Quorn Medical Centre NewApproachComprehensive Report ......Dateofpublication:09/03/2017 1 Quorn...

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 Outstanding –

Are services safe? Good –––

Are services effective? Outstanding –

Are services caring? Good –––

Are services responsive to people’s needs? Outstanding –

Are services well-led? Outstanding –

QuornQuorn MedicMedicalal CentrCentreeQuality Report

1 Station RoadQuornLeicestershireLE12 8BPTel: 01509 410800Website: www.quornmedicalcentre.co.uk

Date of inspection visit: 10/01/2017Date of publication: 09/03/2017

1 Quorn Medical Centre Quality Report 09/03/2017

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 12

Outstanding practice 12

Detailed findings from this inspectionOur inspection team 13

Background to Quorn Medical Centre 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 GeneralPractice

We carried out an announced comprehensive inspectionat Quorn Medical Centre on 10 January 2017. Overall thepractice is rated as outstanding.

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

• There was an open and transparent approach tosafety within the practice. Effective systems were inplace to report, record and learn from significantevents. Learning was shared with staff and externalstakeholders where appropriate.

• Risks to patients were assessed and well managed.Staff assessed patients’ needs and delivered care inline with current evidence based guidance.

• Outcomes for people who use the service wereconsistently better than expected when compared toother practices.

• Training was provided for staff which equipped themwith the skills, knowledge and experience to delivereffective care and treatment.

• Patients were valued as individuals and empoweredas partners in their care. They told us they weretreated with compassion, dignity and respect andthey were involved in their care and decisions abouttheir treatment.

• National patient survey results showed 98% ofpatients said they were able to get an appointmentto see or speak to someone the last time they tried.This was much better than others locally.

• Information about services and how to complainwas available and easy to understand.Improvements were made to the quality of care as aresult of complaints and concerns and learning fromcomplaints was shared with staff and stakeholders.

• The leadership, governance and culture were used todrive and improve the delivery of high quality personcentred care. The practice proactively soughtfeedback from staff and patients, which it acted on.

• The provider was aware of and complied with therequirements of the duty of candour.

We saw some areas of outstanding practice, including:

Summary of findings


• GPs had led and delivered improved outcomes andcare for patients including across the local ClinicalCommissioning Group (CCG) and over wide range ofclinical areas including diabetes. The practiceactively sought to prevent diabetes through theidentification and follow up of patients withpre-diabetes or statistically at risk of diabetes.

• Services were tailored to meet the needs ofindividual people and delivered in a way to ensure

flexibility, choice and continuity of care, asdemonstrated by below average for their use ofaccident and emergency (A&E), emergencyadmissions and outpatient referrals in 2015/16.

• There was evidence of a highly engaged andproactive patient participation group (PPG) whoparticipated in a number of initiatives to enrich thelives of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP)Chief Inspector 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.

• There was an effective system in place to ensure significantevents were reported and recorded.

• Lessons were shared internally and externally whenappropriate to make sure action was taken to improve safety inthe practice.

• When things went wrong patients received support,information and apologies where appropriate. They were toldabout any actions to improve processes to prevent the samething happening again.

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

• Risks to patients were well assessed and managed within thepractice.

• Appropriate recruitment checks had been carried out onrecently recruited staff.

Good –––

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

• Outcomes for people who use the service were consistentlybetter than expected when compared to other practices. Datafrom the Quality and Outcomes Framework (QOF) showedpatient outcomes were above average compared to thenational average. The most recently published results showedthe practice had achieved 100% of the total number of pointsavailable. This was 3% above the clinical commissioning group(CCG) average and 5% above the national average. The overallexception reporting rate was 6.6%, compared to the CCGaverage of 9.6% and the national average of 10%.

• Clinical quality outcomes were highly positive for indicatorsrelated to older people, people with long term conditions andpeople whose circumstances made them vulnerable.

• Staff used current evidence based guidance and localguidelines to assess the needs of patients and deliverappropriate care.

• There was an ongoing programme of clinical audit within thepractice. The audits undertaken demonstrated improvementsin quality.

Outstanding –

Summary of findings


• Staff had the skills, knowledge and experience to delivereffective care and treatment. There was evidence of appraisalsand personal development plans for all staff.

• Staff worked with other health care professionals to understandand meet the range and complexity of patients’ needs.

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

• Patients said they were treated with compassion, dignity andrespect and they were involved in decisions about their careand treatment.

• The practice demonstrated a caring approach by working withtheir PPG to participate in a number of initiatives to enrich thelives of patients.

• Results from the national GP patient survey showed there werea number of areas where patients rated the practice higher thanothers locally and nationally.

• Information for patients about the services available was easyto understand and accessible.

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

• Views of external stakeholders were positive about the practiceand aligned with our findings.

Good –––

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

• Services were tailored to meet the needs of individual peopleand delivered in a way to ensure flexibility, choice andcontinuity of care.

• Patients told us urgent appointments were generally availablethe same day with the GP of their choice and that receptionstaff were accommodating to patients’ needs.

• Feedback from the national patient survey was highly positiveabout access to appointments.

• CCG data indicated the practice was below average for their useof accident and emergency (A&E), emergency admissions andoutpatient referrals in 2015/16.Staff attributed theirperformance to their good access and use of the acute visitingservice.

• Extended opening hours were provided from 6.45am to 8am onThursday and Friday mornings, with GP and nurse

Outstanding –

Summary of findings


appointments. Additionally, the practice self-funded theprovision of appointments with the healthcare assistant duringthe extended opening hours as this was not covered in theiragreement with NHS England.

• The practice provided a range of services within its premisesincluding dermatology and hosted diabetic retinopathy clinics.

• Information about how to complain was available and easy tounderstand and evidence showed the practice respondedquickly to issues raised. Learning from complaints was sharedwith staff and other stakeholders.

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

• The leadership, governance and culture were used to drive andimprove the delivery of high quality person centred care. Thepractice had a clear vision and strategy to deliver high qualitycare and promote good outcomes for patients. This wasunderpinned by clear business development plans and regularmonitoring of areas for improvement and development.

• There was a governance framework which supported thedelivery of the strategy and good quality care. This includedarrangements to monitor and improve quality and identify risk.

• The practice had a well engaged and proactive patientparticipation group who were committed to promoting thepractice health priorities through hosting health events forpatients and the local community.

• The practice proactively sought feedback from staff andpatients, and looked at ways to improve patient experience.

• There was evidence of continuous improvement throughshared learning from the collaboration with neighbouringpractices.

Outstanding –

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.

• They offered proactive, personalised care to meet the needs ofthe older people in their population. Monthly multidisciplinarymeetings were held to review frail patients and those at risk ofhospital admission to plan and deliver care appropriate to theirneeds. These included patients living in care homes.

• Home visits were available for older patients and patients whohad clinical needs which resulted in difficulty attending thepractice. Requests were assigned to a home visiting serviceoperated in the local area, ensuring patients were seenpromptly.

• Elderly people who may be isolated were signposted to a localbefriending scheme where they could be matched to avolunteer who visited them regularly to offer friendship andsupport.

• Feedback from a care home whose residents were registeredwith the practice was positive about the care and treatmentprovided, including support with end of life care needs. Stafffrom the care home told us all practice staff were highlyresponsive to their needs and GPs visited promptly whenneeded.

• Data from 2015/16 showed 75% of eligible patients aged over65 years were given flu vaccinations, compared to the CCGaverage of 71.5%. Pneumonia and shingles vaccinations wereoffered to eligible patients.

• All patients aged over 75 years old had a named GP forcontinuity of care.

• Nationally reported data showed that outcomes for patients forconditions commonly found in older people, including atrialfibrillation, osteoporosis, rheumatoid arthritis and heart failurewere above local and national averages. For example, thepractice achieved 100% for outcomes relating to heart failure.This was achieved with an exception reporting rate of 12%,compared to the CCG average of 9% and the national averageof 9%.

• There were provisions for older patients with mobilitydifficulties to access full medical services on the ground floor.

Outstanding –

Summary of findings


People with long term conditionsThe practice is rated as outstanding for the care of people withlong-term conditions.

• Clinical staff had lead roles in chronic disease management andpatients at risk of hospital admission were identified as apriority.

• The practice operated a recall process for patients with longterm conditions and provided home visits to housebound forroutine checks required. Longer appointments were availablewhen needed.

• The outcomes for patients with long term conditions wereabove national averages. For example, the overall performanceon asthma related indicators was 100%, compared to the CCGaverage of 99% and the national average of 97%. The exceptionreporting rate asthma indicators was 0.7%, below the CCGaverage of 9% and the national average of 7%.

• For patients with the most complex needs, practice staffworked with relevant health and care professionals to deliver amultidisciplinary package of care. People with long termconditions were encouraged to attend structured educationcourses, for example, diabetes and pulmonary rehabilitationcourses, to improve their outcomes.

• The practice actively sought to prevent diabetes through theidentification and follow up of patients with pre-diabetes orstatistically at risk of diabetes. There were 798 patientsidentified who were given lifestyle advice and reviewedannually to delay the onset of diabetes, resulting in betteroutcomes. GPs told us they had observed positive outcomesthrough a lower than expected diabetes prevalence.

• Performance for diabetes related indicators was 100%,compared to the CCG average of 93% and the national averageof 90%. The exception reporting rate was 6%, compared to theCCG average of 11% and the national average of 12%.

• Additionally, diabetic retinopathy clinics were provided fromthe practice premises, reducing the need for patients to travellong distances to access them.

Outstanding –

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

• There were systems in place to identify and follow up childrenliving in disadvantaged circumstances and who were at risk, forexample, children and young people who had a high number ofA&E attendances. The practice had a child safeguarding lead GP

Outstanding –

Summary of findings


and staff were aware of who they were. Meetings were heldregularly with the health visitor, midwife and district nursingteam to review children at risk, with liaison with the schoolnurse as required.

• Antenatal and baby clinics were provided regularly from thepractice premises.

• Immunisation rates were high for all standard childhoodimmunisations. For example, immunisation rates for childrenunder two years old averaged at 98% above the nationalstandard of 90%.

• The practice offered a range of contraception services includingimplants and coil fittings.

• Urgent appointments were available on a daily basis toaccommodate children who were unwell.

• The practice provided general medical services toapproximately 300 students at a local school, including sexualhealth services. The practice encouraged all patients aged 15 to24 years old to have chlamydia screening, with referrals offeredfor complex cases to specialist services.

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

• Extended opening hours were provided from 6.45am to 8am onThursday and Friday mornings, with GP and nurseappointments. Additionally, the practice self-funded theprovision of appointments with the healthcare assistant duringthe extended opening hours as this was not covered in theiragreement with NHS England.

• The practice was proactive in offering online services via itswebsite. Appointments could be made and cancelled online aswell as management of repeat prescriptions. Patients were ableto access their medical records online.

• Uptake rates for screening were similar or better than thenational average. For example, the uptake rate for cervicalcancer screening in 2015/16 was 87%, above the CCG average of83% and above the national average of 81%.

Outstanding –

Summary of findings


• Patients who had been absent from work because of illnesswere supported with their return to work through the use of fitnotes and the local fit to work scheme.

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. The electronic patient record system flaggedpatients who were known to be vulnerable or at-risk to staff,including those with a learning disability and children on thesafeguarding register.

• Patients at risk of admission, receiving end of life care andthose with life limiting conditions were given open access,ensuring that they could see a clinician when they felt theyneeded one.

• There were 33 patients on the learning disabilities register and30 had had attended a face to face review appointment in 2016.Two patients had declined the appointments and one patientwas not deemed appropriate. The practice liaised with thecommunity learning disabilities specialist nurse to ensurepatients who did not attend appointments receivedappropriate care at home.

• The practice provided medical services to three care homes forpeople with learning disabilities. Feedback from one of thehomes where 13 patients were resident was highly positiveabout the caring and attentive manner of the GPs and access tothe surgery when required. Staff from the home told us theirresidents received personalised care with annual health checkscarried out and care plans updated regularly.

• The practice regularly worked with other health careprofessionals in the case management of vulnerable patients,including patients on the palliative care register. There were 47patients on the palliative care register.

• Staff knew how to recognise signs of abuse in vulnerable adultsand children. Staff were aware of their responsibilities regardinginformation sharing, documentation of safeguarding concernsand how to contact relevant agencies in normal working hoursand out of hours.

• The practice had identified 160 patients as carers which wasequivalent to 1.8% of the practice list. Carers were offeredannual health checks.

Outstanding –

Summary of findings


• Information was on display that advised patients printedmaterial and practice documents were available in large print,easy-read format. Language interpreters were also available forpatients who needed them.

• A hearing loop was available in the practice.

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

• There were 56 patients on the mental health register. Publisheddata showed 95% of patients on the mental health register withcomplex mental health conditions had a comprehensive careplan in the preceding 12 months, compared to the CCG averageof 94% and the national average of 89%. This was achieved withan exception rate of 32%, compared to the CCG average of 30%and the national average of 13%. GPs told us they worked witha mental health facilitator who held clinics every two weeks atthe practice to encourage patients who had declined invitationsfor review to attend. In addition, they told us there had beencomputer coding problems discovered in 2015/16 whichaffected their performance, and the problems had beenresolved.

• The practice monitored their performance by keeping a recordof all patients who had not attended an annual review andrecorded the reasons why they did not attend or had not beeninvited.

• There were 71 patients on the dementia register. Nationallyreported data showed 78% of patients diagnosed withdementia had a care plan reviewed in a face to faceappointment, compared to the CCG average of 87% and thenational average of 84%. The exception reporting rate was 9%,compared to the CCG average of 12% and the national averageof 7%.

• Patients could access a practice therapist who provided weeklycounselling clinics through referrals from a GP or via self-referralforms which were available in the waiting area.

• Patients experiencing poor mental health were told how toaccess various support groups and voluntary organisations.

• Staff had a good understanding of how to support patients withmental health needs and dementia.

Outstanding –

Summary of findings


What people who use the service sayWe reviewed the results of the national GP patient surveypublished in July 2016. The results showed the practicewas generally performing above local and nationalaverages. A total of 217 survey forms were distributed and109 were returned. This represented a response rate of50% (1.6% of the practice list size).

Results showed:

• 93% of patients found it easy to get through to thispractice by phone compared to the clinicalcommissioning group (CCG) average of 71% and thenational average of 73%.

• 98% of patients were able to get an appointment tosee or speak to someone the last time they triedcompared to the CCG average of 86% and thenational average of 85%.

• 92% of patients described the overall experience ofthis GP practice as good compared to CCG average of85% and the national average of 85%.

• 87% of patients said they would recommend this GPpractice to someone who has just moved to the localarea compared to the CCG average of 76% and thenational average of 78%.

As part of our inspection we also asked for CQC commentcards to be completed by patients prior to our inspection.We received 24 completed comment cards which werewholly positive about the standard of care received.Patients highlighted the caring and helpful staff and saidthey were listened to during consultations.

We spoke with three patients who were members of thepatient participation group during the inspection.Patients we spoke with were satisfied with the care theyreceived and thought staff were friendly, committed andcaring.

The results of the practice Friends and Family Test (FFT)collected between January and November 2016 werevery positive with 98% of respondents saying they wouldrecommend the practice to their friends and family.

Outstanding practice• GPs had led and delivered improved outcomes and

care for patients including across the local ClinicalCommissioning Group (CCG) and over wide range ofclinical areas including diabetes. The practiceactively sought to prevent diabetes through theidentification and follow up of patients withpre-diabetes or statistically at risk of diabetes.

• Services were tailored to meet the needs ofindividual people and delivered in a way to ensure

flexibility, choice and continuity of care, asdemonstrated by below average for their use ofaccident and emergency (A&E), emergencyadmissions and outpatient referrals in 2015/16.

• There was evidence of a highly engaged andproactive patient participation group (PPG) whoparticipated in a number of initiatives to enrich thelives of patients.

Summary of findings


Our inspection teamOur inspection team was led by:

Our inspection team was led by a CQC Lead Inspector, aGP specialist advisor and a practice nursing specialistadvisor.

Background to Quorn MedicalCentreQuorn Medical Centre provides primary medical services toapproximately 8700 patients through a general medicalservices contract (GMS). This is a locally agreed contractwith NHS England.

The practice has been located in purpose built premisessince 1986 in the Quorn village in Leicestershire. Facilitiesare on two floors and these include consulting andtreatment rooms.

The level of deprivation within the practice population isbelow the national average with the practice falling into theleast deprived decile. The level of deprivation affectingchildren and older people is significantly below thenational average. The practice has a slightly higher thanaverage numbers of patients over 65 years old. The numberof people aged 20 to 40 years old is significantly lower thannational averages.

The clinical team includes two GP partners (male), foursalaried GPs (female), three practice nurses and onehealthcare assistant and one phlebotomist. They aresupported by a practice manager and 11 reception andadministrative staff. It is a teaching practice offeringplacements for university medical students in their thirdand fourth year.

The surgery is open from 8.30am to 6pm on Monday toFriday. Extended opening hours are provided from 6.45amto 8am on Thursday and Friday mornings. There aremorning and afternoon consulting clinics, withappointments starting at 8.45am up to 5.30pm every day.

The practice has opted out of providing out-of-hoursservices to its own patients. This service is provided byDerbyshire Health United (DHU) and is accessed via 111.

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 we holdabout the practice and asked other organisations to sharewhat they knew. We carried out an announced visit on 10January 2017. During our visit we:

• Spoke with a range of staff (including GPs, nursing staff,the practice manager and administrative staff) andspoke with patients who used the service.

• Observed how patients were being cared for and talkedwith carers and/or family members.

QuornQuorn MedicMedicalal CentrCentreeDetailed findings


• Reviewed an anonymised sample of the personal careor treatment records of patients.

• Reviewed comment cards where patients and membersof the public shared their views and experiences of theservice.

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 were provided forspecific groups of people and what good care lookedlike for 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 informationthroughout this report, for example any reference to theQuality and Outcomes Framework data, this relates tothe most recent information available to the CQC at thattime.

Detailed findings


Our findingsSafe track record and learning

The practice had systems and processes in place to enablestaff to report and record incidents and significant events.

• Staff informed the practice manager of any incidentsand completed a form detailing the events. Copies ofthe forms were available on the practice’s computersystem. Reported events and incidents were logged andtracked until the incident was closed. The incidentrecording system supported the recording of notifiableincidents under the duty of candour. (The duty ofcandour is a set of specific legal requirements thatproviders of services must follow when things go wrongwith care and treatment).

• The practice manager kept a comprehensive log of allincidents and shared these with the CCG. The practicetold us they were the second highest contributor to theirCCG’s system for incidents and issues.

• We saw evidence that when things went wrong with careand treatment, patients were informed of the incident,received reasonable support, a written apology andwere told about any actions taken to prevent the samething happening again.

• Learning from significant events was shared with all staffand contributed to safer working practices. An annualreview of all significant events received was undertaken.This enabled the practice to identify any themes ortrends and all relevant staff were encouraged to attend.

Overview of safety systems and processes

Effective and well embedded systems, processes andpractices were in place to help keep patients safe andsafeguarded from abuse. These included:

• Effective arrangements were in place to safeguardchildren and vulnerable adults from abuse whichreflected local requirements and relevant legislation.Policies were accessible to all staff and identified whostaff should contact if they were concerned about apatient’s welfare. There was a named GP lead for childand adult safeguarding and staff were aware of who

these were. There was evidence of regular liaisonthrough regular meetings with GPs and communitybased staff including midwives, health visitors andschool nurses to discuss children at risk.

• Staff demonstrated they understood theirresponsibilities and all had received training onsafeguarding children and vulnerable adults relevant totheir role. GPs were trained to child safeguardinglevel three and nurses were trained to childsafeguarding level two.

• Patients were advised through notices in the practicethat they could request a chaperone if required. All staffwho acted as chaperones had been provided withtraining for the role and had received a Disclosure andBarring Service (DBS) check. (DBS checks identifywhether a person has a criminal record or is on anofficial list of people barred from working in roles wherethey may have contact with children or adults who maybe vulnerable).

• During our inspection we observed the practice to beclean and tidy and this aligned with the views ofpatients. A practice nurse was the lead for infectioncontrol within the practice. There were mechanisms inplace to maintain high standards of cleanliness andhygiene. Effective cleaning schedules were in placewhich detailed cleaning to be undertaken daily andweekly for all areas of the practice. There were infectioncontrol protocols and policies in place and staff hadreceived up to date training. Infection control auditswere undertaken on a regular basis and improvementswere made where required.

• Processes were in place for the review of high riskmedicines. There was a nominated member of staff whoran monthly reports on patients on high risk medicines,and arranged appropriate follow-up with the GPs asappropriate.

• Action was taken when updates to medicines wererecommended by the Medicines and HealthcareProducts Regulatory Agency (MHRA). There wasevidence to show patient searches had beenundertaken in response to alerts and actions taken toensure they were safe. A log was kept of medicinesalerts they had received and acted on.

• There were arrangements for managing medicines,including emergency medicines and vaccines, to keeppatients safe (including obtaining, prescribing,recording, handling, storing, security and disposal).

Are services safe?

Good –––


Processes were in place for handling repeatprescriptions. There were no controlled drugs kept onthe premises. Blank prescription forms and pads weresecurely stored and there were systems in place tomonitor their use. The practice had adopted PatientSpecific Directions for administering child fluvaccinations, which were administered by appropriatelytrained clinical staff. The health care assistants andnurses were trained to administer vaccines andmedicines against patient specific prescriptions ordirections from a prescriber.

• We reviewed four personnel files for clinical andnon-clinical staff and found appropriate recruitmentchecks had been undertaken prior to employment. Forexample, proof of identification, references,qualifications, registration with the appropriateprofessional body and the appropriate checks throughthe Disclosure and Barring Service.

Monitoring risks to patients

Risks to patients were assessed and managed.

• There were procedures in place to manage and monitorrisks to patient and staff safety. The practice had up todate fire risk assessments and carried out regular firedrills. All electrical equipment was checked to ensurethe equipment was safe to use and clinical equipmentwas checked to ensure it was working properly.

• The practice had a variety of other risk assessments inplace to monitor safety of the premises such aslegionella. (Legionella is a term for a particular

bacterium which can contaminate water systems inbuildings). We saw that appropriate action was to actupon any identified risks to ensure these weremitigated.

• Arrangements were in place to plan and monitor staffinglevels and the mix of staff needed to meet patients’needs. There was a rota system in place for all thedifferent staffing groups to ensure enough staff were onduty. There were effective arrangements in place toensure there was adequate GP and nursing cover.

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.

• Staff received annual basic life support training.

• The practice had a defibrillator available on thepremises and oxygen with adult and children’s masks. Afirst aid kit and accident book were available.

• Emergency medicines were accessible to staff and allstaff knew of their location. Emergency medicines heldin the practice which we checked on the day of theinspection were in date.

• The practice had a comprehensive business continuityplan in place for major incidents such as power failureor building damage. The plan included emergencycontact numbers for staff and a copy was kept off thepractice site.

Are services safe?

Good –––


Our findingsEffective needs assessment

Clinical staff assessed the needs of patients and deliveredcare in line with relevant evidence based guidance andstandards, including National Institute for Health and CareExcellence (NICE) best practice guidelines and localguidelines.

• Systems were in place to keep all clinical staff up todate. Staff had access to guidelines from NICE and localguidelines electronically. Relevant updates to thesewere discussed at regular clinical meetings andeducational ‘lunch and learn’ meetings held by thepractice.

• Staff attended regular training which supported theirknowledge about changes and updates to guidelines.

• The practice monitored that these guidelines werefollowed through risk assessments, audits and checks ofpatient records. Where patients required reviews, alertswere added to their records and their prescriptions toensure they were reminded of the reviews.

Management, monitoring and improving outcomes forpeople

The practice engaged with the CCG who undertook regularpractice appraisals to monitor performance in comparisonwith other practices locally and nationally. An annualaction plan was agreed to continue the process ofimprovement in assessment, diagnosis, referral,prescribing and long term disease management. Forexample, one of the action points for the practice was towork on increasing their chronic obstructive pulmonarydisease (COPD) prevalence (the number of patientsidentified as with the condition). They carried out moreopportunistic checks of people with respiratory conditions,and increased their register 103 patients in 2015 to 119 in2017.

The practice used the information collected for the Qualityand Outcomes 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 most

recently published results showed the practice hadachieved 100% of the total number of points available. Thiswas 3% above the clinical commissioning group (CCG)average and 5% above the national average.

The overall exception reporting rate was 6.6%, compared tothe CCG average of 9% and the national average of 10%.Exception reporting is the removal of patients from QOFcalculations where, for example, the patients are unable toattend a review meeting or certain medicines cannot beprescribed because of side effects. During the inspectionwe looked at the rate of exception reporting and found it tobe in line with agreed guidance.

This practice was not an outlier for any QOF (or othernational) clinical targets. Data from 2015/16 showed:

• Performance for diabetes related indicators was 100%,compared to the CCG average of 93% and the nationalaverage of 90%. The proportion of patients withdiabetes who had a blood pressure reading in thepreceding 12 months was 80%, compared to the CCGaverage of 77% and the national average of 78%. Theexception reporting rate for this indicator was 5%, belowthe CCG and national average of 9%.

• Performance for indicators related to hypertension was100%, compared to the CCG average of 98% and thenational average of 97%. The exception reporting ratefor hypertension related indicators was 2%, comparedto the CCG average of 3% and national averages of 4%.

• Performance for mental health related indicators was100%, compared to the CCG average of 97% and thenational average of 93%. The overall exception reportingrate for mental health indicators was 24%, compared tothe CCG average of 22% and the national average of11%.

• The practice achieved 100% for outcomes relating toheart failure, compared to the CCG average of 98% andthe national average of 98%. The overall exceptionreporting rate for heart failure was 12%, compared tothe CCG average of 9% and the national average of 9%.

• There were 33 patients on the learning disabilitiesregister and 30 had had attended a face to face reviewappointment in 2016. Two patients had declined theappointments and one patient was not deemedappropriate.

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

Outstanding –


Effective arrangements were in place to ensure patientswere recalled for reviews of their long term conditions andmedication. Patients were recalled at least three times fortheir reviews using a variety of contact methods includingletters, telephone calls, messages on prescriptions and textmessages. The variety of contact methods reduced the riskof patients not receiving a reminder.

There was evidence of quality improvement includingclinical audit.

• There had been five clinical audits undertaken in thelast two years, and two of these were completed auditswith two cycles. These covered areas relevant to thepractice’s needs and areas for development. Forexample, an audit was carried in 2015 out to identifypatients who were receiving antiplatelet therapy forlonger than 12 months after experiencing a myocardialinfarction. The audit found five patients who no longerrequired the treatment who were informed immediatelyto stop treatments. Clinicians were advised to add stopdates to patient records to ensure they did not continuetaking the medicines when they were no longereffective. The audit was repeated in 2016 and did notidentify any patients who were taking the medicineinappropriately, showing that changes had beenembedded in the practice.

• Regular medicines audits were undertaken whenupdates were received through alerts or changes inguidance. The practice participated in quarterlyprescribing reviews undertaken by the CCG medicinesmanagement team.

The practice regularly assessed their performance in areassuch as hospital admissions and referrals. A riskstratification system was used to identify patients at risk ofadmission and these patients’ notes were flagged toenable a care plan to be made in a consultation. Patients atparticular risk were also offered an appointment.

CCG data indicated the practice was below average for theiruse of accident and emergency (A&E), emergencyadmissions and outpatient referrals in 2015/16. Staffattributed their performance to their good access and useof the acute visiting service. All GP referrals, with theexception of validated 2 week wait referrals, were discussed

with colleagues to ensure that they were appropriate andnecessary to utilise hospital services correctly. GPs alsoused consultant-led telephone guidance to reduce referralsand to access earlier effective management for patients.

One of the GPs had a special interest in dermatology, andundertook additional training to perform minor skinsurgery procedures in the practice. He reviewed alldermatology referrals before they were sent to secondarycare to ensure they were appropriate. Benchmarking datashowed between December 2015 and November 2016, thepractice achieved 5.34 dermatology referrals per 1000patients which was lower than the federation average of7.63 per 1000 patients.

Effective staffing

We saw that staff had the skills, knowledge and experienceto deliver effective care and treatment.

• The practice had comprehensive, role specific,induction programmes for newly appointed clinical andnon-clinical staff. These covered areas such health andsafety, IT, fire safety, infection control andconfidentiality. Staff were well supported during theirinduction and probation periods with opportunities toshadow colleagues and regular reviews with their linemanager.

• The practice could demonstrate how they ensuredrole-specific training and updating for relevant staff.Staff were encouraged and supported to develop intheir roles to support the practice and to meet theneeds of their patients. Staff were also supported toundertake training to broaden the scope of their roles. Ahealthcare assistant was trained to carry out spirometrytests and nursing staff told us they were supported inundertaking additional qualifications to aid chronicdisease management.

• Staff administering vaccines and taking samples for thecervical screening programme had received specifictraining which had included an assessment ofcompetence. Staff who administered vaccines coulddemonstrate how they stayed up to date with changesto the immunisation programmes, for example byaccess to on line resources and discussion at practicemeetings.

• The learning needs of staff were identified through asystem of appraisals, meetings and reviews of practicedevelopment needs. Staff had access to training to meet


Outstanding –


their learning needs and to cover the scope of theirwork. This included ongoing support, meetings,coaching and mentoring, clinical supervision andfacilitation and support for revalidating GPs and nurses.

• There was a comprehensive training schedule whichwas monitored effectively to ensure all trainingconsidered as mandatory was undertaken when it wasdue. Staff received training that included: safeguarding,fire safety, basic life support and informationgovernance. Staff had access to and made use ofe-learning training modules and in-house training.

Coordinating patient care and information sharing

The practice held monthly multi-disciplinary team meetingwhere they discussed unplanned admissions,inappropriate users of A&E, patients on end of life pathwayand patients requiring an increased level of care. Themeetings were attended by all GPs, District Nurses,Community Matrons, End of Life nurses and Specialist carenurses.

In addition, palliative care meetings held with hospice carenurses to discuss patients coming to the end of their life.The practice reviewed all patient deaths annually to ensurethey were identifying patients in need of support.

Information needed to plan and deliver care was availableto staff in a timely and accessible way through thepractice’s patient record system and their intranet system.This included care and risk assessments, care plans,medical records and investigation and test results. Thepractice shared relevant information with other services ina timely way, for example when referring patients to otherservices.

The practice had a system linking them to the hospitals sothat they were able view test results completed in hospitalinstead of waiting to receive discharge letters. The practiceshared information with the out of hours service throughspecial patient notes with detailed care plans.

Patients at the practice could access the South CharnwoodGP Federation weekend access service. The service was setup for patients identified by practices in the locality aslikely to require medical advice during the weekendbecause they were at risk of deteriorating and/or in need offurther medical intervention. Patients were given a ‘patient

passport’ with a telephone number to speak to anemergency care clinician. GPs working at the practiceprovided the majority of clinical cover to the weekendaccess service.

GPs had a buddy system for review of test results whichensured that results were viewed and acted upon on theday of receipt, and patients were informed in a timelymanner if the initiating GP was away from the practice.

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 carried out assessments of theircapacity to consent in line with relevant guidance.

• Where a patient’s capacity to consent to care ortreatment was unclear clinical staff undertookassessments of mental capacity.

Supporting patients to live healthier lives

The practice identified patients who may be in need ofextra support. For example:

• Members of the Quorn PPG were featured on televisednational news in November 2016 encouraging eligiblepatients to attend flu vaccination clinics. This resulted inall practices within their federation receiving anincreased number of requests for flu vaccinations afterthe broadcast.

• Quorn Medical Centre took a lead role in organising alearning event for patients in the South Charnwoodlocality, conducted by pulmonary rehabilitationspecialists for patients with asthma and COPD. It wasattended by 93 patients and feedback was 100%positive indicating they had an increased knowledge inmanaging their condition and use of inhalers.

• One of the GPs with a special interest in pre-diabetesscreening led a health promotion event organised bythe PPG at their local village hall to encourage healthylifestyles.

• The PPG organised health walks every third Thursday ofthe month; created a poster for keeping children fit andshared it with local schools.


Outstanding –


• The practice referred patients to a signposting servicewhich provided a single point of access to varioussupport agencies. Additionally, there was a wide rangeof printed information was available to signpostpatients to community or specialist services.

• A member of the PPG had created a prostate cancerawareness display board to promote screening withinthe practice. Staff told us a number of patients attendedscreening appointments as a result of the campaign,and the board was subsequently shared with otherpractices across the locality because of the positiveresponse.

The practice’s uptake rate for cervical cancer screening in2015/16 was 87%, above the CCG average of 83% andabove the national average of 81%. Reminders were offeredfor patients who did not attend for their cervical screeningtest. There were failsafe systems in place to ensure resultswere received for all samples sent for the cervical screeningprogramme and the practice followed up women who werereferred as a result of abnormal results.

The practice also encouraged its patients to attendnational screening programmes for bowel and breastcancer screening and screening rates were comparable tolocal and national averages. For example, the practiceuptake rate for breast cancer screening in the last 36months was 79% compared with the CCG average of 78%and the national average of 72%.

Childhood immunisation rates for the vaccinations givenwere higher than CCG averages. For example, immunisationrates for children under two years old averaged at 98%,above the national standard of 90%.

Patients had access to appropriate health assessments andchecks. These included health checks for new patients andNHS health checks for patients aged 40–74 and over 75years old. Practice supplied data showed 233 patients wereinvited to attend health check appointments, and 35% hadtaken up the offer. Appropriate follow-ups for the outcomesof health assessments and checks were made, whereabnormalities or risk factors were identified.


Outstanding –


Our findingsKindness, dignity, respect and compassion

We observed during the inspection that members of staffwere polite, friendly and helpful towards patients. Thepractice had a dignity policy in place which all staff workedto.

Measures were in place within the practice to maintain theprivacy and dignity of patients and to ensure they felt atease. These included:

• Curtains were provided in consulting rooms to maintaindignity during examinations, investigations andtreatments.

• Patients could be seen downstairs if they were unable touse the stairs to access the first floor consultationrooms. Consultation and treatment room doors wereclosed during consultations.

We received 24 completed comments cards as part of ourinspection. All of the comment cards were positive aboutthe service provided by the practice. Patients said that staffwere caring, compassionate and helpful. Patients also saidthey felt listened to by staff and they were treated withdignity and respect.

We spoke with three patients who told us they weregenerally happy with the care provided by the practice andsaid their dignity and privacy was respected.

Results from the national GP patient survey showedpatients felt they were treated with compassion, dignityand respect. The practice was in line with local andnational averages for its satisfaction scores onconsultations with GPs. For example:

• 88% of patients said the GP was good at listening tothem compared to the clinical commissioning group(CCG) average of 89% and the national average of 89%.

• 88% of patients said the GP gave them enough timecompared to the CCG average of 86% and the nationalaverage of 87%.

• 95% of patients said they had confidence and trust inthe last GP they saw compared to the CCG average of95% and the national average of 95%.

• 86% of patients said the last GP they spoke to was goodat treating them with care and concern compared to theCCG average of 85% and the national average of 85%.

The practice was above local and national averages for itssatisfaction scores on consultations with nurses. Forexample:

• 98% of patients said the last nurse they saw or spoke towas good at giving them enough time compared to theCCG average of 93% and the national average of 92%.

• 96% of patients said the last nurse they spoke to wasgood at treating them with care and concern comparedto the CCG average of 91% and the national average of91%.

• 100% of patients said they had confidence and trust inthe last nurse they saw or spoke to, compared to theCCG average of 97% and the national average of 97%.

Satisfaction scores for interactions with reception staff wereabove local and national averages:

• 96% of patients said they found the receptionists at thepractice helpful compared to the CCG average of 86%and the national average of 87%.

• 93% of patients described their experience of making anappointment as good, compared to the CCG average of72% and the national average of 73%.

During our observations in the waiting room we sawreception staff greeted patients warmly and withconsideration to each person’s preference, such as if theyliked to be addressed by their first name.

Care planning and involvement in decisions aboutcare and treatment

Information was on display that advised patients printedmaterial and practice documents were available in largeprint, easy-read format and Braille. Information onobtaining a British Sign Language interpreter was alsoavailable.

Feedback from patients demonstrated that they feltinvolved in decision making about the care and treatmentthey received. Patients told us they felt listened to, made tofeel at ease and well supported by staff. They also told usthey were given time during consultations to makeinformed decisions about the choice of treatment available

Are services caring?

Good –––


to them. Patient feedback from the comment cards wereceived was also positive and aligned with these views. Wesaw evidence that care plans were personalised to accountof the individual needs and wishes of patients.

Results from the national GP patient survey showed themajority of patients responded positively to questionsabout their involvement in planning and making decisionsabout their care and treatment. Results were in line withlocal and national averages. For example:

• 85% of patients said the last GP they saw was good atexplaining tests and treatments compared to the CCGaverage of 86% and the national average of 86%.

• 83% of patients said the last GP they saw was good atinvolving them in decisions about their care comparedto the CCG average of 80% and the national average of82%.

The practice provided facilities to help patients be involvedin decisions about their care. Although patients within thepractice population mostly spoke English, the practiceused translation services to ensure effectivecommunication with other patients when required.

Patient and carer support to cope emotionally withcare and treatment

The practice’s computer system alerted GPs if a patient hadcaring responsibilities. The practice had identified 160patients as carers which was equivalent to 1.8% of thepractice list. Of these patients, 15% had attended healthcheck appointments. A member of staff was nominated asa ‘carers champion’ within the practice to support theneeds of carers. Carers’ information packs were available,which included a pocket card which alerted people that theholder cared for someone in emergency situations.

There was a dedicated carers notice board with patientinformation leaflets and notices in the patient waiting areawhich told patients how to access a number of supportgroups and organisations. This included guidance forcarers and information relevant to the needs of the localpopulation including on dementia, Alzheimer’s disease andbreast cancer. Specialist information was provided foryoung people who were carers and for psychological andemotional support groups. Information about supportgroups was also available on the practice website.

Staff told us that if families had experienced bereavement,they were contacted by the practice by a telephone call or avisit if appropriate, and also sent a sympathy card.Information about support available to patients who hadexperienced bereavement was provided where required.

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 recognised the limitations of their currentpremises and initiated plans to build an extensionupwards; looking at obtaining planning permission andaccessing funds.

The practice worked to ensure its services were accessibleto different population groups. For example:

• A GP with additional training in dermatology providedweekly clinics for registered patients who requiredminor skin surgery and cryotherapy. This reduced theneed for patients to go to secondary care to access theprocedures.

• The practice offered a range of appointments whichincluded telephone appointments, and pre-bookableappointments. There were longer appointmentsavailable for patients with a learning disability and thosewho needed them.

• Home visits were available for elderly patients andpatients who had clinical needs which resulted indifficulty attending the practice.

• Same day appointments were available for children andthose patients with medical problems that require sameday consultation.

• Appointments could be booked online andprescriptions reordered. Patients were encouraged touse the online appointments system for theirconvenience.

• Extended opening hours were provided from 6.45am to8am on Thursday and Friday mornings, with GP andnurse appointments. The practice providedappointments with the healthcare assistant which werenot funded as part of the service.

• The practice provided general medical services toapproximately 300 students at a local school, including

sexual health services. The practice encouraged allpatients aged 15 to 24 years old to have chlamydiascreening, with referrals offered for complex cases tospecialist services.

• CCG data indicated the practice was below average fortheir use of accident and emergency (A&E), emergencyadmissions and outpatient referrals in 2015/16. Staffattributed their performance to their good access anduse of the acute visiting service.

• A mental health facilitator held clinics every two weeksat the practice to encourage patients with mental healthconditions who had declined invitations for review toattend.

• Diabetic retinopathy clinics were provided from thepractice premises, reducing the need for patients totravel long distances to access them.

• Patients were able to receive travel vaccinationsavailable on the NHS and they were referred to otherclinics for vaccines available privately. The practice wasa designated Yellow Fever centre.

• There were provisions for elderly infirm patients toaccess full medical services on the ground floor.

• There were themed display boards in the waiting roomproviding information to patients in easy to readformats.

• Information was on display that advised patientsprinted material and practice documents were availablein large print, easy-read format. Language interpreterswere also available for patients who needed them.

• A hearing loop was available in the practice.

Access to the service

The surgery was open from 8.30am to 6pm on Monday toFriday. Extended opening hours were provided from6.45am to 8am on Thursday and Friday mornings.Consulting times started from 8.45am with the latestappointment offered at 5.30pm. There were GP and nurseappointments available during extended opening hours.The practice provided appointments with the healthcareassistant which were not funded as part of the service.

The practice operated a GP triage system whereby patientsringing for an appointment received telephone call fromthe duty doctor to assess if they needed to be seen on thesame day. Patients were informed of the system when theyjoined the practice and information was available on the

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

Outstanding –


practice website. The reception team followed a triagepolicy which specified urgent scenarios that required thecaller to be transferred to the doctor immediately, such aschest pain, difficulty breathing and high fever.

Results from the national GP patient survey showed thatpatients’ satisfaction with how they could access care andtreatment was significantly higher than local and nationalaverages:

• 93% of patients said they could get through easily to thepractice by phone compared to the CCG average of 71%and the national average of 73%.

• 98% of patients said they were able to get anappointment to see or speak to someone the last timethey tried, compared to the CCG average of 86% and thenational average of 85%.

• 78% of patients said they usually wait 15 minutes or lessafter their appointment time to be seen, compared tothe CCG average of 69% and the national average of65%.

The comment cards we received and the patients we spoketo told us the levels of satisfaction with access to thepractice were good. Patients told us they were usually ableto get appointments when they required them and that theGP triage system guaranteed they saw or spoke to a GP onthe same day.

Listening and learning from concerns and complaints

The practice systems in place to handle complaints andconcerns.

• Its complaints policy and procedures were in line withrecognised guidance and contractual obligations forGPs in England.

• There was a designated responsible person whohandled all complaints in the practice.

• We saw that information was available to help patientsunderstand the complaints system including posters.The complaints policy was on display in the mainreception area and was also detailed in the patientinformation leaflet, which was also available in thewaiting area.

• Staff we spoke with were aware of the complaintsprocedures within the practice and told us they woulddirect patients to practice manager if required.

The practice had logged 12 complaints in the last 12months including verbal complaints. We reviewed a rangeof complaints, and found they were dealt with in a timelymanner in accordance with the practice’s policy onhandling complaints. The practice provided people makingcomplaints with explanations and apologies whereappropriate as well as informing them about learningidentified as a result of the complaint.

Meetings were held regularly during which complaints werereviewed and an annual review of all complaints receivedwas undertaken. This enabled the practice to identify anythemes or trends and all staff were encouraged to attend.Lessons learned from complaints and concerns and fromtrend analysis were used to improve the quality of care. Allstaff were informed of outcomes.

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

Outstanding –


Our findingsVision and strategy

The practice had a clear vision to treat patients withcourtesy, dignity, integrity and in complete confidence atall times. Staff were engaged with the aims and values ofthe practice to deliver high quality, accessible patient care.The mission statement was displayed in the waiting room.

GP partners told us they shared the same approach topractice performance and development, which enabledquick decisions to be made and communicated to thepractice manager for action. The practice manager wasgiven autonomy to carry out her role in line with thepractice strategy.

The practice acknowledged the challenges they faced withan increasing and ageing population with multiple healthneeds, coupled with limited finances. There was adocumented five year strategy to meet the challenges,which included succession planning. The practice wasplanning to extend their premises to accommodate moreconsulting rooms and office space. Patients and staff havebeen involved in the discussions and the PPG was activelyinvolved in seeking planning permission.

Governance arrangements

The practice had a strong and effective governanceframework which provided effective oversight and enabledissues to be identified and addressed. This ensured that:

• There was a clear staffing structure and that staff wereaware of their own roles and responsibilities. Clinicaland non-clinical staff had lead roles in a range of areassuch as diabetes, prescribing, human resources and IT.The team worked effectively together with a shared aimto maximise patients’ health and wellbeing.

• A comprehensive understanding of the performance ofthe practice was maintained and the practiceperformance in terms of clinical outcomes wasconsistently good. The providers were not complacentand looked for further opportunities to improve clinicaloutcomes. For example, the practice held learningevents for patients with long term conditions topromote good outcomes for patients.

• Complaints and significant events were reviewedannually with the whole practice team.

• Practice specific policies were implemented and wereavailable to all staff. Policies were availableelectronically or as hard copies and staff knew how toaccess these.

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

• There were arrangements in place to identify, recordand manage risks within the practice and to ensure thatmitigating actions were implemented. There was ahealth and safety lead within the practice responsiblefor health and safety issues. The safe prescribing of highrisk medicines was given priority and a specific staffmember was responsible for overseeing this aspect ofcare and treatment.

• There were weekly partner meetings and monthlyclinical and team meetings held within the practice. Thisensured that partners retained oversight of governancearrangements within the practice and achieved abalance between the clinical and business aspectsinvolved with running the practice.

Leadership and culture

The partners and management within the practicedemonstrated they had the experience, capacity andcapability to run the practice and ensure high quality care.Clinical and non-clinical staff had a wide range of skills andexperience. Staff told us the partners and managementwere approachable and always took the time to listen to allmembers of staff. There was a low staff turnover, with mostpeople leaving due to retirement.

• Regular meetings were held within the practice for thewhole practice team. In addition, there was a rollingprogramme of educational meetings which involved allstaff.

• The practice recorded positive feedback as part of itssignificant event reporting to share with all staff. ‘ThankYou’ was a standing item on the agenda for practiceteam meetings. Any compliments received wereemailed to the whole team.

• Staff told us there was an open culture within thepractice and they had the opportunity to raise anyissues at meetings and felt confident and supported indoing so. We saw examples of staff who had beensupported to develop and progress to other roles.

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

Outstanding –


The practice was aware of and had systems in place toensure compliance with the requirements of the duty ofcandour. (The duty of candour is a set of specific legalrequirements that providers of services must follow whenthings go wrong with care and treatment). The partnersencouraged a culture of openness and honesty. Thepractice had systems in place to ensure that when thingswent wrong with care and treatment:

• The practice gave affected people support, informationand apologies where appropriate.

• The practice kept records of verbal interactions as wellas written correspondence.

Seeking and acting on feedback from patients, thepublic and staff

The practice encouraged and valued feedback frompatients, the public and staff. It proactively sought patients’feedback and engaged patients in the delivery of theservice.

• The practice had gathered feedback from patientsthrough the patient participation group (PPG) andthrough a suggestion box, surveys and compliments,concerns and complaints received.

• There was a well-established PPG with 20 members whomet five times a year and a virtual group of 146members. The meetings were held in evenings toaccommodate working people, and attended by one ofthe GP partners, the practice manager and seniorreceptionist. Meeting dates were set in advance for theyear and followed CCG network meetings to ensureupdates to the PPG were timely. Information about thegroup was available on the practice website, thepractice leaflet and on a display board in the waitingroom.

• We spoke with three members of the PPG, including thechair, who told us they had a positive workingrelationship with the practice and felt able to influencechange. For example, their suggestions to provide earlymorning appointments for working age people andchanging the practice telephone number so thatpatients were charged lower calling rates were bothadopted by the practice.

• The PPG was committed to promoting the health andwellbeing of patients registered with the practice andthe wider community. Since their formation in 2011,

they held health annual health awareness campaigns inline with national themes. These included mentalhealth, childhood obesity, osteoporosis and prostatecancer. They told us recent events for patients withmultiple long term conditions and COPD had attractedthe support of their local Member of Parliament andCCG. The Quorn PPG members were featured ontelevised national news in November 2016 encouragingeligible people to attend flu vaccination clinics, resultingin increased number of requests for flu vaccinationsafter the broadcast.

• The group ran a stall at annual May Day celebrationsheld in the village to promote the work of the group andthe practice. Additionally, they advertised in their localnewspaper, magazines, local colleges, pharmacies andthe parish notice board.

• The PPG obtained patient feedback through asuggestion box, the NHS Friends and Family Testfeedback and national survey results. Additionally, theyorganise an in-house patient survey carried out duringflu clinics when the greatest number of patientsattended the surgery. A sub-group of the PPG analysedthe results and suggested an action plan to themanagement in response to the feedback.

• The practice manager and the PPG led the formation ofthe federation PPG for all practices in their locality. Thegroup planned to coordinate health awarenesscampaigns to reduce duplication and save costs.

• Practice staff took part in an annual charity fundraisingevents to raise awareness of key issues and supportcommunity involvement.

Continuous Improvement

GP partners demonstrated a forward thinking approach byadopting innovative developments in primary care. Forexample, the practice was an early adopter of the GP triagesystem which was offered to patients since 2000. Otherareas they led on ahead of their peers werecomputerisation of medical records, and electronic referralsystems to facilitate secondary care access for theirpatients. The practice was research ready, withinvolvement in eight research studies since 2015.

There was evidence of collaborative working with otherpractices within the South Charnwood Federation and thewider healthcare community. GPs had lead roles within the


Outstanding –


CCG and federation, providing them with platforms forlearning and influencing improvements within their localhealth community. The partners maintained close liaisonwith the local university as trainers for medical students.

Additionally, the practice manager attended regular localmanagement forums to share best practice and keep up todate with local and national changes affecting practicemanagement.


Outstanding –


Quorn Medical Centre NewApproachComprehensive Report ......Dateofpublication:09/03/2017 1 Quorn...

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