Archived: Estover Surgery

Updated 13 September 2016

We inspected the practice in November 2015 and found improvements were needed in the area of governance. The provider sent us an action plan which detailed the steps they would take to meet the breaches in regulation. During our latest inspection on 9 August 2016 we found the provider had made the required improvements.

Estover Surgery is a GP practice providing primary care services for people living in suburbs around the city of Plymouth. The premises are a single storey building, which was purpose built and is accessible for people who are wheelchair users.

Estover Surgery has two partner GPs, (one female and one male) one practice nurse, one healthcare assistant, four receptionists who also undertook administrative duties, and a practice manager. The practice had about 2000 people registered as patients on the day of the inspection visit who received care and treatment including chronic disease management, child immunisation, travel vaccinations, phlebotomy (the process of taking blood), family planning and minor surgical procedures.

Estover Surgery is a teaching practice, where medical students observe GP clinics and gain knowledge of working in a GP practice.

Estover Surgery shares its premises with another GP surgery. The staff told us that people were given a practice leaflet about both practices to enable them to make a choice about which practice to join. The staff also said that people could change practices if this was their preference.

The practice is open between 8.30am and 6pm Monday to Friday. Appointments times varied each day but were generally from 8.30am until 1pm and from 3:30pm to 6pm. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were also available for people that needed them.

Extended hours surgeries are offered on Wednesday evenings until 7:45pm.

When the practice is closed there is a telephone service to an NHS out of hours provider.

Updated 13 September 2016

Letter from the Chief Inspector of General Practice

We carried out an inspection of Estover Surgery on the 9 August 2016. This review was performed to check on the progress of actions taken following an inspection we made on 4 November 2015. Following that inspection the provider sent us an action plan which detailed the steps they would take to meet their breaches of regulation. During our latest inspection on 9 August 2016 we found the provider had made the necessary improvements.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published on 11 February 2016. This can be done by selecting the 'all reports' link for Estover Health Centre on our website at www.cqc.org.uk

Our key findings at this inspection were as follows:

• The practice had improved the health and safety for patients by improving the arrangements for managing medicines (vaccines).

• Patient safety had been improved by introducing more robust recruitment checks of locum staff.

• Improvements to records had improved patient safety. This had included ensuring the confidentiality of patient records, ensuring fire safety records were available and identifying a lead GP who would be responsible for safeguarding vulnerable patients at the practice.

• Staff had received additional training to show they had the skills, knowledge and experience to deliver effective care and treatment.

• The practice had gathered feedback from patients through the surveys and complaints received. The practice had begun to establish a patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

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.
• 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 encouraged patient self-management. For example, patients with a chronic lung disease (chronic obstructive respiratory disease) were assessed and supplied a home rescue pack (containing steroids and anti-biotics) to keep so they could start taking them immediately if chest symptoms present.

Updated 11 February 2016

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

• There were systems in place to identify and follow up children who were at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were high for all standard childhood immunisations.
• Children and young people were treated in an age-appropriate way and were recognised as individuals. For example, the practice was part of the C card scheme. This allows teenage patients to obtain condoms by registering and using their C Card at the reception desk. In this way they do not have to make an appointment or explain their reason for visiting the practice, which they may find embarrassing.
• The latest published figures for the percentage of women aged 25 – 64 whose notes record that a cervical screening test had been performed in the last 5 years was 90.18% compared to the national average of 88.18%.
• Appointments were available outside of school hours; the premises were suitable for children and babies.
• We saw good examples of joint working with midwives and health visitors. The health visiting team shared on-site premises with the practice.

Updated 11 February 2016

• The practice offered personalised care to meet the needs of the older people in its population.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable with local CCG and national averages, for example in the percentage of older patients with a fragility fracture who are currently treated with an appropriate bone-sparing agent.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was comparable with the CCG and national averages.
• Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.
• Patients aged 75 and older had a named GP within the practice. They could, however, book to see either of the GP partners.

Updated 11 February 2016

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

• 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.
• Appointments could be booked up to six weeks in advance.
• There were evening appointments every Wednesday.
• The nursing team held flexible appointments so that working people could be seen earlier than normal clinic times if these patients requested this.
• Repeat prescriptions could be requested on-line.

Updated 11 February 2016

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

• 83.33% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was in line with the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 11 February 2016

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 homeless people and those with a learning disability.
• It offered longer appointments for people with a learning disability and carried out annual health checks for these patients.
• 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.