15 December 2017
The practice is situated in the town of Plymstock near Plymouth. The practice provides a primary medical service to approximately 10300 patients. This is an increase of 630 patients since our inspection in May 2015. The practice is a training practice for doctors who are training to become GPs.
There is a team of five GP partners and two salaried GPs (five female and two male). The team were supported by a practice manager, two nurse practitioners, four female practice nurses, two health care assistants and a phlebotomist. The clinical team were supported by additional reception, secretarial and administration staff.
Patients using the practice also have access to community staff including community matron, district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.
The practice is open from Monday to Friday, between the hours of 8.00am and 6.00pm. Appointments are available to be booked up to six weeks in advance and take place between 8.30 and 6pm. Patients told us they felt the appointment system was good. Extended hours are offered by the GPs and nurses on a weekly rota basis. Appointments are available for early mornings from 7.30am and later in the evening until 7.30pm four days a week. Outside of these hours patients are directed to contact the out of hour’s service and the NHS 111 number in line with local contract arrangements.
The Dean Cross Surgery provides regulated activities from the main site at Dean Cross Surgery, 21 Radford Park Road, Plymouth, PL9 9DL. Information on their service can be found on their website www.deanxsurgery.co.uk .
15 December 2017
Letter from the Chief Inspector of General Practice
This practice is rated as Good overall. (Previous inspection 20 May 2015 – rated as Good)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at Dean Cross Surgery on 7 November 2017 as part of our inspection programme.
At this inspection we found:
- The practice had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- Staff involved and treated people with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they were able to access care at the right time.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider should make improvements are;
- The practice should look ways to improve outcomes for patients with diabetes.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
16 July 2015
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 practice had clinics for asthma and chronic lung disorders and used spirometry, a lung capacity test, as part of their service to assess the evolving needs of this group of patients. The practice also promoted independence and encouraged self-care for these patients.
There were weekly diabetic clinics to treat and support patients with diabetes, this included education for patients to learn how to manage their diabetes through the use of insulin. Health education was provided on healthy diet and life style.
Yearly home visits and medication reviews were arranged for housebound patients with long term conditions.
The practice worked closely with the community matrons to monitor patients who had chronic conditions to help prevent hospital admissions. Patients who were on the unplanned admissions register were contacted following discharge from hospital to identify any changes to care and treatment required and reviews of care were discussed at practice meetings.
Clear alerts were shown on the appointment system highlighting vulnerable patients, this ensured reception staff acted in a timely manner and allocated same day appointments or home visits where appropriate.
16 July 2015
The practice is rated as good for the care of families, children and young people. Systems were in place for identifying and following-up vulnerable families who were at risk.
Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals, we saw evidence to confirm this. We saw that staff dealing with young people under 16 years of age without a parent present were clear of their responsibilities to assess Gillick competency. Sexual health, contraception advice and treatment were available to young people including chlamydia screening.
Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. Immunisation rates were high for all standard childhood immunisations.
All of the staff were very responsive to parents’ concerns and ensured parents could have same day appointments for children who were unwell.
A GP took the lead for safeguarding with the local authority and other professionals to safeguard children and families. Staff were knowledgeable about child protection and proactive in raising concerns with the safeguarding lead to follow up on any identified.
16 July 2015
The practice is rated as good for the care of older people. Nationally reported data showed the practice had better than average outcomes for conditions commonly found amongst older people. The practice had a register of all patients over the age of 75 and these patients had a named GP. 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 dementia, shingles vaccinations and end of life care.
The care for patients at the end of life was in line with the Gold Standard Framework. This means they work, as part of a multidisciplinary team and with out of hours providers, to ensure consistency of care and a shared understanding of the patient’s wishes.
The practice was responsive to the needs of older people, GPs, nurses and health care assistants provided home visits and rapid access appointments for those with enhanced needs. We saw care plans were in place for patients at risk of unplanned hospital admissions, and those aged 75 and over who were vulnerable had care plans in place.
Patients who lived in nursing homes had twice yearly reviews of their care undertaken by the GP visiting them at the home.
16 July 2015
The practice is rated as good for the care of working age people. 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 staff were proactive in calling patients into the practice for health checks. This included offering referrals for smoking cessation, providing health information, routine health checks and reminders to have medication reviews. This gave the practice the opportunity to assess the risk of serious conditions on patients which attend. The practice also offered age appropriate screening tests including prostate and cholesterol testing.
Patients who received repeat medications were able to collect their prescription at a place of their choice. The staff often posted the prescription to a pharmacy of the patient’s choice, which may be convenient to their work place.
16 July 2015
The practice is rated as good for the care of people experiencing poor mental health. All people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice had in place advance care planning for patients with dementia.
The practice had sign-posted patients experiencing poor mental health to various support groups and in house wellbeing services were provided on site. The practice had a system in place to follow up on patients who had attended accident and emergency where there may have been mental health needs. Staff had received training on how to care for people with mental health needs and dementia.
16 July 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 learning disabilities. The practice had offered annual health checks for people with learning disabilities and 71% of these patients had received one. Those that declined were offered again. The practice offered longer appointments for people with learning disabilities and recognised their individual needs. For example, they used the same members of practice staff and visited the patient at home if that avoided distress to the patient.
The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector 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 and out-of-hours.