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Visiting ‘outstanding’ GP practices during a public health rotation

By Helen McGeown, GPST1
 
One of the many innovative posts offered on the Imperial GP training scheme is a six month placement in public health.  Having some background knowledge of this area, I was pleased to have the opportunity to work in public health, enabling me to see how the theories which I have studied are translated into practice.

During my placement, I have been primarily working with the Immunisations team at NHS England (London region). This team has responsibility for commissioning and monitoring vaccination services for all of London. So far I have undertaken numerous projects for this group, including the appraisal of an intervention to improve vaccination uptake, and a consultation on effective social media strategies for vaccine promotion.

Perhaps most valuable, however, has been the opportunity to visit GP practices which have been rated as delivering ‘outstanding’ care by the Care Quality Commission (CQC). During CQC inspections, practices are assessed on the following areas:

·          Are they safe?

·         Are they effective?

·         Are they caring?

·         Are they responsive to people’s needs?

·         Are they well-led?

(from CQC website, accessible at: http://www.cqc.org.uk/content/five-key-questions-we-ask)

CQC visits emphasise the care of patient groups that are often under-served, including homeless people, those with mental health needs, and the elderly. Their stringent criteria are reflected in the fact that only 9 practices within London have received the top rating of ‘outstanding’. The two practices I have visited to date are Amersham Vale practice and the Dr Hickey Surgery.

Amersham Vale practice, based in New Cross, Lewisham, serves a diverse patient group, including a large homeless population, those battling drug and alcohol addictions, and those who have recently moved to the UK from abroad. Dr Louise Irvine, a GP at the practice, shared some ways in which care is tailored to the needs of their patients. These included using extended appointment times as standard, text message reminders for appointments, and frequent use of translation services. Some GPs in the practice had also completed the RCGP Certificate in the Management of Drug and Alcohol Misuse to reduce the need for referrals when caring for patients with addictions.  

Established by Dr Mary Ursula Hickey, the Dr Hickey surgery provides care exclusively for the homeless population living around Westminster. It adopts a flexible approach to maximise the accessibility of its services, with the majority of appointments being ‘walk-in’. Appointment lengths are not defined, and there is an emphasis on delivery of holistic care.  Members of staff at the practice seek to support patients in their engagement with social services and voluntary organisations, and engage in opportunistic health promotion at each appointment. All patients are provided with free sandwiches (courtesy of Pret-a-Manger) and hot drinks while they wait to see a healthcare provider.

Common to both practice visits was a clear emphasis on patient voice. Numerous staff members cited their patients as their greatest resource, and efforts were made to include patient feedback in decisions about the future running of the practice through surveys and patient participation groups. Staff members in both practices had a clear sense of vocation, and a commitment to delivering quality care. Staff spontaneously used words like ‘caring’, ‘kindness’, and even ‘love’ when asked about their relationship with their patients. It was clear that it was this attitude that underpinned and sustained the ability of these practices to deliver outstanding care in what are often challenging contexts.

A short video made during my visits to these practices is accessible here:

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