You are here

Inspection Summary


Overall summary & rating

Outstanding

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leatside Surgery on Wednesday 28 October 2015. Overall the practice is rated as outstanding.

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

  • 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.
  • 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.
  • Feedback from patients about their care was consistently and strongly positive.

  • 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 named GP and that there was continuity of care, with urgent appointments 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. The practice proactively sought feedback from staff and patients, which it acted on.
  • 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. The practice had an effective approach to succession planning.

We saw areas of outstanding practice. The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. which impacted on the population groups served by the practice. For example:

Older people

GPs at the practice provide daily medical support to inpatients at Totnes Community Hospital and one specialist GP had recently expanded the role. This included liaising with staff, patients, carers, social services and the voluntary sector to ensure patients once well enough to be discharged, do so in a timely, safe manner. The impact of this service also reduced admissions to the local district general hospital.

The practice worked in partnership with a third sector organisation, Totnes Caring. This team originated through the practice and have a GP on their Board. The 200 volunteers provide befriending, transport, and support to patients who need services that are not provided by the statutory sector. They organise a daily lunch club and arrange transport for patients to attend. The GPs refer patients and carers to the Totnes caring bi-monthly memory café for patients suffering with dementia. Appropriately vetted Totnes Caring staff were invited to the practice multi-disciplinary meetings to facilitate the support patients may need.

Families, children and young people

The practice had responded well to the low uptake of childhood immunisations in the town. The practice carried out an awareness campaign which included the local press as well as the Totnes Directory. The GPs also gained TV coverage on both the ITV and BBC on working collaboratively with the local schools, nurseries and Devon County Council to improve the uptake. The staff ran clinics outside of school times and offered ‘drop-in’ sessions, the result of the campaign increased immunisation uptake by 1.5%.

The practice had responded to the needs of the town by offering two family planning clinics per week, for all patients in Totnes including patients from neighbouring practices.

Working age people (including those recently retired and students)

The practice had been nominated for an award as General Practice Team of the Year in the HEART UK NHS Health Check Awards 2015. This was for outstanding teamwork in the delivery of a project/ innovation in the commissioning or delivery of the NHS Health Check Programme. The impact of this team delivered programme has been an increased prevalence and treatment of patients with pre-diabetes, diabetes and hypertension. The practice increased their Health Care Assistant capacity by 16 hours per week to improve access for patients.

People whose circumstances may make them vulnerable

The practice worked with the Caring Town Totnes group to recently raise the issue of homelessness and people begging on the streets of Totnes. Practice staff link with the local pastors and the ‘drop-in’ centre supporting homeless people in keeping these patients safe.

The GPs had also offered an outreach service to two traveller communities in Totnes to ensure they were aware of the services available, particularly for young family members.

The practice had also supported a programme in Totnes in offering sanctuary to refugees and asylum seekers if they wish to live in Totnes. Leatside Surgery stated they supported this to ensure people had access to healthcare.

The areas where the provider should make improvement are:

Introduce a system to ensure all equipment carried in GPs bags were included on the programme of calibration and safety checks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 December 2015

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, people received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Outstanding

Updated 24 December 2015

he practice is rated as outstanding for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. The GPs wrote regular columns in two local parish magazines.The monthly articles have included updates on public health or medical education issues, which has been effective in increasing the uptake of cervical screening, immunisation uptake and raising awareness of cardiac risk in the young.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

  • The practice had been nominated for an award as General Practice Team of the Year in the HEART UK NHS Health Check Awards 2015 for outstanding teamwork in the delivery of a project/ innovation in the commissioning or delivery of the NHS Health Check Programme. This had resulted in an increased identification and treatment of patients with pre-diabetes, diabetes and hypertension.

Caring

Outstanding

Updated 24 December 2015

The practice is rated as outstanding for providing caring services.

  • Data showed that patients rated the practice higher than others for several aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

The practice worked in partnership with a third sector organisation, Totnes Caring. This team originated through the practice and have a GP on their Board. The 200 volunteers provide befriending, transport, and support to patients who need services that are not provided by the statutory sector. They organise a daily lunch club and arrange transport for patients to attend. The GPs refer patients and carers to the Totnes caring bi-monthly memory café for patients suffering with dementia. Appropriately vetted Totnes Caring staff were invited to the practice multi-disciplinary meetings to facilitate the support patients may need.

Responsive

Outstanding

Updated 24 December 2015

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs. The practice was conscious that the immunisation uptake was lower than national averages due to the alternative lifestyles of a significant number of parents in this locality. We saw many initiatives provided to attract more parents. For example, flexible appointments, opportunistic immunisations and producing articles for the community magazine. The practice staff had also communicated the difficulties of encouraging the local population to increase acceptance with Public Health and included the local press and TV coverage on both the ITV and BBC. Practice staff also worked collaboratively with the local schools, nurseries and Devon County Council to improve the uptake. The practice ran clinics outside of school times and offered ‘drop-in’ sessions, which had increased immunisation uptake by 1.5%.

  • There are innovative approaches to providing integrated person-centred care. For example, GPs at the practice provided daily medical support to inpatients at Totnes Community Hospital and one specialist GP had recently expanded the role. This included liaising with staff, patients, carers, social services and the voluntary sector to ensure patients once well enough to be discharged, did so in a more timely, safe manner.

  • 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.
  • People could access appointments and services in a way and at a time that suits them. For example, the practice was open Monday to Thursday until 7.30pm with the adjacent pharmacy matching these opening hours to accommodate the commuting population. Travel clinics were available at any time and advice was also available on the telephone from the duty nurse service every morning.

  • 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, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 24 December 2015

The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care

which impacted on the population groups served by the practice.

The practice is rated as outstanding for being well-led.

  • It had a clear vision with 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.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • There was a proactive and effective attitude towards succession planning.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • The practice gathered feedback from patients using new technology, and it had a very active patient participation group which influenced practice development.

Checks on specific services

Older people

Outstanding

Updated 24 December 2015

The practice is rated as outstanding for older people.

  • It had a clear vision with 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.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.

  • There was a proactive and effective attitude towards succession planning.

  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • The practice gathered feedback from patients using new technology, and it had a very active patient participation group which influenced practice development.

People with long term conditions

Outstanding

Updated 24 December 2015

The practice is rated as outstanding 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.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice had a system to identify patients with long term conditions that required monitoring and treatment. These patients were supported by the multi-disciplinary team, with a clinical lead assigned to each domain. The practice had strong links with the Clinical Commissioning Group (CCG) and had expanded the skills in their team through the recruitment of a Prescribing Pharmacist to further improve the chronic disease management of these patients. The practice were also involved in the training of a second pharmacist externally to the practice in order to further support Chronic Disease Management.

Diabetic patients were managed by two GPs and two practice nurses who had extended skills and knowledge. Patients had access to the ‘TQ9 club’ which provided exercise and support for patients with chronic obstructive pulmonary disease (COPD). This service had been supported and funded by the practice.

The practice had two health pods in reception which enabled patients to self-manage their conditions by checking their own height, weight and blood pressure regularly. This information was automatically fed through to their medical record and flagged an email message to the GP if any readings are out of range.

Families, children and young people

Outstanding

Updated 24 December 2015

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

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

There was a safeguarding children lead who also acted as the families and young people specialist GP for the practice. This GP held weekly clinics with the health visitors for mums and babies to ensure any concerns are addressed. Monthly meetings were held with the health visitors to discuss concerns of vulnerable families.

The immunisation programme was managed by the nurse administration team, inviting the children in when appropriate. The practice nurses then administer the vaccines and provide health and wellbeing advice. The practice was conscious that the immunisation uptake of 70% was lower than national averages due to the alternative lifestyles of significant numbers of parents in this locality. We saw many initiatives provided to attract more parents. For example, flexible appointments, opportunistic immunisations and producing articles for the community magazine. The practice staff had also communicated the difficulties of encouraging the local population to increase acceptance with Public Health. The practice had also contacted the local press and TV coverage on both the ITV and BBC. Practice staff also worked collaboratively with the local schools, nurseries and Devon County Council to improve the uptake. The practice ran clinics outside of school times and offered ‘drop-in’ sessions and saw an increased uptake by 1.5%.

The practice offered two family planning clinics per week, for all patients in Totnes including patients from neighbouring practices. The practice had three GPs skilled in the insertion of a range of contraceptive devices to offer choice. One of the practice nurses also supported these clinics and could prescribe contraceptive solutions. Chlamydia screening was offered to young people up to 25 years. The practice had also recently held a few clinics to offer the new Meningitis vaccine to sixth form students and encouraged the uptake of chlamydia screening during these clinics.

There was a patient participation group (PPG) at the practice. The chair was in the process of trying to encourage students from the local school to participate with the Leatside Patient Group to ensure services were designed to meet their needs.

The practice supported the charity Cardiac Risk in the Young (CRY) allowing them use of Leatside Surgery and some of its staff over a weekend period to screen young people who may be at risk of sudden death. This service had been promoted within one of the community newsletters written by the practice.

Working age people (including those recently retired and students)

Outstanding

Updated 24 December 2015

The practice is rated as outstanding for the care of working age people (including those recently retired and students).

The practice had above the Devon average number of working age population.

The practice proactively focused on making services easier to access. For example, with on line appointments, on line telephone consultations, and email consultations so that services could be accessed outside normal working hours. The practice were the first in South Devon and Torbay CCG to implement the Electronic Prescription Service (EPS), enabling patients to obtain their medicine quickly, efficiently and safely electronically. The practice used text message and reminders extensively for informing patients of results and appointment reminders.

The practice was open each day from 8am to 7.30pm except Friday when the practice closed at 6.30pm. The pharmacy adjacent matches these opening hours which were designed to accommodate the commuting population. Travel clinics were available at any time and advice was also available on the telephone from the duty nurse service every morning. The duty nurse and all the GPs had a direct dial telephone service so patients could call them direct without the need to go through the switchboard. The practice offered four different types of appointments enabling patients to access a service that meets their needs.

Practice staff had invited every patient aged 40-74 to the practice for an NHS health check, and had been shortlisted for ‘General Practice Team of the Year’ for the integrated whole team approach service to patients.

The GPs wrote regular columns in the local community magazine. The monthly articles have included updates on public health or medical education issues including promotions of the immunisation programme, meningitis vaccine, carer’s health and information on managing flu. The editorials had all had impact both direct and indirect to the patients of Totnes and surrounding areas – not just Leatside. For example, the newsletter raised awareness of cardiac risk in the young and advertised free screening sessions held annually. The newsletter also raised awareness of cervical cancer screening. This increased uptake of screening by 1%.

Patients had access to two self-service health pods which enabled working patients to update their blood pressure, height and weight without the need for an appointment.

Patients within this group told us they appreciated the ability to see a GP on the day, morning or afternoon, if there was urgent need.

People whose circumstances may make them vulnerable

Outstanding

Updated 24 December 2015

The practice is rated as outstanding for the care of people who 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.
  • It offered longer appointments for people with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • It had told 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 learning difficulties were all offered an annual health check, by the health care assistant. The practice had performed 75% of these so far this year with the remainder scheduled. The practice staff support care homes for people with learning disabilities in the town and home visits were offered where patients were unable to visit the practice.

Three of the GPs provide a recovery programme to patients suffering from substance misuse. This means these patients could access specialist support in their own town rather than travelling to central services further away.

The practice worked with the Caring Town Totnes group to recently raise the issue of homelessness and people begging on the streets of Totnes. The practice had become involved in this group to ensure that access to medical services was not prevented by their inability to provide a registered address. Practice staff link with the local pastors and the ‘drop-in’ centre supporting homeless people in keeping these patients safe.

The GPs had also offered an outreach service to two traveller communities in Totnes to ensure they were aware of the services available, particularly for young family members.

The practice had also supported a programme in Totnes in offering sanctuary to refugees and asylum seekers if they wish to live in Totnes. Leatside Surgery stated they supported this to ensure people had access to healthcare.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 24 December 2015

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

Of people diagnosed with mental illness, 81% had their care reviewed in a face to face meeting in the last 12 months.

The practice worked closely with the community mental health team who were based at the practice. This meant the GPs and staff had access to psychiatrists, community psychiatric nurses (CPNs) and support workers.

The dementia lead at the practice worked with the in-patient care at Totnes community hospital and had effective links with the mental health team for the elderly who were also based there. Dementia prevalence was low in Totnes but GPs referred patients to the local Memory Café. The practice had held a successful dementia awareness event at the practice to raise awareness of the signs to look out for and to encourage people to become a ‘dementia friend’.

There was a counselling service available to patients and a self-referral service for those patients suffering with anxiety and depression.

Practice staff performed blood tests on patients taking specialist mental health medicines. This included practice patients in care homes in the town. One of the GPs provided a link for these care homes.