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Inspection carried out on 28 October 2015

During a routine inspection

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 carried out on 4 December 2013

During a routine inspection

Patients were very positive about the care they received and told us they thought the practice was "really good" and "satisfactory for my needs" and "super". Another patient said “I have no complaints at all."

We were told that staff treated patients with respect, dignity and said staff were "lovely", "very kind" and "professional." Patients all said they had been involved in the decisions made about their care. One patient said "I am not bullied into anything. It is a two way discussion."

Patients told us they could see the doctor they preferred and liked this, although it sometimes meant they had to wait a little longer for an appointment. Patients said it was easy to make a same day ‘emergency appointment’ and added, "if you phone early" or "if you tell them you need to be seen on the day they squeeze you in somewhere.”

All staff knew the correct local safeguarding procedures to follow if abuse was suspected and all had attended safeguarding training.

Patients told us that they always felt safe in the care of the staff. There were appropriate arrangements in place which ensured that staff kept their knowledge and skills up to date. Staff spoke about the supportive environment.

The practice was organised and well led. There were effective systems in place to monitor the quality of the service provided and patients felt able to give feedback about the service they received.

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone. The evidence tables published alongside our inspection reports from April 2018 onwards replace the information contained in these files.