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Inspection carried out on 24/04/2019

During a routine inspection

We carried out an announced comprehensive inspection at St Levan Surgery on 24 April 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good overall. We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Staff were aware of current evidence based guidance. GPS, nurses and locum GPs were skilled in caring for the patient groups and in addition had qualifications and experience in caring for patients with substance misuse, challenging behaviours and supporting patients who were homeless or vulnerably housed.
  • One of the GPs working at the practice was a GPwSI (GP with a special interest) and with others prescribed medicines used in heroin, alcohol and opioid addictions.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • Patients we spoke with said they found it easy to speak with a GP and said there was continuity of care, with urgent appointments and routine available the same day. Patients could be seen by appointment at different times of the day if they preferred. The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We have rated this practice good for the Older People, Families, children and young people and vulnerable people population groups.

We have rated this practice as requires improvement for the People with long-term conditions population group because: -

  • There was not an effective screening programme in place to follow up patients who did not attend the practice or invitations for reviews in relation to their long term conditions

We have rated this practice as requires improvement for working age people population group because:-

  • There was not an effective programme in place to follow up patients who did not attend cancer screening programmes.

The areas where the provider should make improvements are:

  • The practice should review arrangements to improve the uptake for patients with long term conditions.
  • The practice should review arrangements to improve the uptake for patients receiving cervical screening and bowel cancer screening.

We saw several areas of outstanding practice including:

  • The practice understood its population profile and had used this understanding to provide services tailored to meet the needs of individual patients. Staff worked collaboratively with many other providers, including running dedicated surgeries within homeless drop in centres and hostels, to ensure vulnerable patients were supported to receive coordinated care which met their needs.

  • Practice staff used opportunistic, innovative and efficient ways to deliver more joined-up care to patients. For example, the practice worked with the Hepatology Department at to provide a clinic to see patients with viral hepatitis.

  • The practice took account of the needs and preferences of patients with vulnerabilities which included poverty, mental health issues, homelessness and substance misuse and provided a special allocation GP service to patients who had been barred from other services due to the nature of their behaviour.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 4 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

St Levan is a general practice surgery that provides NHS services and is based in a modern purpose built building at 350 St Levan Road, Keyham, in the outskirts of Plymouth.

The practice comprises of five GPs and a managing partner working in partnership. The practice currently has 6800 patients listed. We talked with six patients on the day of our inspection and they were all satisfied with the standard of care, service and treatment they received. We saw 21 comment cards had been completed by patients who used the practice. We noted that all of these had been positively completed with patients stating they received a very high level of care from all staff at the practice and felt involved in all aspects of their treatment and care.

Our key findings were as follows:

We found that the practice engaged with the patient population on a regular basis. Evidence showed that the practice responded positively to feedback from annual surveys. The practice kept patients informed via their own website.

The practice had a stable staff group, many of which had worked there for over ten years. All staff we spoke with told us they felt supported and well led. Staff said that their opinions and ideas were listened to and taken seriously. St Levan surgery is a training practice for trainee doctors and we saw evidence that staff training and involvement formed a strong part of the overall management of the practice.

The practice is rated as good. We found St Levan 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 professionals, organisations and local authorities.

We found the practice had initiated many positive service improvements for their patient population that were over and above their contractual obligations, particularly for people in vulnerable circumstances.

The practice had been awarded two awards. The National HSJ Acute and Primary Care Innovation Award for its appointment system which has improved outcomes and patient experience. The practice obtained the Investors in People award in 1997 and has continued to maintain the award since then. This showed a commitment to adhere to the principles of excellence in people management.

Historical surveys showed a significant demand for extended hours, patients wanted to see the GP of their choice and extended hours did not facilitate this. As a result of this the practice introduced a patient access system which offered all patients a same day telephone consultation regardless of urgency or importance. Those patients who required an appointment were offered one on the same day.  The system allowed flexibility. For example all patients were offered a 15 minute appointment and longer if needed.

There was a large part of the local population who had problems related to substance misuse. The practice developed skills to ensure these patients received good care. One GP had a special interest and had developed excellent links with local drugs workers and rehabilitation centres. All GPs had extended skills in the management of substance misuse and attended regular drug and alcohol training updates as part of this speciality work.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice