Nurse practitioner who took the lead sees her practice rated outstanding by CQC

When nurse practitioner Carol Sears took on the lease of the practice in which she worked, she had no idea of where the journey would lead

When nurse practitioner Carol Sears took on the lease of the practice in which she worked, she had no idea of where the journey would lead.

She made the decision after the GP partners moved on, and ten years later, the nurse-led Cuckoo Lane Practice in Hanwell, west London, is attracting praise and was recently rated outstanding by the Care Quality Commission (CQC).

Nurse practitioner Carol Sears, left, with client

Inspectors highlighted a number of areas of outstanding practice including the targeted treatment for people with mental illness, which has enabled 19 patients who had been receiving treatment in secondary care to access treatment from the local practice instead.

Operating under an Alternative Provider Medical Services contract, the practice was also commended by the regulator for being ‘particularly responsive to the needs of the local community’ and for providing ‘a safe, caring, effective and well-led service’.

'Delighted and shocked'

Director Ms Sears, who runs the practice with fellow nurse practitioner Julie Belton, says she was ‘delighted and shocked’ by the CQC’s verdict, which followed an inspection of the practice’s services in January.

‘We weren’t expecting it at all but when we received the outstanding rating it felt like the whole team had been rewarded for ten years of hard work and others being sceptical about whether we could run a practice securely and safely,’ she says.

Ms Sears attributes the practice’s success to its team approach to patient care. The practice is staffed by five nurse practitioners, three practice nurses, two healthcare assistants, three part-time salaried GPs and a range of non-clinical staff. It has 4,700 patients on its register.

Good communication

Ms Sears says good communication between colleagues at the practice, including two five-minute meetings each day where staff can talk about patient and operational issues, is key.

‘We have built up a strong team approach to how we do things and communication is very important to us so everyone is aware of what is happening every day and can contribute ideas if there are any issues.

‘At our twice-daily huddles, for example, we can report which staff are in and who is away, discuss new guidelines or the introduction of new services such as the meningitis vaccine. It is a really good way of getting everyone involved and on board.’


The practice also regularly gets involved in research to ensure it stays at the cutting edge of patient care and is currently taking part in an integrated care pilot to streamline health and social care for patients who need both.

The Cuckoo Lane model has attracted interest from NHS England and other nurses wanting advice on how to go about setting up similar practices in their local areas.

Ms Sears believes nurses have the necessary values and skills, including good communication and an ability to engage with patients, to run primary care services, and that the practice could be a model for others.

Lead by example

She says: ‘My priority is being a clinician and I aim to lead by example providing good care, keeping the business up to date and demonstrating good communication skills. I would love to inspire nurses to run practices and use ours as a model.’

Helen Ward, principal lecturer in non-medical prescribing at London South Bank University, works at the practice one day a week as an advanced nurse practitioner. She says she feels honoured to be part of the team.

‘We are dedicated to providing the best possible patient care and we are open to discussions about cases we work with at clinical meetings,’ she says. ‘There is a tight peer support network at the practice which helps to make it successful.’


Ms Ward says she would like to see more nurse-led practices in operation, but ‘there is a big risk involved and you have to have the right sort of nurses prepared to take that risk’.

‘As a profession we still like to hide behind our medical colleagues, but there is a lot of extremely valuable work going on in terms of advanced practice.’

Ms Sears’ advice to nurses thinking of running their own practice is: ‘Ask yourself, do you really want to do it, and, if you do, make sure you have the support of friends, family and colleagues.’

Sophie Blakemore is assistant editor, RCNi

More information

The full CQC report






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