totheir work.

Results from the national GP patient survey showed thepractice received scores that were comparable to theClinical Commissioning group (CCG) and national averagefor matters relating to the care and concern shown to themduring consultations with nurses. The practice scored lowerthan local and national averages for the same matters forconsultations with GPs.

For example:

• 79.6% of respondents said the last GP they saw gavethem enough time compared to a CCG average of 89.2%and a national average 86.6%.

• 91.9% said the last nurse they saw or spoke to was goodat giving them enough time (CCG average of 94.3%,national average of 91.9%).

• 69.79% said that the last time they saw or spoke to a GP,the GP was good or very good at treating them with careand concern (CCG average 87%, national average85.34%).

• 90.15% said that the last time they saw or spoke to anurse, they were good or very good at treating themwith care and concern (CCG average 90.76%, nationalaverage 90.58%).

• 91.1% said they had confidence and trust in the last GPthey saw (CCG average 96.8%, national average 95.2%).

• 97.6% said they had confidence and trust in the lastnurse they saw or spoke to (CCG average of 98.1%,national average 97.1%).

The practice scored comparable to local and nationalaverages with regards to the helpfulness of reception staffand patients’ overall experiences of the practice: Forexample:

• 84.5% found the receptionists at the surgery helpful(CCG average 84.4%, national average 86.8%).

• 83.28% described their overall experience of the surgeryas good or fairly good (CCG average 82.15%, nationalaverage of 85.5%).

We met with ten patients who were attending the practiceat the time of our inspection including some members ofthe patient participation group (PPG). All of the patients wespoke with gave us very positive feedback about the caringnature of the GPs, clinical staff and the reception team.

Care planning and involvement in decisions aboutcare and treatment

Patients told us they in face to face discussions and incomments cards that they felt listened to and wellinformed about their health conditions. They told us theclinical staff provided them with information to enablethem to make informed decisions about their treatment.

Results from the national patient survey showed that thepractice received scores that were comparable to theClinical Commissioning group (CCG) and national averagefrom patients for matters relating to their involvement indecisions during consultations with nurses. The practicescored lower than local and national averages for the samematters for consultations with GPs. For example;

Are services caring?

Good –––


• The percentage of respondents who said the last GPthey saw was good at listening to them was 81.9%compared to a CCG average of 90.6% and a nationalaverage of 88.6%.

• 89.7% said the last nurse they saw or spoke to was goodat listening to them (CCG average of 92.6%, nationalaverage of 91.0%).

• 69.2% said the last GP they saw was good at explainingtests and treatments (CCG average of 86%, nationalaverage of 86%).

• 89.4% said the last nurse they saw or spoke to was goodat explaining tests and treatments (CCG average of90.8%, national average of 89%).

• 63.92% stated that the last time they saw or spoke to aGP, the GP was good or very good at involving them indecisions about their care (CCG average 82.72%,national average 81.61%).

• 80.97% said the last nurse they saw or spoke to wasgood or very good at involving them in decisions abouttheir care (CCg average 85.26%, national average of85.09%).

The provider had taken a number of actions to improvepatients’ experiences of their consultations with GPs inresponse to the patient survey results. These included; aseries of ‘effective communications skills’ and ‘triage skills’workshops and staff had completed two out of six plannedhalf day workshops. GPs were bringing forward theirpatient satisfaction questionnaire for their next appraisal.The provider felt the use of a number of different locumGPs may have contributed to the patient survey findings.This had since reduced with the use of long term sessionalGPs.

Translation services were available for patients who did nothave English as their first language. Polish and Kurdishspeaking volunteers had been identified to support EasternEuropean patients experiencing cultural and languagebarriers. The practice’s website provided information aboutthe services provided in a wide range of languages.

Patient and carer support to cope emotionally withcare and treatment

Patient information leaflets and notices were available inthe patient waiting area which informed pateints of how toaccess a number of support groups and organisations.Information about support groups was also available onthe practice website.

The practice’s computer system alerted GPs if a patient wasalso a carer. The practice had identified 70 patients ascarers. The practice wrote to carers advising them of theirservices and a carers’ leaflet was available. Writteninformation was available to direct carers to the variousavenues of support available to them. Carers were offeredflu immunisations and health checks and could be givenlonger appointments if they required this.

Patients receiving end of life care were signposted tosupport services and a number of patients told us that theend of life care provided to members of their family hadbeen very good.

Staff told us they contacted families who had sufferedbereavement and signposted them to bereavementsupport services. A number of patients we spoke with toldus the support provided by the practice team followingbereavement was very good and supportive.

Are services caring?

Good –––


Our findingsResponding to and meeting people’s needs

The practice reviewed the needs of its local population andengaged with the NHS England Area Team and ClinicalCommissioning Group (CCG) to secure improvements toservices where these were identified. For example, thepractice worked to ensure unplanned admissions tohospital were prevented through identifying patients whowere at risk and developing care plans with them toprevent an unplanned admission.

The practice was providing a number of innovative practiceled services in response to the needs of the patientpopulation. For example:

• The practice provided primary care to homeless peoplein central Warrington. The service was initiated by theprovider and was not part of a contracted service. An‘outreach nurse’ and other leads (including a lead GP)were designated to support homeless patients. Clinicalstaff provided primary care on an outreach basis once ortwice per week. Patients were also signposted to seeksupport from other agencies and support networks. Thiswork was set up following engagement with homelesspeople and some of the local agencies supportinghomeless people. One of the local agencies the practiceworked alongside told us the impact of the support thepractice provided had resulted in an increase in theuptake of treatment for homeless patients and that thisin turn contributed to patients avoiding attendance atA&E.

• The practice provided primary care to a secure mentalhealth service. Designated leads within the practicesupported this and weekly visits were provided inaddition to requests for individual appointments. Thepractice had supported patients to establish secureinternet access to their records. The service had beenrunning for four years and was progressing to supportpatients with further enhancements to include fullannual medicals for all patients, genetic screening,assessments for cardio myopathies and assessments formetabolic disorders as some of the patients wereprescribed toxic anti-psychotic medication.

• Nurse clinicians visited a large local nursing home on adaily basis to provide clinical oversight of the residents.This was supported by regular GP visits and oversight.

This had resulted in a decrease in unplanned hospitaladmissions for the residents. Nurse clinicians had alsoprovided training to staff to enable them to bettersupport residents and further training was planned.

• A patient co-ordinator made regular contact with olderor housebound patients who had not had any otherform of contact with the practice. They used a screeningtool as part of this to establish if there was any cause forconcern for the patient’s health.

• The practice had established a group of Polish andKurdish speaking volunteers to support new patients inresponse to an increase in patients from EasternEurope. They had also established a working group withthe Clinincal Commissioning Group (CCG) and LocalAuthority with an aim to address social isolationamongst this group.

Access to the service

The practice was open from 8am to 8pm Monday to Fridayand 8am to 1pm on Saturdays. The practice had a branchsurgery located at 74 Bewsey Street, Bewsey, Warrington,WA2 7JE. The Bewsey Surgery was open from 9am to 5.30Monday to Friday. Outside of practice hours patients canaccess the Bridgewater Trust for primary medical services.

The appointment system was well managed andsufficiently flexible to respond to peoples’ needs. Thenumber of clinical appointments provided and theprovision of extended opening hours, which was practiceinitiated and not contracted, meant that patients hadaccess to a range of appointments that suited their needs.Urgent appointments were available for patients whorequired these and routine appointments could be madeon the day or they could be pre-booked. Longerappointments and home visits were available for olderpatients and patients with enhanced needs. Same dayappointments were provided for patients who required anurgent appointment and for young children and patientswith serious medical conditions.

Patients told us on the day of the inspection that they wereable to get appointments when they needed them. Resultsfrom the national GP patient survey showed that patients’satisfaction with how they could access care and treatmentwas comparable to local and national averages.

Are services responsive to people’s needs?(for example, to feedback?)

Outstanding –


• The percentage of respondents who gave a positiveanswer to ‘Generally how easy is it to get through tosomeone at your GP surgery on the phone’ was 63.62%compared to a CCG average of 60.54% and a nationalaverage of 73.26%.

• 75.25% were ‘very satisfied’ or ‘fairly satisfied’ with theirGP practice opening hours (CCG average 73.71%,national average of 78.3%).

• 67.9% said they were able to get an appointment thelast time they wanted to see or speak with a GP or nurse(CCG 70.5%, national average of 76%).

• 76.9% described their experience of making anappointment as good (CCG average 68.1%, nationalaverage 73.3%).

• 91.4% said the last appointment they got wasconvenient (CCG average of 91.7%, national average of91.8%).

The practice was located in a purpose built building. Thepremises were accessible and facilities for people whowere physically disabled were provided. Other reasonableadjustments had been made and action taken to removebarriers when people found it hard to use or accessservices. For example, a hearing loop system was availableto support people who had difficulty hearing andtranslation services were available.

The Bewsey Surgery branch surgery provided ground floorfacilities. This was located directly opposite a new site

which was in the process of being built at the time of theinspection. The new site will provide purpose built and fullyaccessible facilities and the provider told us they intendedthat this would become the new main location for thepractice. The provider had consulted with patients aboutthe design and the provision of services and facilities forthe future premises.

Listening and learning from concerns and complaints

The practice had an effective system in place for handlingcomplaints and concerns. A complaints policy andprocedure was in place. This required review to ensurepatients were provided with the most up to dateinformation about making a complaint. Information wasavailable to inform patients how to make a complaint anda leaflet was available to inform patients of how to make acomplaint about an NHS service.

There was a designated member of staff responsible forhandling complaints. We looked at complaints received inthe last 12 months and found that these had been handledappropriately. Complaints had been logged, investigatedand responded to in a timely manner and patients hadbeen provided with a thorough explanation and anapology when this was appropriate.

We found the practice had learnt from complaints andaction had been taken improve the quality of care andpatients’ experience of the service.

Are services responsive to people’s needs?(for example, to feedback?)

Outstanding –


Our findingsVision and strategy

The practice had a statement of purpose which outlinedtheir aims to deliver high quality care and promote goodoutcomes for patients. Staff knew and understood thevalues within this.

The GP provider had knowledge of and incorporated localand national objectives. They were the chair for afederation of practices within the Clinical CommissioningGroup (CCG) and worked to provide services as part of acluster of practices. The GP provider held a position withinthe Health and Social Care Information Centre (HSCIC) as asenior clinical advisor. They had won a national award in2013 in recognition of their work supporting NHS clinicians.The provider was keen to pilot new and innovativepractises at the practice. For example the practice hadpreviously been involved in a community diagnosticimaging pilot and the practice had received accolade forthe innovative use of information technology.

Governance arrangements

The provider had an overarching framework for governingthe practice. This supported the delivery of the strategy andgood quality care.

• Clinical staff used evidence based guidance in theirwork and systems were in place to ensure there wasoversight of clinical decisions and treatment.

• The GPs had a clear understanding of the performanceof the practice. The practice used the Quality andOutcomes Framework (QOF) and other performanceindicators to measure their performance. The QOF datashowed that the practice achieved results comparableto or higher than other practices locally and nationallyfor the indicators measured.

• A programme of continuous clinical and internal auditwas used to monitor quality and to makeimprovements.

• There were arrangements for identifying, recording andmanaging risks and implementing mitigating actions.

• There were clear methods of communication across thestaff team. Records showed that a range of regularmeetings were carried out as part of the quality reviewand improvement process.

• Practice specific policies and standard operatingprocedures were available to all staff. Staff we spokewith knew how to access these and any otherinformation they required in their role.

Leadership, openness and transparency

The GP provider had the experience, capacity andcapability to run the practice and ensure high quality care.They prioritised safe, high quality and compassionate care.The provider was visible in the practice and staff told usthat they were approachable and took the time to listenthem.

The provider was aware of and complied with therequirements of the Duty of Candour. The partnersencouraged a culture of openness and honesty. Theprocesses for reporting concerns were clear and staff toldus they felt confident to raise any concerns withoutprejudice.

Significant events had been fully investigated and whenthere were unexpected or unintended safety incidentsaffected people had been given reasonable support and anexplanation.

There was a clear leadership and staffing structure and staffwere aware of their roles and responsibilities. Staff in allroles felt supported and appropriately trained andexperienced to meet their responsibilities. Staff had beenprovided with a range of training linked to their roles andresponsibilities.

Staff in all roles said they felt respected, valued andsupported in their role. Staff were involved in discussionsabout how to run and develop the practice, and theprovider encouraged staff to identify opportunities toimprove the service delivered.

The GPs had been supported to meet their professionaldevelopment needs for revalidation (GPs are appraisedannually and every five years they undergo a process calledrevalidation whereby their licence to practice is renewed.This allows them to continue to practise and remain on theNational Performers List held by NHS England).

Seeking and acting on feedback from patients, thepublic and staff

Feedback from patients about staff in all roles was verypositive. Patients told us they felt the practice provided agood quality service.

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


The practice used feedback from patients to makeimprovements to the service. For example they madeimprovements in response to the learning from complaints,they had introduced training for staff in response to theresults of the national patient survey and they regularlyreviewed the results of the NHS Friends and family test toidentify where they could make improvements.

The practice actively encouraged and valued feedbackfrom patients. The practice had a well-established andengaged patient participation group (PPG). Members of thePPG told us they attended regular meetings with the GPprovider and practice manager and they gave us a numberof examples of how the practice had made improvementsto the service in response to their feedback. For example,the extended opening hours had been introduced inresponse to feedback form the PPG. The PPG had also beenconsulted with regarding the building and design of thenew premises which were in the process of being built.

Continuous improvement

There was a strong focus on continuous learning andimprovement at all levels within the practice. The providerwas forward thinking and had initiated local pilot schemesto improve outcomes for patients in the area. The providerwas keen to promote nurse led clinical work alongside GPgovernance and this was having a positive impact onoutcomes for patients in a number of areas. The providerwas clearly aware of the impact of the demographics of thepatient population and impact of the prevalence of healthand social care issues. They were keen for completion ofthe building of the new practice and the potential for thefuture development of the service as a result of this.

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


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