Archived: Dr Jonathan Carlson and Dr Amanda Beasley

Updated 19 March 2015

Dr Jonathan Carlson and Dr Amanda Beasley (also known as Tothill Surgery) provide care and treatment to approximately 2,300 patients living in Plymouth. They are a two partner practice. One GP works full time at the practice. The other GP works three sessions with additional sessions for DVLA assessments and is also a GP appraiser. There are two practice nurses and one health care assistant who also works some sessions as an administrator. Four reception and administration staff are trained to work in reception and administration roles. They rotate between jobs to ensure all areas are covered.

The practice has a Personal Medical Services (PMS) contract. PMS agreements are locally agreed contracts between NHS England and a GP practice, and allow local flexibility in the range of services provided by the practice, the financial arrangements for those services, and the contract holder.

The practice provides services from Tothill Surgery, 10 Tothill Avenue, St Judes, Plymouth PL4 8PH where we carried out an announced inspection on 16 October 2014.

The practice opening times are 8.30am to 6pm Monday, Tuesday, Thursday and Friday, and 08.30am to 12pm on Wednesdays. The practice closes on Wednesday afternoons from 12pm. Out of hours services are provided by another organisation except Wednesday afternoon when the practice is closed and this is provided by a GP from the practice.

The practice has recently formed a virtual patient representation group (PRG). This is a group that acts as a voice for patients at the practice.

Updated 19 March 2015

Letter from the Chief Inspector of General Practice

Dr Jonathan Carlson and Dr Amanda Beasley (also known as Tothill Surgery) is a GP practice providing primary care services for people in Plymouth. It provides services from single premises located at Tothill Surgery, 10 Tothill Avenue, St Judes, Plymouth, PL4 8PH where we carried out an announced inspection on 16 October 2014.

When the practice is closed patients are advised to contact the Out of Hours service, which is operated by a different provider.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

We rated this practice as good.

Our key findings were as follows:

• The practice had a patient-centred focus.
• Patients felt they were treated with dignity and respect and in a professional manner that showed kindness and care towards them.
• Patients were able to see a GP or have a telephone consultation on the day of requesting an appointment.
• Repeat prescriptions were available within 24 hours of being requested.

We saw several areas of outstanding practice including:

• The practice maintained patient registration for its transient population of homeless people and travellers because it recognised these patients were likely to return to the area. Home visits were made to all patients regardless of where they lived including patients with no fixed address who were rough sleeping.
• Patients were able to collect repeat prescriptions within 24 hours of requesting them.

In addition the provider should:

• Ensure annual checks such as professional body registration (e.g. GMC) and medical insurance are made for locum GPs, who are used regularly for the practice.

We found Tothill Surgery to be a well led practice that was safe, caring, effective and responsive to patients’ needs. The practice showed they had an open, fair and transparent manner with the management team showing clear leadership. The patients, clinical and administrative staff we spoke with all told us they felt the practice was well led, approachable and demonstrated good working relations with other health care professionals, organisations and local authorities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 March 2015

Tothill Surgery is rated as good for the care of people with long-term conditions including asthma, diabetes, and heart disease. Patients were able to book routine appointments with a practice nurse or a GP for monitoring and treatment of their conditions. Nationally reported data showed that some outcomes for patients were below expectation for long term conditions however nursing staff and GPs explained this was due to a high prevalence of patients with a learning disability who also had one or more long term condition and there may be other issues such as difficulty with swallowing or refusal of needles. Nursing staff and GPs were opportunistic about offering health screening checks to patients with long term conditions when they attended the practice. The practice routinely carried out reviews, audits and checks to ensure patients with long term conditions were receiving the correct medicines. The practice followed best practice guidance to ensure it was meeting and protecting patients’ medical needs and complying with other statutory guidance issued by, for example, the Department of Health. There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed.

Updated 19 March 2015

Tothill Surgery is rated as good for the care of families, children and young people. Effective systems were in place for GPs to seek advice and support if they had concerns about a child, and to raise a safeguarding alert with a place of safety if they felt the child was in immediate danger of harm. Practice staff were observant for signs of neglect. GPs and health visitors monitored these families with escalation to the relevant agencies as needed. They were also aware of the impact of poverty on patients and provided signposting information to various services. 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. We saw good examples of joint working with midwives and health visitors. Emergency processes were in place and referrals were made for children and pregnant women whose health deteriorated suddenly and we saw evidence of this.

Updated 19 March 2015

Tothill Surgery is rated as outstanding for the care of older people. The practice had a high percentage of its patient population in the 65 and over age group. Overall the older people we spoke with were appreciative of the GPs and nurses. They felt they were treated in a professional and kindly manner. Nursing staff were trained and experienced in providing care and treatment for medical conditions affecting older people. They were able to refer people to local services such as dementia screening clinics and falls assessment clinics. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The GPs and nurses were able to book longer appointments if they considered this was appropriate to meet the patient’s needs

Updated 19 March 2015

Tothill Surgery 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 a full range of health promotion and screening that reflects the needs for this age group.

Updated 19 March 2015

Tothill Surgery is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). 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 good access to the local mental health team for support and urgent same day appointments for assessment if these were needed. Staff had received training on how to care for patients with mental health needs and dementia.

The practice provided a daily open access service which had no time constraints on consultations, and the GPs offered longer than average booked consultation periods. The practice did not have a high proportion of missed appointments mainly for these reasons. Afternoon booked appointments were monitored and GPs made follow up calls for missed appointments particularly if they considered the patient was vulnerable and or was known to have mental ill health. The GPs considered longer consultations provided an improvement in patient safety.

The practice offered support and treatment for patients of all ages experiencing mental ill health. The GPs told us they were pleased with the local mental health services which were effective and responsive to referrals for adults and children.

Updated 19 March 2015

Tothill Surgery is rated as outstanding for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including people with dementia and those with a learning disability. It had carried out annual health checks for people with a learning disability. It offered longer appointments for people who were vulnerable. Home visits were made to patients needing this, regardless of where the patient was residing.

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.