Sleights and Sandsend Medical Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sleights and Sandsend Medical Practice on 6 October 2016. Overall the practice is rated as outstanding.

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

• There is a genuinely open culture in which all safety concerns raised by staff and people who use services are highly valued as integral to learning and improvement.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• All staff were open and transparent and fully committed to reporting incidents and near misses. The level and quality of incident reporting shows the levels of harm and near misses, which ensures a robust picture of safety.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, organised a ‘Warm and Well’ day providing advice from and links to social services and third sector groups.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, increasing GP appointment times to 15 minutes. This is above and beyond the requirements of their contract with NHS England.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example the practice provides a no-cost medicines delivery service for housebound patients.
• The practice held several support groups on their premises and was actively involved in running most of them.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice including:

• The practice funded a weekly psychotherapy service which they had audited. They provided numerous case studies demonstrating reduced GP consultations, more appropriate use of healthcare services and reduced levels of medication.
• An advanced nurse practitioner visited weekly all seven care homes in the local area to provide training and advice to staff. This had led to an 80% reduction in home visit requests from care homes and a reduction of 30% in all home visits.
• A no-cost medication delivery system to housebound dispensing patients was offered using an eco-car powered by solar panels on the surgery roof.
• The practice had set up various social and community groups to suit the needs of their patient population. For example a“Living with Health and Illness Group” project which worked with people with long term conditions in order to help them understand and learn strategies to live with their condition.

However there were areas of practice where the provider should make improvements:

• Implement procedures to record and monitor near misses and dispensing errors to improve the safety of the service.
• Ensure dispensary staff follow new protocols.

• Maintain appropriate cold storage records to be in line with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice