Archived: Tudor Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Tudor Practice on 17 June 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice used learning from incidents to improve services.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• 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 met patients’ needs. For example redesigning services to better support patients in primary care and reduce hospital admissions.
• 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. For example, changes to the appointment system to improve access.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• 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 to meet changing needs in primary care and secure future services for patients.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw areas of outstanding practice including:

• The practice had been a key player in developing a successful scheme to reduce unplanned admissions in collaboration with two other practices. The scheme extended beyond the local enhanced scheme by including all patients over 70 years. The senior partner formed a steering group with the other practices involved and employed a service redesign expert to support the project. During the initial stages they visited and listened to a wide range of stakeholders and patients to identify and address challenges faced by organisational boundaries. The organisations were brought together through organised networking events to improve working relationships and understanding of roles. As part of service redesign software was developed to enable the practices to view their patients in the system and intervene as appropriate. The practice initially employed two but now has three community matrons to facilitate hospital discharges and put in place appropriate packages of care to minimise the risk of readmission to hospital. The practices involved maintain a blog to support communication across the partnership. Through this programme of service redesign the practice has made demonstrable improvements to patient outcomes and experiences as well as benefiting the local health economy in facilitating early safe discharge from hospital. To date the practice has reduced the average number of hospital deaths by 90, saved 5800 hospital bed days and reduced admission spend by £1.2 million. As a result of this success three further practices have joined the scheme which covers a population of 64,000. The scheme has led to a fall in hospital readmissions by more than 6 admissions on average each week and the facilitation of early safe discharge for over 200 patients among the participating practices.

The areas where the provider should make improvement are:

• Review and implement ways in which the identification of carers might be improved so that they may receive support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice