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Inspection Summary


Overall summary & rating

Good

Updated 19 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Yealm Medical Centre on 9 August 2017. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patient feedback about the care and treatment were comparable to other practices both nationally and in the same area.
  • 96% of patients described the overall experience of this GP practice as good compared with the CCG average of 91% and the national average of 85% and added there was continuity of care, with urgent appointments available the same day.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was clean, tidy and hygienic. We found that suitable arrangements were in place ensuring cleanliness of the practice was maintained to a high standard.
  • The practice had focussed on issues around equality and diversity. For example, making information accessible to patients with a learning disability or mental health needs, such as an online virtual tour of the practice.
  • The practice was run efficiently and was well organised. 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 provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw areas of outstanding practice:

There was a proactive approach to understand the needs of their patients. Examples being:

  • A large proportion of the patient population are elderly and the practice works hard to support this group of patients enabling them to embrace new technologies within the practice. This is achieved by offering support to patients who need help with navigating the online functions of the practices website by giving them a step by step handout they devised for patients to take away. Further support is provided by offering one to one ‘guided’ tours of The Waiting Room 2 (website software) where one of their apprentice receptionists will sit with a patient in one of the practice rooms and show them on the computer how to navigate the website to be able to make the most of the online services. This is reflected in that the practice has the highest percentage of users of online services (requesting prescriptions or booking online appointments) in the whole of the NEW Devon CCG (Evidence: NHS Choices).
  • The practice had recently won recognition as the highest recruiting practice to a national study in the early detection of arthritis in an early arthritis study. The Practice had been conducting research studies for around five years and was committed to providing its patients with a high standard of care and attention. These studies involved approximatley 600 patients and included diabetes, cancer detection and asthma treatment for children. Clinical trials are research studies in which people help test treatments or approaches to prevention or diagnosis of health conditions to evaluate whether they are safe and effective.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 October 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They 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 to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 19 October 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were above average compared to the local CCG and national averages.
  • Staff were aware of current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Two GP partners had a particular interest in research and one partner, was the Macmillan Lead for Cancer and Palliative Care for Devon CCG.
  • The practice participated in clinical research to achieve better outcomes for patients
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff. The practice encouraged young people to work within the health profession by offering apprenticeships leading to full employment
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 19 October 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for in the majority of aspects of care. For example, 94% of patients said the last GP they spoke to was good at treating them with care and concern compared to the national average of 86%.
  • Survey information we reviewed showed that 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 accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice identified military veterans in line with the Armed Forces Covenant 2014. This enabled priority access to secondary care to be provided to those patients with conditions arising from their service to the country.

Responsive

Good

Updated 19 October 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example the practice worked closely with the local community and Dementia friendly Parish links.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • Patients we spoke with said they found it easy to make an appointment with a named GP and 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.
  • The practice had increased its number of partner GPs to provide greater flexibility in appointments.
  • The practice provided support for other services on site to make it easier for patients to access services; for example, podiatry, physiotherapy, ultrasound, midwifery, health visitor and counselling.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients; for example, end of life care and drug and alcohol addiction.
  • Information about how to complain was available and evidence from examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 19 October 2017

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour. In the examples we reviewed we saw evidence the practice complied with these requirements.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.
  • There was a strong focus on continuous learning and improvement at all levels.
  • The Yealm Medical Centre provided placements for GP registrars, qualified doctors training to be GPs, medical associates and medical students. Feedback from trainees and students demonstrated this was a popular placement.

Checks on specific services

People with long term conditions

Good

Updated 19 October 2017

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators were higher than the CCG and national averages. The percentage of patients with diabetes on the register for whom the most recent blood sugar readings were in the average range was 86% compared the CCG average of 76% and the national average of 78%.
  • A diabetes nurse specialist worked with the practice nurse to provide extra support for patients with complex needs.
  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met.
  • Weekly meetings were held to discuss patients with complex needs and the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 19 October 2017

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

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations. For example, 93% for children under one years of age and 100% for children aged one to two years.

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

  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 97%, which was above the national average of 82%.
  • Family planning, implant contraception and emergency contraception was available at the practice.
  • Minor surgery such as joint injections and minor skin lesions was available in the practice.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

Older people

Good

Updated 19 October 2017

The practice is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. For example, the practice computer system alerted staff to patients who required longer routine appointments because of their complex health needs.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Where older patients had complex needs, the practice shared summary care records with local care services. For example, with out of hours services.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible
  • The GPs provided dedicated flu clinics in the local residential home and visited housebound patients to provide this service.
  • The practice provided twice weekly delivery service of medicines to housebound patients and delivered urgent medicines to patients in the local villages during their breaks.
  • The practice undertook sessional research projects through a NHS research centre aimed to benefit the older patients. 94% of the patients who were invited to take part in research felt their participation was valued.

Working age people (including those recently retired and students)

Good

Updated 19 October 2017

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

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours appointments.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 October 2017

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

  • The practice carried out advance care planning for patients living with dementia.
  • 96% of 64 patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia.
  • The practice had developed an online virtual tour of the practice for patients with a learning disability or mental health problems.
  • The practice was a dementia friendly practice and had appropriate signage.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 94% of 23 patients, which was better than the national average of 89%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 19 October 2017

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, travellers and those with a learning disability.
  • The practice had focussed on issues around equality and diversity. For example, making information accessible to patients with a learning disability or mental health needs, such as an online virtual tour of the practice.
  • The practice offered longer appointments for patients with a learning disability and offered an annual health review.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
  • Pre prepared medicine blister packs were available for patients who needed them.
  • The practice worked effectively with members of the community to ensure vulnerable patients received the care they required. For example, schools, local charities and the local Church.
  • A GP specialised in the treatment of patients with drug and/or alcohol abuse and offered support and treatment.