A west Norfolk doctors' surgery has revealed the steps it took to turn its performance around to become rated outstanding by its regulators.

Litcham Health Centre was rated as requires improvement by the Care Quality Commission (CQC) in February 2015. But by November 2016 inspectors found it was outstanding.

Now, the practice has been included in a report from the CQC to show what drives improvement.

Senior partner at the surgery, Dr Julian Brown, said: 'Getting a rating of requires improvement did bother me. It demoralised the team and undermined some trust in my clinical leadership. The team felt I was doing something wrong with the set-up in the surgery.'

Senior receptionist June Burton was also disappointed with the rating. She said: 'I had worked here for 11 years and thought patients were treated really well. I read the report at home, and once you see the report, you realise it was right. We did have management problems; the practice manager had left and we didn't have a replacement so people were filling in but not keeping up with all the things that needed to be done. Inspectors picked up on this.'

But the staff sprung into action to make changes as while clinical outcomes were good, processes and infrastructure needed attention.

Dr Brown said: 'The problem with a small surgery like this, with someone like me who focuses on the clinical side, you need to have someone who focuses on the blind spots. And we've now got that. Maybe I had focused too much on front line and left holes in the overall management of practice. It's all very well doing clever stuff, but you have to get the basics right as well.'

Two new practice managers, Tony Bailey and Marta Haskiewicz were brought in to tackle issues and soon work was under way.

And the pair faced the challenge of getting a lot of work done in a short space of time, including spending £30,000 to improve the infrastructure.

They were successful and when the inspectors returned Dr Brown found a big difference between the first and second inspections, particularly as the most recent inspection focused more on the positive work being done.

But he said there was no sitting back now the surgery was rated as outstanding. He said: 'You are never finished. We now have a structure and know where we are going. We review everything annually to make sure we stay on track and although our staffing is fairly stable, we need to start planning for retirements.'