6 July 2017
Church View Surgery was inspected on 1 June 2017. This was a focused inspection. The practice is situated in the town of Plymstock near Plymouth. The practice provides a service to approximately 12000 patients of a diverse age group with a larger than national average population of patients over the age of 54. The practice has a Personal Medical Service (PMS) contract and also offers Directed Enhanced Services, for example, providing a service to patients with a learning disability.
There is a team of 10 GPs at the practice. There are eight female and two male GPs of which six are GP partners. Partners hold managerial and financial responsibility for running the business. The team are supported by a practice manager, two nurse practitioners, four practice nurses, one healthcare assistant and four phlebotomists and administration staff.
The practice is a research centre and training practice for doctors who are training to become GPs, and for medical students from the Peninsula Medical School.
Patients using the practice also had access to community nurses, midwives, community mental health teams and health visitors who visit the practice.
The practice is open from Monday to Friday 8am to 6.30pm. Appointments commence at 8.30am with the last appointment ending at 5.40pm. Outside of appointment times there is a local agreement that the practice transfer telephone lines over to the out-of-hours service which is provided by Devon Doctors. The practice offered a range of appointment types including 'book on the day,' telephone consultations and advance appointments, bookable up to six weeks in advance. The practice also used the ‘patient partner service’ which enabled patients to book appointments by telephone 24 hours a day, even when the practice was closed.
The Church View Surgery provides regulated activities from 30 Holland Road, Plymstock, Plymouth Devon PL9 9BN.
6 July 2017
Letter from the Chief Inspector of General Practice
This announced focused inspection was carried out on 1 June 2017 to confirm that the practice had made improvements to meet the actions falling below a regulatory breach in our previous comprehensive inspection on 13 October 2015. In October 2015 the overall rating for the practice was Good The full comprehensive report for the October 2015 inspection can be found by selecting the ‘all reports’ link for The Church View Surgery on our website at www.cqc.org.uk.
This report covers our findings in relation to improvements made since our last inspection.
Our key findings across all the areas we inspected were as follows:
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
21 January 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 medicine 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.
Special messages were attached to the computerised patient records that Out of Hours services could see, to ensure consistent care. If a patient was admitted to hospital, the practice sent a written summary to the hospital with details of both the current problem and of past medical history including current medicines and allergies to enable consistency of care.
When necessary, home visits were made by GPs or community nurses to carry out reviews.
The practice extended hour’s appointments to allow access to working age patients with chronic diseases.
21 January 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 living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
Immunisation rates were relatively high for all standard childhood immunisations. 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. There was health information displayed in the waiting room for patients to look at, however, we saw limited health promotional information specifically for younger people. For example, sexual health information.
Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.
21 January 2016
The practice is rated as good for the care of older people.
Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with greater needs.
The practice was responsive to the needs of older people, offering home visits and longer appointments. The practice worked closely with other health and social care professionals, such as the district nursing team and community matron, to ensure housebound patients received the care they needed. Residents within two local care homes, who were registered with the practice, were case managed by their own GP to prevent unplanned hospital admissions and to provide continuity of care.
21 January 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. 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.
The practice offered patients to register to book appointments and request repeat prescriptions on-line, and subscribe to the ‘patient partner service’ which enabled them to book appointments by telephone 24 hours a day, even when the practice was closed.
21 January 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Of the people experiencing poor mental health 87.5% had received an annual physical health check; this was higher than the national average of 83.82%. 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.
Systems were in place to review patients receiving certain mental health medicines to ensure the dosage was correct and observe for any side effects.
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 (A&E) where they may have been experiencing poor mental health. All clinical staff had received training on how to care for people with mental health needs and dementia and all other staff had training planned once the e learning system was established.
The practice had a community mental health worker assigned to them who could was able to see patients for urgent or routine appointments.
21 January 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, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability and 99% of these patients had received a follow-up. 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.