Archived: Grosvenor Road Surgery

Updated 24 December 2015

Grosvenor Road Surgery is situated in the seaside town of Paignton, Devon. The practice is one of two practices who come under the Paignton Medical Partnership. Together, the practice provides a primary medical service to approximately 8,100. Grosvenor Road provides primary medical services to 5,500 patients of a diverse age group.

The practice is a training practice for doctors who are training to become GPs.

There is a team of three GP partners and one salaried GP within the organisation. Partners hold managerial and financial responsibility for running the business. There were two male and two female GPs. The team were supported by a strategic business manager, five practice nurses, two nurse practitioners, four phlebotomists (staff who take blood) and a nurse assistant. The clinical team were supported by additional reception, secretarial and administration staff.

Patients using the practice also had 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 8am and 6pm. Appointments are available to be booked up to six weeks in advance and take place between 8.30 and 17.30 but telephone consultations sometimes take place from 8.00am. Saturday morning appointments between 9am and 11.20am are available three Saturdays out of four for people who are unable to access appointments during normal opening times.

The practice had opted out of providing out-of-hours services to their own patients and referred them to another out of hours service.

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out a desk topped follow up inspection on Wednesday 18 November 2015 in response to concerns found at the inspection in April 2015. At the inspection in April 2015 we found the practice required improvement for providing safe services. These areas included concerns around:

• Recruitment procedures
• The premises and risk assessments
• Fire safety processes, assessments and training and
• Distribution and recording of prescription stationary

Following the inspection the provider sent us an action plan explaining how and when the shortfalls would be achieved.

Our key findings relating to the areas we followed up were as follows:

• Recruitment processes had been improved
• Environmental risks to patients were assessed and well managed.
• Systems had improved in relation to fire safety, fire risk assessments
• Processes for monitoring the distribution of prescription stationary had been introduced.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 July 2015

The practice identified patients who might be vulnerable, have multiple or specific complex or long term needs and ensured they were offered consultations or reviews where needed. The staff at the practice maintained links with external health care professionals for advice and guidance. Patients with long term conditions have tailor-made care plans in place.

The practice called in every patient with any combination/or single long term condition for a ”birthday review”. Patients had an initial consultation which consisted of lifestyle advice being given and basic examinations being performed, for example weight and blood pressure. Patients were then seen by the GP or specialist Nurse. Additional appointments were added as required. The nurses attended educational updates to make sure their lead role knowledge and skills are up to date. Practice staff also involved healthcare specialists for advice where appropriate.

The practice had clinics for asthma and chronic lung disorders and used spirometry, a lung capacity test, as part of its service to assess the evolving needs of this group of patients. The practice also promoted independence and encourage self-care for these patients. There was a weight management referral service for patients to attend and they could also be referred to dieticians should it be necessary. The service offered was a level 2 and 3 obesity service.

There were weekly diabetic clinics to treat and support patients with diabetes which 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.

There were fortnightly Gold Standard Framework meetings with multi-disciplinary team members, and also monthly Primary Care Team meetings regarding patients with concerns outstanding.

The practice computerised patient record system could be accessed by the local ‘BIG’ Team, which was a group of local GP’s and Nurses who dealt with complex patients in a proactive way before they reached crisis.

Updated 30 July 2015

There were well organised baby and child immunisation programmes available to ensure babies and children could access a full range of vaccinations and health screening. These included the 8 week check for both mother and child, along with the immunisation clinics.

Ante-natal care was provided by a team of midwives who worked with the practice. Midwives held clinics at the surgery had access to the patients’ computerised notes and could speak with a GP should the need arise. The practice also had effective relationships with health visitors, the school nursing team, and were able to access support from children’s workers and parenting support groups via the health visitors. Systems were in place to alert health visitors when children had not attended routine appointments and screening.

The practice had monthly safeguarding meetings to discuss vulnerable children or families, especially those subject to child protection plans. These meetings were attended by the GPs, Midwife, Health Visitor, School Nurse, Practice Nurse and Nurse Practitioner allowing for broad input.

Patients had access to a full range of contraception services and sexual health screening including chlamydia testing and cervical screening. There were quiet private areas in the practice which can be made available for women to use when breastfeeding.

Appropriate systems were in place to help safeguard children or young people who may be vulnerable or at risk of abuse.

Updated 30 July 2015

Patients aged 75 and over had an allocated GP but had the choice of having an appointment with another GP if they preferred.

Pneumococcal vaccination and shingles vaccinations were provided at the practice for older people. Vaccines for older people who had problems getting to the practice or those in local care homes were administered in the community by the practice nurses. The majority of all influenza vaccines were given during Saturday morning sessions which are administered by GPs and Nurses.

Nurses and doctors undertook home visits for older people and for patients who required a visit following discharge from hospital.

There were not specific older person clinics held at the practice. Treatment was organised around the individual patient and any specific condition they had.

The practice had a system to identify older frail or vulnerable patients and appropriately coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for people approaching the end of life. This included a community matron for the elderly in the community. The practice website included a number of links containing extensive information about the promotion of health for conditions which affect older people.

The practice worked to avoid unnecessary admissions to hospital and worked with other health care professionals to provide joint working. The GPs had direct access to a consultant geriatrician for advice on the best treatment and advice, including whether it was appropriate for the patient stay in the community. The GPs were also involved in an acute geriatric intervention service. This was a joint community service with the ambulance service where GPs, community staff and the local ambulance service visited the patient at home to assess the best course of treatment to avoid admissions to hospital.

The practice liaised with local pharmacies to provide medication in blister packs for patients with memory problems.

The practice was arranged on multiple levels. Stair-lifts were available for those that can manage them with the assistance of a member of staff. The GPs were also happy to move downstairs to see patients who were not able to get upstairs. Chairs in the waiting room had been changed to include some with arm rests to assist patients to stand.

Housebound, nursing and residential home patients had an annual review done in their home by a relevant clinician. This review included chronic disease review, medication review, nutrition review, and also addressed any problems or concerns the patient had. This was done in addition to visits performed.

Updated 30 July 2015

Patients who are of working age or who have recently retired were pleased with the care and treatment they received, this was shown in the Friends and Family survey which had been undertaken.

Advance appointments (up to six weeks in advance) and Saturday morning appointments were available three out of four weeks to assist patients who were not able to access appointments due to their work times. There was an online appointment booking system, which patients said was useful.

There was a virtual patient participation group at the practice which had a high number of working age members. They used electronic communication to provide feedback to the practice.

Suitable travel advice was available from the GPs and nursing staff within the practice and supporting information leaflets were available within the waiting areas.

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 and used the electronic prescription service. The local pharmacies collected prescriptions from the practice each morning.

The practice provides sports medicine expertise for young people and promoted healthy lifestyles.

Updated 30 July 2015

A register at the practice identified patients who have mental illness or mental health problems.

Patients had access to an anxiety and depression service and were monitored when they had depression. These appointments were conducted within the practice and in the community. Patients who had depression were seen regularly. There was also a mental health team available for more severe conditions including a memory clinic for dementia patients.

In house mental health medication reviews were conducted to ensure patients received appropriate medication. Blood tests were regularly performed on patients receiving certain mental health medications. These patients were called in the same basis as those with chronic conditions.

The practice used nationally recognised examination tools used for people who are displaying signs of dementia.

Updated 30 July 2015

Patients with learning disabilities were offered a health check every year during which their long term care plans were discussed with the patient and their carer if appropriate.

Practice staff were able to signpost patients with alcohol problems and addictions to Torbay alcohol service for support and treatment. The same applied to patients with drug problems who had access to a weekly drop in service at the library. There were also occasions when these patients were also seen within the practice by this team.

The practice worked with a community matron who visited any vulnerable patients at their home to assess and facilitate any equipment, mobility or medication needs they may have and to advise about treatment.