Archived: Lifton Surgery

Updated 6 August 2015

The GP partnership run the practice from Lifton Surgery and provide general medical services to people living in the town of Lifton and the surrounding villages.

At the time of our inspection there were 3386 patients registered at the practice. There is a higher percentage of patients over 55 years when compared to national statistics. The practice is placed within the mid range of the social deprivation scale.

The practice is contracted to provide general medical services, which includes maternity and pre-conceptual care, contraception, cervical smears, child health services, child immunisation and travel vaccinations and minor surgery. Lifton Surgery works in close collaboration with three other larger practices, where patients are referred to for specific women’s healthcare including coil fitting.

There are two male GP partners, who held managerial and financial responsibility for running the business. Lifton Surgery is a training practice, with one GP partner approved to provide vocational training for medical students from Plymouth and Bristol medical schools. There were no medical students on placement when we inspected the practice. The GPs were supported by a registered nurse, dispensary manager and dispensers, other administrative staff including reception staff.

Patients using the practice also have access to community staff including community nurses, health visitors, and midwives. NHS funded counselling is available on site at the practice, as well as privately funded counselling provided by the practice which patients are referred to by their GP.

Lifton Surgery is open from 8.30 am - 6pm Monday to Friday, with clinic sessions running from 9 am to 12.30pm and 3.30 pm to 5.45pm. A walk in clinic runs every Friday between 3.30 pm and 5.45 pm. Flexible arrangements are offered for working age patients following consultation with patients and appointments are offered before and after clinics into the early evening by arrangement. The dispensary opens every day between 9 am and 5.30 pm. During evenings and weekends, when the practice is closed, patients are directed to an Out of Hours service delivered by another provider. This is in line with other GP practices in the Northern, Eastern and Western clinical commissioning group, which includes an arrangement for the Out of Hours service to take calls from 6pm.

Patients with minor conditions also have access to two small branches held at Lewdown village hall every Monday at 12 midday. On the 1st and 3rd Monday of the month patients can see a GP at Bratton Clovelly village hall at 3pm. Telephone appointments are available with both the GPs and practice nurse. Home visits are available for vulnerable, sick patients by arrangement.

During evenings and weekends, when the practice is closed, patients are directed to an Out of Hours service delivered by another provider. This is in line with other GP practices in the Northern, Eastern and Western Devon clinical commissioning group.

The nearest minor injuries unit is based at Launceston hospital and information about this is provided for patients on the practice answerphone out of hours.

Updated 6 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lifton Practice on 12 May 2015. This was a comprehensive inspection. The practice is based at Lifton Surgery and provides general medical services to people living in the village of Lifton and surrounding villages in Devon. The practice has a dispensary on site, which we inspected. The practice has two branches at Lewdown village Hall and Bratton Clovelly village hall, with weekly sessions held on a Monday, for the treatment of simple conditions. We did not inspect either of these branches at this inspection. The practice provides services to a diverse population, covering an area of approximately 250 square miles.

At the time of our inspection there were 3386 patients registered at the service with a team of two GP partners. Lifton Surgery is a training practice. When we inspected there were no medical students on training placements at the practice.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

Overall the practice is rated as GOOD.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was good for providing services to older people, vulnerable people and people with mental health needs including dementia, people with long term conditions, families, babies children and young people and working age people.

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

• Patient satisfaction was higher than the national average Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was a strong commitment to providing well co-ordinated, responsive and compassionate care for patients. A named GP and practice nurse monitored the health and well being of older and vulnerable patients with a learning disability and/or complex mental health needs.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Patients reported high levels of satisfaction and confirmed that routine and urgent appointments were available the same day and staff were flexible and found same day gaps for patients needing routine appointments.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Audits were used by the practice to identify where improvements were required. Action plans were put into place, followed through and audits repeated to ensure that improvements had been made.

We saw an area of outstanding practice including:

• The practice is the sole provider of general medical services to an adult social care nursing home for 24 patients with Huntington’s Disease (a complex progressive neurological disease). Huntingdon’s Disease is rare and opportunities to develop expertise across the county are limited for medical staff. One of the GP partners has developed expertise in caring for patients with this disease and works closely with a national centre for long term conditions providing expert advice to this centre. Patients with Huntington’s disease from across the UK are referred to this service.

The practice should

• Set up a Patient Participation Group to engage patients in the on-going development of the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 August 2015

The practice is rated as good for the care of people with long-term conditions.

The practice nurse had a lead role in chronic disease management and had dedicated appointments set aside to review patients with diabetes, asthma and/or chronic respiratory disease. Patients at risk of hospital admission were identified as a priority. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice held multidisciplinary meetings every month to review the needs of all patients with complex long term conditions.

Longer appointments and home visits were available when needed. Home visits for patients newly discharged from hospital were undertaken jointly with the community nursing team to carry out an assessment and arrange additional support where needed. All patients newly discharged from hospital were contacted or visited within 48 hours.

The practice recognised the needs of patients and their difficulty with transport to the hospital for appointments. They had arranged for screening for certain conditions to be carried out at the practice. For example, eye screening took place at the practice every year for patients at risk of developing diabetic retinopathy. This was appreciated by some patients we spoke with as it avoided them having to travel to the opthalmology clinic based at the main hospital some 35 miles away.

The practice had links with the external health care professionals to provide advice and guidance as required. GPs and the practice nurse attended a quarterly virtual Diabetic clinic with hospital specialists, to review patient care and treatment. These staff also had expertise in certain areas, for example a GP was nationally recognised for their expertise in the care and treatment of patients with Huntington’s disease. The practice nurse held additional diploma qualifications for more complex treatments for minor illness, diabetes and leg ulcers.

Health education around diet and lifestyle was promoted by the practice. The practice took an early intervention approach and helped identify and signpost patients to external support. This included assistance with smoking cessation.

Updated 6 August 2015

The practice is rated as good for the care of families, children and young people.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies. The waiting room had toys for children to play with whilst waiting for their appointments.

Emergency processes were in place for acutely ill children, young people and pregnant women with acute complications.

The practice worked collaboratively with midwives, health visitors and school nurses to deliver antenatal care, child immunisation and health surveillance. For example, close working links with the school nurse were used to gain a broader understanding of whether a young person had the maturity to make decisions and understand potential risks before advice or treatment was provided.

Young people had access to information about sexual health matters and could request chlamydia screening and be seen by either a GP or practice nurse of their choice.

Support was being accessed for parents from children's workers and parenting support groups where relevant.

Parents with children attending the practice in feedback cards confirmed that they were always present during consultations. Staff understood Gillick principles with regard to assessing whether a young person was able to understand and therefore consent to treatment. Parents told us that all of the staff engaged well with their children so that they found it a positive experience when attending the practice for appointments.

Updated 6 August 2015

The practice is rated as good for the care of older people.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. There was a strong commitment to providing well co-ordinated, responsive and compassionate care for patients nearing the end of their lives. Patients were experiencing proactive management of emergency and short term pain relief medicine by reviewing this with the patient at intervals suited to their needs. This helped carers avoid having to travel long distances for these medicines.

Patients with complex care needs were well monitored by the practice working in partnership with other agencies. They were responsive to the needs of older people, and offered GP home visits and rapid access appointments for those with enhanced needs.

GPs were proactive in reducing risks associated with poly pharmacy for older people. For example, patients prescribed multiple different medicines had been frequently reviewed and changes made to reduce these.

Information systems enabled the practice to appropriately share important clinical and social information about patients with complex needs. This facilitated continuity of care for those patients.

Pneumococcal vaccination was provided at the practice for older people. In 2014, the practice had provided flu vaccinations for patients over 65 years. The practice population consisted of high numbers of farming families recognised as being stoical and rarely presenting at the practice for care or treatment, which affected the uptake for vaccinations. Shingles vaccinations were also provided to patients who fit the age criteria. Patients were contacted to offer them the opportunity to make an appointment to have the vaccination, which had increased the uptake of patients being given this.

The practice held regular carers clinics and works with a community support worker to provide additional help for carers.

The practice worked in collaboration with local day centres and the Tavistock area service which included a befriending service for people. Vulnerable patients were signposted to these services and this was done compassionately and patients in this position were treated with dignity.

Updated 6 August 2015

The practice is rated as good for the care of working-age people (including those recently retired and students).

The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice had online facilities which enabled patients to book appointments and repeat prescriptions on-line. The practice website offered information about the full range of health promotion and screening available for this group. For example, the practice took a flexible person centred approach. Where needed appointments were offered to working patients outside of normal opening hours by arrangement. Over the course of two months, 13 patients had been seen outside of normal opening hours. Appointments were available for patients to see a GP, practice nurse or health assistant. Patients would be able to request repeat prescriptions on-line within a month, at the local pharmacy or in person at the practice. Repeat prescriptions were being given for up to six months.

Overseas travel advice including up-to-date vaccinations and anti-malarial drugs was available from the practice nurse within the practice with additional input from the GP’s as required.

Opportunistic health checks were being carried out with patients as they attended the practice. This included offering referrals for smoking cessation, providing health information, routine health checks including blood tests as appropriate, and reminders to have medication reviews.

Updated 6 August 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

Flexible services and appointments were available, which enabled patients experiencing poor mental health to have longer appointments up to an hour at quieter times of the day, avoiding times when people might find this stressful.

Staff were skilled in recognising and responding to patients experiencing mental health crisis, providing support to access emergency care and treatment. The practice worked collaboratively with the community mental health team and consultant psychiatrists from the mental health partnership trust.

The practice had a list of patients with known mental health needs and worked to engage them in healthy living programmes. Each appointment with a patient was seen as an opportunity to screen patients and signpost them to additional services. In house mental health medication reviews were conducted to ensure patients received appropriate doses. For example, patients taking lithium had regular blood tests to ensure safe prescribing.

Advice and support was sought as appropriate from the psychiatric team with referrals made for psychiatry review or entry into counselling. Patients could refer themselves or be referred directly to the depression and anxiety counselling service, which ran one session per week. The practice had recognised that demand for this was increasing and was funding private counselling sessions for patients at the practice. In total, 14 patients had been seen by this service over the last 12 months in a total of 64 face to face sessions and 1 telephone session had been held. Information about depression, including a diagnostic questionnaire was available on the practice website for patients to see and use. Patients found this helpful and made them more aware of when to seek help from their GP.

Early identification of patients with suspected dementia were being screened and referred to the memory clinic for diagnostic tests. GPs worked closely with the NHS memory clinic, consultants and other mental health workers specialising in care of older people. Data showed the practice was above the clinical commissioning group average of 93% at 96.7% in diagnosing people with dementia. Patients had care plans in place, which supported their on-going changing needs and those of their carers. The practice worked closely with a social centres in and around Tavistock and Launceston to provide services to support patients experiencing poor mental health.

Updated 6 August 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It had carried out annual health checks for people with a learning disability and 100% of these patients had received a follow-up. It offered longer appointments for people with a learning disability and their carers for reviews. Home visits by GPs were carried out where needed to patients living in a newly opened adult social care home. The practice had liaised with the learning disability nurse specialist and was in the early stages of working with them to ensure information was communicated in a person centred way, for example in easy read or picture formats.

Shared care arrangements were in place for patients with complex mental health needs. The practice worked closely with the community mental health team and regularly reviewed each patient. Every patient had a care plan and risk assessment, which was reviewed.

Health education, screening and immunisation programmes were offered as appropriate. This included alcohol and drug screening. Patients with alcohol addictions were referred to an alcohol service for support and treatment and to the local drug addiction service.

The practice worked closely with the community matron to arrange visits to vulnerable patients to assess and arrange any equipment or other assistance needed by the patient and their carers.

Systems were in place to help safeguard vulnerable adults. The practice welcomed all patients to the practice and had systems in place to temporarily register and communicate with homeless people.

Carer checks were carried out and the practice hosted a carer support worker clinic every month to support patients.