We carried out an announced focused inspection at The Hall Practice, a GP practice in Chalfont St. Peter, South Buckinghamshire on 26 February 2020 as part of our inspection programme.
We carried out an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:
- Are services effective?
- Are services well-led?
Following assurance received from our review of information we carried forward the ratings for the following key questions from the previous inspection in April 2015:
- Are services safe?
- Are services caring?
- Are services responsive?
We based our judgement of the quality of care at this service on a combination of:
- What we found when we inspected
- Information from our ongoing monitoring of data about services
- Information from the provider, patients, the public and other organisations.
Following this inspection, the overall rating remains the same and we have rated this practice as Outstanding overall. The practice continues to be rated as Outstanding for providing effective services and is now rated Outstanding for providing well-led services. Two population groups: older people and people whose circumstances may make them vulnerable are also rated Outstanding whilst the remaining four population groups (people with long term conditions, families, children and young people; working age people (including those recently retired and students) and people experiencing poor mental health (including dementia) have been rated as Good.
We rated the practice as Outstanding for providing effective services because:
- Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools. This included the adaption of tools to ensure practice staff shared standardised, concise and focused information.
- Historically outcomes for patients who use services were consistently very good. We saw evidence of data irregularities for the 2018/19 period and saw the practice was proactive and sort a resolution to address these irregularities. Unverified data collected during the inspection indicated timely and correct clinical interventions had taken place.
- The practice worked in partnership with other services and organisations and kept up to date with new research and development to make sure staff are trained to follow best practice and patients received effective care. For example, an ongoing quality improvement programme to improve outcomes for a cohort of complex care patients who accessed GP services.
- There was a proactive support and appraisal system for staff, which recognises that continuing development of skills, competence and knowledge is integral to ensuring high-quality care and support.
- Staff, teams and services were committed to working collaboratively and have found innovative and efficient ways to deliver more joined-up care to people who use services.
We rated the practice as Outstanding for providing well-led services because:
- The practice had a clear vision, strategy and supporting objectives which were stretching, challenging and innovative, whilst remaining achievable. The core vision of the practice was now underpinned by four values.
- We found there was good staff morale in the practice, with high levels of team spirit and motivation. There was a strong learning culture evident in the practice. This came across clearly through discussions with staff members and in the approach to adopting and championing new initiatives. Already an accredited training practice, the practice had signed up to a project to introduce and support 6th formers (aged 16-18) from under represented backgrounds into general practice.
- There was a reformed, yet clear leadership structure and staff felt supported by management. Staff commented on recent positive changes within the management team, the strong sense of team across all teams and the focus to achieve the practice objectives and deliver an outstanding service to people accessing services at the practice.
We saw several areas of outstanding practice:
- The practice had innovation and quality improvement at its heart and was continually seeking new ways to develop new and more effective pathways for patient care. This included the use of known quality improvement models and methodologies to improve patient outcomes. All staff we spoke with and received feedback from commented on the culture to learn, improve and how they were supported to lead and deliver change. This included feedback from staff members currently at the practice in a learning and developmental role, such as the GP registrars.
- The practice had recently been recognised for its endeavour in becoming a more environmentally friendly practice and was awarded a bronze award as part of the Green Impact for Health project. The scheme was designed to improve the environmental performance of the practice while saving money and ensuring that the provision of services offer the greatest benefit to society as a whole.
Whilst we found no breaches of regulations, the provider should:
- Continue to improve uptake for cervical screening to ensure the practice meets the national target of 80%.
Details of our findings and the evidence supporting the change in rating are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care