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Inspection Summary


Overall summary & rating

Outstanding

Updated 21 March 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection May 2015 - Outstanding

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? – Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) – Outstanding

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice was open and transparent, and had systems in place to adhere to the Duty of Candour. When things went wrong, we saw that the practice offered patients an apology and an explanation. Quality improvement was embedded into practice. There was a comprehensive programme of clinical and non-clinical audit that all staff were involved with that was routinely monitored and changes made to practice resulted in measurable improvements to patient care.
  • The practice was proactive in identifying new ways of working to streamline services and improve patient experience.
  • The practice was strongly committed to multidisciplinary working and could evidence how this had a positive impact on patient care.
  • Discussions with staff and feedback from patients demonstrated staff were highly motivated and were inspired to offer care that was kind, caring and supportive and met the needs of the population.
  • The practice organised and delivered services to meet patients’ needs. The practice had initiated positive service improvements for their patients. There was a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met their needs and where possible, their preferences.
  • Patients were able to access a wide range of services at the practice, which enabled patients to be treated closer to home.
  • The practice improved services where possible in response to unmet needs. They made reasonable adjustments when patients found it hard to access services even if it was only for a small number of patients.
  • The practice was passionate about ensuring they always provided their patients with the best care possible. They demonstrated a determined attitude to overcome barriers faced by the practice and the population they served. They focussed on the challenges faced by a rural community and planned their services around this.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw a wide range of outstanding practice. Examples included:

The practice proactively ensured that end of life care was delivered in a coordinated way which took into account the needs of different patients, including those who may be vulnerable because of their circumstances. Nationally reported data showed the number of patients of Reeth Medical Centre dying in their preferred place was significantly above the national data.

The number of patients on the practice’s palliative care register was three times the national average.

The practice funded a local community transport scheme to provide free at the point of use transport for housebound patients so they could attend appointments at the practice. This included using the bus service or someone walking the patient to their appointment. The practice worked closely with the district nursing team hosting their services allowing them to see patients centrally at the practice which after one year, there were 42% fewer district nurse home visits and a high level of satisfaction from the patients using the scheme.

The practice had provided unfunded voluntary support to the Yorkshire Ambulance Service since 2007. This worked by allowing the ambulance service to directly mobilise and inform the practice of incidents in which it was beneficial for the GP to attend (usually the GP could be on scene before the ambulance arrived). On average the practice attended approximately four serious or life threatening incidents a year.

The areas where the provider should make improvements are:

Review the practice’s home delivery service in relation to maintaining an appropriate audit trail.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 March 2018

Effective

Good

Updated 21 March 2018

Caring

Outstanding

Updated 21 March 2018

Responsive

Outstanding

Updated 21 March 2018

Well-led

Outstanding

Updated 21 March 2018

Checks on specific services

People with long term conditions

Outstanding

Updated 21 March 2018

Families, children and young people

Outstanding

Updated 21 March 2018

Older people

Outstanding

Updated 21 March 2018

Working age people (including those recently retired and students)

Outstanding

Updated 21 March 2018

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 21 March 2018

People whose circumstances may make them vulnerable

Outstanding

Updated 21 March 2018