Lockside Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lockside Medical Centre on 27 July 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, including those relating to recruitment checks.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example a team lead by a GP working with patients over 75 years and the introduction of an holistic annual review programme for patients with long term health conditions.

• Data showed patient outcomes were above those locally and nationally, including unplanned hospital admissions.
• Feedback from patients about their care was consistently and strongly positive.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The practice valued continuity of care for patients and working as a team had improved continuity of care. Data from the GP national survey published in July 2016 showed that 83% of patients stated they were able to see their usual GP compared to the CCG average (60%) and national average (59%).
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients.

• Information about services and how to complain was available and easy to understand.

• Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day. The practice embraced new ways of working including online access and email consultations.

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

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice embedded quality improvement into all areas of work. The strategy and supporting objectives were clear, owned by all the staff, monitored regularly, challenged, while remaining achievable.

We saw areas of outstanding practice, including:

• There was a holistic approach to assessing, planning and delivering care and treatment to people who use services. For over three years the practice have adopted a process of continuous quality improvement and small cycles of change, a process which exceeds a clinical audit system by embedding and sustaining outcomes. We saw the detail and wide range of interventions being monitored clearly displayed on a performance board for all staff. We were provided with a wide range of quality improvement work and key performance indicators set by the practice team, for example: the length of stay project, continuity of care, telephone access and safe prescribing of medicines such as antibiotics.
• The practice employed a team including a GP for 3.5 sessions a week to provide care for those patients over 75 years. The GP was supported by a HCA and patient support worker. The care included a weekly review of patients within residential/nursing homes, a hospital in reach service, visiting patients on discharge from hospital and carrying out regular reviews of housebound patients. Additionally the patient support worker also provided holistic care and support to those patients over 75 who were not in residential/nursing homes but who had one or more chronic disease. Data showed that following the introduction of the scheme the practice had a lower than the local average rate of unplanned hospital admissions and shorter length of stay in hospital.
• The practice had established a programme of work to reduce the length of stay patients experienced following an unplanned hospital admission. The practice was looking to see if GP intervention could improve discharge rates. This was achieved by monitoring a daily list of patients in hospital, a GP contacted clinicians on the ward to share patient history and knowledge of those patients. GPs would then offer to support continued assessment and re-enablement in the community. As a result the practice liaised with the hospital discharge lead and had direct contact with ward discharge facilitators to aid communication and enabled, where possible, early discharge. The practice identified a number of barriers to the work in the initial phase but had established successful lines of communication and had several examples of successful early discharges. Early indicators showed as a result of the work, on average the number of bed days used by Lockside patients had reduced and was lower in comparison with neighbourhood practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice