Archived: Sid Valley Practice

Updated 9 July 2015

Sid Valley practice was inspected on Tuesday 15th April 2015. This was a comprehensive inspection.

The main practice is situated in the seaside town of Sidmouth and covers a five mile radius of the surrounding villages. The practice provides a primary medical service to approximately 14500 patients. The practice is a training practice for doctors who are training to become GPs.

There is a team of ten GP partners and one salaried GP within the organisation. Partners hold managerial and financial responsibility for running the business. There are seven male and six female GPs. The team are supported by a senior management team which consists of a practice relations manager, a facilities and administration manager and a finance manager. Together they share the role of the traditional practice manager. The practice employs seven female practice nurses and seven health care assistants. The clinical team are supported by additional reception, secretarial and administration staff.

Sid Valley Practice is a training practice, accredited by the South West Deanery of Postgraduate Medical Education.

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 8.15am and 6.30pm. There is also a branch practice open five days a week between the hours of 8.30am and 5.30pm, but is closed on a Tuesday afternoon. Appointments are available to be booked up to six weeks in advance and take place between 8.30 and 17.30 but telephone consultations are available from 8.00am. The surgery closes for lunch between 1pm and 1.45pm.The practice has an ethos of never turning anyone away and offers a telephone consultation service every day. This is used when a patient telephones the practice and requests to see a GP that day. A GP will telephone the patient and discuss their concerns within two hours of the initial request from the patient. An appointment is offered to the patient that day if it is needed. Patients told us they felt the appointment system was good.

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 9 July 2015

Letter from the Chief Inspector of General Practice

We inspected Sid Valley Practice on 15th April 2015 as part of our comprehensive inspection programme.

We have rated the practice overall as providing a good service. Specifically we found the practice to be good for providing responsive safe, effective, caring and well led services.

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.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• There were arrangements in place to respond to the protection of children and vulnerable adults and to respond to any significant events affecting patients’ well-being.

• The practice worked well with other health care service to enable a multi-disciplinary approach in meeting the health care needs of patients receiving a service from the practice.

• The practice managed complaints well and took them seriously. Information about how to complain was available and easy to understand.

• There was a clear management structure with approachable leadership. Staff were supported and had opportunities for developing their skills, were well supported and had good training opportunities. Sid Valley Practice is a training practice, with two GP partners approved to provide vocational training for GPs, second year post qualification doctors and medical students.

• 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 (PPG).

• The practice premises is an old building with facilities that need improving. However the practice managed well and was well equipped to treat patients and meet their needs.

• The practice had a vision and informal set of values which were understood by staff. There were clear clinical governance systems and a clear leadership structure in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 July 2015

Sid Valley Practice is rated as good for the care of people with long-term conditions. 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.

The practice identified patients who might be vulnerable, have multiple or specific complex or long term needs and ensured consultations or reviews were offered where needed. Particular clinics operated for patients with diabetes, heart failure, hypertension, high cholesterol and asthma. The nurses attended educational updates to make sure their knowledge was up to date.

The practice computerized patient record system was accessed by out of hours service providers if the patient had given permission for this to happen. GP’s and out of hours doctors were then aware of any treatment that they had been given to people with long term conditions or those at the end of their life.

Updated 9 July 2015

The practice is rated as good for the care of families, children and young people. Baby and child immunisation programmes were well organised and available to ensure babies and children could access the full range of vaccinations and health screening. These included the 8 week check for both mother and baby, along with the immunisation clinics. Last year’s performance for child immunisations showed that 90% of two years old had received all vaccinations required.

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

The practice worked with the health visitors and the school nurse to safeguard children. A joint child protection meeting was held every 3 months and one of the GPs met with the health visitors at least monthly for more frequent liaison. A GP partner was the lead for safeguarding and the practice had just introduced a lead nurse for safeguarding.

The midwife team provided antenatal care at the local community hospital and liaised with the practice as needed. The practice provided unlimited same day telephone access so that children needing same day appointments were able to do so.

Woman had access to a full range of contraception services and sexual health screening including chlamydia testing and cervical screening.

Updated 9 July 2015

The practice is rated as outstanding for the care of older people. The practice had a large elderly population (40% of the patients were over 65) and was particularly focused on addressing their needs. All patients had their own named GP and this provided valued continuity of care. However, they did not always get to see their own GP without booking in advance. Care plans were in place for patients at high risk of unplanned admission and these were shared with local out–of-hours providers, the ambulance services and emergency department. Regular hospital avoidance of admission meetings were held. The community hospital was situated next door to the practice. The GPs undertook a daily ward round at the hospital during the week and were responsive to urgent requests from the hospital for things such as medicine changes and X ray requests.

The practice offered home visits when needed and automatic same day access to telephone advice and if needed GP appointments.

The practice worked closely with the hospiscare nurses to provide responsive end of life care. They held a quarterly palliative care meeting with the hospiscare and community nurse teams. They also worked closely with the complex care team with one of the GPs meeting each week with them to discuss patients with complex care needs. The practice had achieved and implemented the gold standards framework for end of life care. It had a palliative care register and also had regular internal meetings to discuss the care and support needs of patients and their families.

The prescriptions team at the practice worked closely with local pharmacies to ensure blister packs were provided for older people with memory problems and delivered to a location of the patient’s choice. A GP partner was a dementia champion and used their knowledge and experience to make early diagnosis and referrals as necessary, they also sat as a trustee on a voluntary basis at the local memory café. This was a useful link for those patients with early onset dementia.

The practice had responsive systems in place for the care of their patients in care homes. The practice manager and one of the GPs visited six care homes in the area to discuss and review the care provided to their patients with a view to find ways to continually improve the service provision. As a result of these meeting the care homes were given a direct line telephone number so that they could contact the practice without delay when needed.

Updated 9 July 2015

The practice is rated as good for working age people.

Advance appointments (up to six weeks in advance) were available for patients to book. There was an online appointment booking system, which patients said was useful. For those patients who required urgent access and where appointments were not available on the day the practice offered the option of a telephone consultation with a GP. This was particularly useful to patients with other commitments who were not able to make it 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 medicine 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 cholesterol testing.

Updated 9 July 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients who experienced mental health problems. The register supported clinical staff to offer patients an annual appointment for a health check and a medicine review.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations for example MIND. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

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. They actively screened patients who were displaying signs of, or who were at risk of developing dementia, using a professionally recognised tool. For example the diagnosis rate increased from 26% in year 2009-10 to 51.8% in 2014-5. This meant that advice and some treatments had been offered at the early onset of the illness. One GP partner was a dementia champion and they also sat as a trustee on a voluntary basis at the local memory café. This was a useful link for those patients with early onset dementia.

Updated 9 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 with a learning disability and had carried out annual health checks for just fewer than 50% of these patients. The others that had not attended were re invited and this was followed up by the nurses. Longer appointments were offered to those patients with long term illnesses or learning disabilities.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. Vulnerable patients had been advised 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 both normal working hours and out-of-hours.

There were a small number of patients whose first language is not English. A translation service was available.

The practice promoted their chaperone service and reminded patients that if they do require assistance, they could ask. All clinical staff and senior reception staff had received chaperone training.