Archived: St Ann Street Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Anne Street Surgery on 3 November 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 report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. Examples were:
• The practice worked with two other local practices to ensure frail patients over the age of 75 received domiciliary visits from the practice pharmacist and care coordinator to support them in their social care needs and medicines management.
• The practice provided care for patients admitted to the 15 intermediate care beds in the city, which provided an environment that would enable successful rehabilitation at a place close to home.
• The initiation of a community heart failure clinic.
• 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 the introduction of mental wellbeing courses to support different cohorts of patients towards a healthier life.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were 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.
• The practice was a teaching and training practice and provided placements for GP registrars, medical students and administrative apprentices from the local college.

We saw several areas of outstanding practice including:

• The practice worked with the local heart failure specialist nurse to improve the care of patients with this condition. A 12 week pilot project was initiated by the practice, that incorporated six local practices and assessed the impact of a primary care community heart failure service. During the pilot, patients were referred to the service for assessment, diagnosis and continuing care. A number of these patients were found to require immediate changes to treatment and hospital admission was avoided in over 80% of these patients. Weekly involvement from a local consultant cardiologist gave the opportunity for complex cases to be discussed. An education programme was also delivered to patients which enabled them to recognise symptoms and improve self-management. The success in terms of patient outcomes of the pilot project had led to the clinical commissioning group extending the project to the whole area. The team had won their category for Clinical Community team of the year in the National GP awards 2016.

• People’s individual needs and preferences were central to the planning and delivery of tailored services. For example, a GP at the practice, who had a special interest in drug and alcohol misuse, recognised that a number of working patients wanted to reduce alcohol intake before it became a major problem, but away from the perceived stigma of the drug and alcohol service. The GP worked with the substance misuse service to deliver one to one counselling appointments at the practice outside of work hours. We saw evidence that the service had made a positive impact for these patients.

• We saw proactive innovative approaches to understanding the needs of different groups of people to ensure care was delivered in a way to meet those needs. For example, the practice initiated three mental wellbeing courses, delivered by Active Plus (a charity that delivers personal development, education and wellbeing programmes to people in need). The objective of the courses was to deliver the programme to patients seeking medical support, but who would be more likely to benefit from positive practical activities, interaction with others and the development of a personal action plan to take them forward. Following positive outcomes further cohorts of patients had been identified, for example, carers and patients who were finding it challenging to return to work following sickness, and courses made available to them. Positive outcomes had enabled the practice to obtain further funding in order to continue this work.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice