Archived: Catherine House Surgery

Updated 31 March 2016

Catherine House Surgery was inspected on Tuesday 19 January 2016. This was a comprehensive inspection.

The practice is situated in the semi-rural town of Totnes in the South Hams area of South Devon. The practice provides a primary medical service to 2,970 patients of a diverse age group. The practice is a teaching practice for medical students and a training practice for foundation year two doctors and student nurses.

There is a team of three GPs partners, all three were male. There was also a female salaried GP. Some GPs worked part time and some full time. The whole time equivalent is 2.2 GPs. Partners hold managerial and financial responsibility for running the business. The team were supported by a practice manager, two practice nurses including a nurse prescriber, one health care assistant, and additional administration staff.

Patients using the practice also had access to community nurses, mental health teams and health visitors. Other health care professionals visited the practice on a regular basis.

The practice is open between the NHS contracted opening hours 8am - 6.30pm Monday to Friday. Appointments are offered anytime within these hours. Extended hours surgeries are offered; every Tuesday 6.30 – 8pm. The practice also provided a walk in and wait clinic open surgery every weekday from 8.30 – 10.30am. The practice offered a range ofappointment types including book on the day, telephone consultations and advance appointments. Patients could choose which GP they saw for any of these appointments, including the open surgery.

Outside of these times patients are directed to contact the Devon doctors out of hour’s service by using the NHS 111 number.

The practice has a General Medical Services (GMS) contract with NHS England.

The practice provides regulated activities from its sole location at New Walk, Totnes, TQ9 5HA. We visited this location during our inspection.

Updated 31 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Catherine House Surgery on 19 January 2016. Overall the practice is rated as Good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• All feedback from patients about their care was consistently and strongly positive. This included face to face feedback, written comments and online national surveys.
• The practice worked closely with local charity organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, PPG members told us that the practice had consulted them about the extended hours offered.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• 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.

We identified areas of outstanding practice:

• The practice faced challenges in providing childhood immunisations in an area where many patients favoured an alternative lifestyle. The practice had overcome these obstacles to raise its vaccination rate for 2 year olds from 78% in January 2014 to 93% in July 2015. The practice had also increased the meningitis C five in one childhood immunisations in the same period from 81% to 96%. These were significant achievements in this geographical area and above the national averages.
• The practice met up bi-monthly to discuss the top 20 most at risk patients. These meetings included practice GPs, the community matron, social services, physiotherapists and mental health team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes who had received an annual review and a blood pressure check in the last 12 months was 87%, which was significantly better than the national average of 78%.

• Nurses at the practice provided specialist clinics for patients with long term conditions such as asthma and diabetes. One of the practice nurses was a trained diabetic specialist who carried out a regional role delivering educational courses on diabetes for newly diagnosed patients in Devon. The impact of this was that patients at the practice benefitted from the most up to date care and treatment for diabetes.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 31 March 2016

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

• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice provided a room and resources for a dedicated midwife to be based at the practice, offering a weekly clinic. Patients provided positive feedback about this service.

• 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.

• The practice was based in Totnes, a town with a percentage of the population which favoured an alternative lifestyle. As a result the practice faced challenges in providing childhood immunisations. The practice had overcome these obstacles to raise its vaccination rate for 2 year olds from 78% in January 2014 to 93% in July 2015. The practice had also increased the meningitis C five in one childhood immunisations in the same period from 81% to 96%. These were significant achievements in this geographical area and above the national averages.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practices cervical screening rate was 83% which was better than the national average of 81%. This represented a substantial improvement on the previous financial year when the practice had achieved 78%. The practice had achieved this through providing a telephone reminder service to relevant patients.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice provided a weekly clinic every Friday for young people. These were aimed at providing guidance on issues relevant to young people including sexual health, skin problems and eating disorders. A sign on the outside of the practice advertised these clinics and their timings.

• The practice provided a room and resources for a specific midwife who was dedicated to the practice and provided a weekly clinic. Patients were very satisfied with this service.

Updated 31 March 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population such as regular visits to remote rural villages with poor transport links. CQC data showed that 24% of the practice’s population of 2,970 were aged over 65 years, which was higher than the national average of 16%.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice catchment area included Harbertonford, a remote village with poor transport links with a large proportion of older patients, many of whom found it difficult to leave their homes. A practice GP visited Harbertonford every Thursday where they carried out numerous home visits for these patients.

• GPs at the practice provided older patients who found it difficult to leave their homes with their flu vaccinations. GPs told us this gave them the opportunity to meet and speak with these patients when they were well.

• The practice had access to a four wheel drive vehicle which was used to transport staff to the practice and carry out home visits in the event of heavy snow or flooding. This was particularly important in the large rural area the practice covered (150 square miles), where many older patients lived in remote villages.

• The practice liaised with a local charity called Totnes Caring which offered befriending services, transport, home help and meal deliveries to older patients who found it difficult to leave their homes.

Updated 31 March 2016

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. For example, signage on the outside of the practice advertised evening appointments aimed at the working population every Tuesday between 6.30pm – 8pm and the Saturday walk in surgery 9am – 12 noon.

• Practice services included online appointments and online repeat prescriptions, telephone consultations and comprehensive information on the practice website to allow working people and students to easily access the service.

• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

• The practice had systems in place to identify military veterans and ensured their priority access to secondary care in line with the national Armed Forces Covenant. The practice had an Armed Forces Treatment Priority policy which had been reviewed in May 2015.

Updated 31 March 2016

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

• There was a proportionately high prevalence of patients with a mental health diagnosis in the practice population. One of the GPs had become a Professor in clinical education with an interest in mental health, who lectured on the subject at the Plymouth University Peninsula School of Medicine and also carried out research which had a positive benefit on patients in this group. Benefits included regular counselling sessions, a holistic approach to help patients return to work such as counselling and medicines reviews and a close liaison with local support organisations.

• CQC data showed 84% of patients diagnosed with dementia had received a care plan review within the last 12 months. This was in line with the national average.

• The percentage of patients with diagnosed physical and/or mental health conditions whose notes recorded their smoking status in the preceding 12 months was 94.97% which was in line with the national average of 94.1%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 91% which was better than the national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 31 March 2016

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 homeless people, travellers and those with a learning disability. The practice also offered its support to a local homeless shelter in Totnes and signposted patients to other local agencies who helped the homeless.

• The practice had pledged its support to a local campaign to assist Syrian refugees and was working with a housing development nearby to ensure the new arrivals received adequate primary healthcare provision.
• The practice offered longer appointments for patients with a learning disability.The practice offered support services to patients with gender dysphoria (the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex), such as counselling and signposting to appropriate agencies. GPs provided us with examples of several patients who had benefitted from this support and provided positive feedback to the practice.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice met up bi-monthly to discuss the top 20 most at risk patients. These meetings included practice GPs, the community matron, social services, physiotherapists and mental health team.