Archived: Ivybridge Medical Practice

Updated 14 April 2016

Ivybridge Medical Centre was inspected on Wednesday 16 March 2016. This was a comprehensive inspection.

Ivybridge Medical Centre is part of the Beacon Medical Group which on 1st April 2014 merged the then Plym River Surgery (now called Plympton Health Centre), Ivybridge Health Centre, Ridgeway Surgery, Chaddlewood Surgery and Wotter Surgery.

There is now one partnership practice organisation delivering service out of four sites, serving a total patient list of 33,000.

Ivybridge Medical Centre is located in the rural town of Ivybridge which is situated on the edge of Dartmoor National Park and nine miles from the city of Plymouth. It provides a service to approximately 11,300 of the 33,000 patient group.

The practice is a training practice for doctors who are training to become GPs, for student nurses, paramedics, pharmacists and for medical students. The practice also supports the apprentice scheme.

There is a team of 19 GP partners across the organisation. Eight of these were based at Ivybridge, five male and three female. Partners hold managerial and financial responsibility for running the business. The team at Ivybridge are supported by a further two salaried GPs, a chief operations officer, operations managers and additional clerical and reception. There is also a team of three senior nursing staff, nine practice nurses, three health care practitioners and four phlebotomists who work across the four sites. The GPs tend to work at a named practice for patient continuity but could also cross cover in periods of staff absence.

Patients using the practice also have access to community nurses, midwives, mental health teams, counsellors, research nurses, health visitors and school nurses who were either collocated at the practice or provided services at the practice.

The practice is open from 8.15am to 6pm Monday, Wednesday and Friday and until 8pm on Tuesday and Thursdays. Telephone lines were open from 8am each day. Outside of these times patients are directed to contact the Devon doctors out of hours service by using the NHS 111 number.

Updated 14 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ivybridge Medical Practice on Wednesday 16 March 2016. Overall the practice is rated as good.

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

• The practice had gone through organisational changes in the last eighteen months. There was now one partnership practice organisation delivering service out of four sites. Staff said this transition had been handled well and had improved resources. Patients told us they had been made aware of the changes but said they had not found the changes disruptive.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Medicines were manged well at the practice. The practice actively worked with the community pharmacy to develop a model where patients with less complex needs could access support through their high street pharmacy. Patients from the practice accessed support via the Pharmacy First scheme. The practice were working with the patient groups to increase this offer at more convenient locations with longer opening hours than the practice.

• Staff had access to a structured induction programme which was tailored to the role of each member of staff, including temporary staff. There was an encouraging culture of education and learning within the organisation which was monitored well.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice offered specialist musculoskeletal and dermatology clinics by specialist GPs whom provided additional screening and treatment plans for an increased number of patients rather than onward referral to secondary care. Feedback of this service has been positive and patients have been seen within 4-6 weeks rather than 18 weeks and received services closer to their home. The practice had found that for 80% of patients seen, care and treatment was provided locally rather than referral into secondary care.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 GP, although a small number of patients said getting through on the telephone was sometimes a problem. Patients added that there was continuity of care, with urgent appointments being available the same day.
• 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.
• There was a ‘staff comms’ group who met with senior managers and partners to discuss staff issues and concerns. The group consisted of 12 self-volunteered members of staff and had performed staff surveys regarding management issues, workload and pay. Staff told us that this group had encouraged them to be involved and engaged in how the practice was run.
• The provider was aware of and complied with the requirements of the Duty of Candour.

• There was an active patient participation group (PPG) which met regularly and contained representatives from all population groups. The group had been involved in the survey questionnaire, had worked with other PPGs within the organisation to improve community involvement and had recently organised a lifestyle fayre for people in the community. The PPG had also organised information evenings on topics including stroke and dementia which had been attended by the GP.

The area where the provider should make improvements are:

• Continue with the discussions and investigation into why exception reporting figures for mental health and cancer indicators are higher than expected.

• Review the need to store controlled drugs at practice taking into consideration the location of the practice and proximity of nearest pharmacy and paramedic cover.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 April 2016

The practice is rated as good for the care of patients 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.
• 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. For example, consultants and community workers across the area. The practice pharmacist worked alongside the organisation business intelligence team and nursing team to promote safe prescribing – highlighting national and local medicines advice.
• The practice engaged with partners in the universities and business sectors to provide innovation including research. This includes diabetes, pre-diabetes, respiratory disease, dementia, and low level mental health issues.
• The practice worked with the local pharmacist to deliver flu jabs in the community.
• The practice were constantly improving systems to support patients to get rapid access to support. The practice used electronic prescribing, the new website enabled patients to book appointments and view their summary care records.
• The practice shared information with the out of hour’s service provider who were also able to input notes directly into the practice clinical system.

Updated 14 April 2016

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

• 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 patients 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 patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice had performed 80.9% of cervical screening in the last five years. This was in line with national averages of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Appropriate toys and books were available for families. Reception staff had been trained to support mothers who wish to breastfeed and offer a private location if needed.
• Ante-natal care was provided by a team of midwives who were located in the practice or use practice facilities for clinics.
• In Ivybridge, there were productive working relationships with the local secondary school. GPs provided sexual health outreach service and health advice within schools.
• The practice worked with local schools regularly, through competitions among students interested in medicine and picture competitions to support health education events.
• Patients had access to a full range of contraception services and sexual health screening including chlamydia testing and cervical screening. The practice had recently launched a well woman clinic at the Ivybridge and Plympton sites providing specialist contraceptive services by trained staff.
• The clinical system used at the practice could be accessed by the community health provider, Cumberland centre minor injuries service, health visitors, mental health teams and district nurses where patient gave consent.

Updated 14 April 2016

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

• All patients had an allocated GP but could also have access to any GP they preferred across the four sites.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Pneumococcal vaccination, shingles and flu vaccinations are provided at the practice for older people. The practice ensured that patients in care homes or those that have problems getting to the practice are given vaccines by the practice.
• The practice staff proactively supported the most frail patients through the unplanned admissions scheme. Staff across all four practices developed and reviewed care plans, discharge records and medicines for this vulnerable group.
• The practice had effective relationships with partner agencies and ran a virtual ward engaging with social care, mental health, palliative care, district nursing and other community providers to review cases of the most vulnerable patients.
• The community nurses and matrons were co-located in Ivybridge Medical Practice and met with the GPs and staff monthly with providers to discuss the most vulnerable patients and to understand the organisational challenges.
• The practice had been building much closer links to voluntary and community groups to identify the needs of older people, in particular around isolation with an aim to increase independence.
• The practice worked hard to avoid unnecessary admissions to hospital and referred patients to the rapid response care coordination team and falls service.
• The practice had effective working relationships with local nursing and residential homes and had dedicated access to support. The larger care homes had a nominated GP link. Care home managers had access to a dedicated telephone line if there were urgent concerns.

Updated 14 April 2016

The practice is rated as good for the care of working-age patients (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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice had a higher than Clinical Commissioning Group (CCG) average number of working age adults.
• The practice offered extended opening hours across all four sites between Monday and Thursday. These were popular with patients. The practice had recently extended the clinical team support to provide long term conditions and contraceptive support during these times. The patient survey highlighted that patients didn’t know about what was on offer so the practice had used direct mailing to outline services that were available.
• The practice provided additional triage to patients so that the in-house pharmacist could screen minor ailments or medicine queries. This was done by telephone to support patients from any of the organisations four locations.
• Patients at the practice had access to the Urgent Care Team at the Plympton location which included a Practice Pharmacist, Advanced Paramedic Practitioner and Nurse Practitioner who work alongside the duty doctor each day.
• The practice had promoted additional weekend and evening vaccination access for working people which had significantly increased the proportion of the patient population accessing these types of healthcare.
• The practice offered advance appointments up to six weeks and used a text message reminder service for some patients.
• Suitable travel advice, including vaccines for yellow fever was available from GPs, the nursing team and in-house pharmacist.
• The practice offered health checks to patients aged 40-74. These were well established within Ivybridge and staff worked with medical students from the Peninsula medical school to help design the service to attract more patients. Typically the checks included smoking advice, health information and routine health checks including near patient cholesterol testing.
• The Ivybridge practice offered a minor injuries service that was open to the general public. People could turn up without pre-booking an appointment, within 48 hours of their injury.
• The practice offered out of area registrations to enable people who worked in the local area to access healthcare support and offered online consultations as well as information and guidance for most conditions.
• The practice offered new specialist musculoskeletal and dermatology clinics by specialist GPs whom provided additional screening and treatment plans for an increased number of patients rather than onward referral to secondary care. Feedback about this service had been positive and patients had been seen within 4-6 weeks rather than 18 weeks and closer to their home. The practice had found that for 80% of patients seen, care and treatment was provided locally rather than referral into secondary care.

Updated 14 April 2016

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

• The practice had a nominated lead for dementia and mental health and referred patients to the memory café where appropriate.

• 79% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%. The practice had been proactive in identifying dementia patients and had increased awareness of dementia, with all staff trained as Dementia friends. The practice had also hosted a patient education evening highlighting dementia. Staff explained that these had given patients the opportunity to learn more about the health condition and provided links to support organisations in the community.

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 held a register that identified patients who had or previously had mental health problems. This was regularly reviewed with the mental health team. The practice provided reviews on an annual basis and each patient had a tailored care plan. 91% of patients with mental health within the organisation had been reviewed and had a care plan in place.
• Patients had access to an in house counsellor or had access to counselling. All GPs performed medicine reviews for their own patients with mental health problems to provide continuity of care. Blood tests were regularly performed on patients receiving certain mental health medicines.
• There was regular communication, referral and liaison with the local mental health team. Clinical staff referred patients to the crisis team within the mental health service where patients would benefit from rapid intervention because of deteriorating mental health. Patients usually saw a worker the same day within their own home and were offered rapid support, keeping patient safe. 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.

Updated 14 April 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
• 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.
• Patients with a learning disability were offered a health check every year during which their long term care plans were discussed with the patient and their carer if appropriate. If a patient did not respond to the invitation for a health check or to reminders, staff liaised with the local service who provide community support to adults with learning difficulties to encourage access.
• One of the GPs was a named GP at a local school for children and young people with learning difficulties and visited monthly for continuity of care and communication. Another GP was the named GP for a local special needs school supporting children and young people with severe learning needs and visited weekly.
• Practice staff referred patients with alcohol addictions to a local alcohol service for support and treatment. Up to date posters were displayed in waiting areas referring patients to community support.