Archived: ASSIST

This practice is rated as Outstanding overall.

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? - Good

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

We carried out an announced comprehensive inspection at Assist on 9 March 2018 as part of our inspection programme.

At this inspection we found:

• The Assist Practice was a GP practice specifically designed to provide asylum seekers and eligible patients with access to high quality healthcare within Leicester City.

• The leadership, governance and culture of this practice was used to drive and improve the delivery of high quality patient centred care.

• At the inspection we found that patients were protected by a strong comprehensive safety system and a focus on openness, transparency and learning when things go wrong. We found an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents. When incidents did happen there was a genuinely open culture in which all safety concerns raised by staff and people who use services were highly valued as opportunities for learning and improvement. All opportunities for learning from internal and external incidents were maximised.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. 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.
• We saw a patient centred culture and strong evidence that staff were motivated and inspired to offer kind and compassionate care, working to overcome obstacles to achieve this. There were many positive examples to demonstrate how patients’ choices and preferences were valued and acted on.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Information about services and how to complain was available and accessible in different languages via the practice website. Improvements were made to the quality of care as a result of complaints and concerns. The practice was proactive in capturing complaints and acted positively to make 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 leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care and were clear, supportive and encouraged creativity.
• Governance and performance management arrangements were proactively reviewed
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The provider was a social enterprise and had a board of directors who were responsible for making business decisions. High standards were promoted and owned by all the practice staff with evidence of team working. It recognised staff for their efforts and achievement through a number of different schemes including award ceremonies.

We saw a number of areas of outstanding practice:

• The practice had also developed the ‘Inclusion bike project’. The practice obtained local funding and purchased 10 bicycles, with safety equipment and worked with the local police who provided cycle proficiency training which in turn was linked to patients being able to learn the English language. The provider now worked with partner agencies and had created a ’Bike Library’ which are loaned to patients who had completed the cycling proficiency training. We were told that this helped alleviate the social isolation which many asylum seekers experienced and enabled them to attend the practice from areas outside Leicester City and improve their physical and mental health.

• In special circumstances the practice provided direct funding to patients, for example, for taxis to enable patients to access essential health care, mental health and well-being resources such as purchasing colouring books and radios for adult mindfulness/distraction and tenancy support packs providing essential personal items such as underwear and socks.

• The provider had created a Social Enterprise ‘Inclusion Communities Fund’. We were told that staff and shareholders made decisions together on how the funds were allocated in keeping with the provider’s vision and values. Over recent months money was donated to a local charity which provided support for asylum seekers and refugees.

• The practice had a vision and strategy in place driven by quality and safety which reflected compassion, dignity and respect. All staff we spoke with felt engaged in this vision and strategy through regular practice meetings and a strong team culture at the practice.

The areas where the provider should make improvements are:

• Improve the process for the documentation of safeguarding meetings.

• Improve the current process in place for coding of medication reviews.

• Improve the current process in place for prescription stationery.

• Review and improve the monitoring of training to ensure all staff have training relevant to their role, for example, infection control, sepsis awareness, health and safety.

• Review and improve the clinical governance agenda to includes areas that will provide information and guidance to staff , for example, MHRA and NICE .

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice