Letter from the Chief Inspector of General Practice
This practice is rated as Outstanding overall. (Previous inspection 29/09/2015 – Good)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Outstanding
Are services caring? – Good
Are services responsive? – Good
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 – Good
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced inspection at Saxon Cross Surgery on 14 November 2017 as part of our inspection programme.
At this inspection we found:
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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.
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The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
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At our last inspection, we found that a GP partner had led on the implementation of eHealthscope, a shared intranet system across the local CCG to facilitate learning by the sharing of data and access to a range of documents including best practice guidance. This innovation had led to eHealthscope being rolled out to all practices across Nottinghamshire. At this inspection, we found the practice had continued to develop this system to review and improve patient care by creating information sharing platforms with other practices and healthcare providers.
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The practice used information about care and treatment to make improvements. For example, they initiated opportunistic pulse rhythm checks to improve their identification of people with atrial fibrillation, resulting in 78% of eligible people having checks for the condition and two people being diagnosed with the condition.
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Staff involved and treated patients with compassion, kindness, dignity and respect.
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Staff had the skills, knowledge and experience to carry out their roles. Mentorship of the nursing staff was shared amongst all GPs in the practice, enabling them to learn different skills from the clinicians.
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The practice understood the needs of its population and tailored services in response to those needs. Patients were able to access care and treatment from the practice within an acceptable timescale for their needs through a variety of methods.
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There was a strong focus on continuous learning and improvement at all levels of the organisation. This included the sharing of policies, significant events and clinical audits with other practices within the CCG using the shared eHealthscope system and practice group meetings. As a result, some practices implemented the audits and adopted the same approach to improving the quality of care across the whole CCG.
We saw some areas of outstanding practice:
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The practice continued to promote innovation by developing a workflow system within the eHealthscope which enabled holistic care of registered patients with complex needs by identifying community teams that were involved or needed to be involved in their care.
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Clinicians initiated opportunistic pulse rhythm checks to improve their identification of people with atrial fibrillation, resulting in 78% of eligible people over 64 years old having checks for the condition and two people being diagnosed with the condition.
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Leaders at all levels were visible within the practice as well as the CCG where they held various positions, enabling them to influence improvements across the group of practices. Mentorship for the nursing team was rotated amongst all the GP partners to share skills and build resilience within the team.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice