Cricketfield Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cricketfield Surgery on Wednesday 27 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, safe, effective, caring and responsive services. We found the practice was good for providing services for patients with long term conditions, families, children and young people, working age people (including those recently retired and students), People experiencing poor mental health (including people with dementia) and patients who are considered vulnerable. We found the practice was providing outstanding services for older people.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. The process of managing and learning from complaints and incidents was effective.
• Risks to patients were assessed and well managed. This included clinical risk and environmental risks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance including robust templates to guide staff.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they could make a same day appointment but sometimes found it hard to get through on the telephone and make advance appointments at a time that suited them and hard to get an appointment with a GP of choice. The practice were aware of this feedback and had introduced ways to improve the system and get further feedback from patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

We saw areas of outstanding practice:

The nursing team had been proactive in conducting clinical audits of the care they provided.

The GPs had used and developed the computer system to improve patient care by introducing prompts which triggered the use of National Institute for Health and Care Excellence (NICE) guideline templates. One example had been introduced following a significant event and included the use of one of the NICE templates for treatment and diagnosis of children and babies with high temperature. The GPs had developed the computer system to include the NICE traffic light assessment and automated referral letters. The system also prompted staff to give parents the NHS Sepsis assessment and management (SAM) leaflet and UK Sepsis leaflet which gives guidance and advice on sepsis. This template had been identified by NHS England as good practice and was being shared with other practices.

Care of older people was outstanding. This can be demonstrated by:

• The practice had been instrumental in the development of a ‘1 care home, 1 practice’ model in Newton Abbot. The model allocated a designated GP who cared for the majority of residents in a named care home which meant the GP were able to offer regular review visits and develop strong relationships with the residents, managers and staff. The named GP for a care home for people with severe dementia often visited during quieter periods to give more time to the residents. She had given talks to relatives regarding the Mental Capacity Act and Best interest decisions. We spoke with two care home managers who were part of this initiative. One manager said they had found the GP and service ‘extremely supportive’ and ‘beneficial’ for residents with dementia who were able to see ‘the same face’ each time. Another care home manager described their relationship with the GP as ‘absolutely wonderful’ and said the residents were familiar to the GP and that the GPs approach to care of the elderly was ‘second to none’.

• The practice were taking part in a pilot project led by Age UK Devon whereby a health and wellbeing worker was based within the practice to work with their ‘pre-frail’ population, using guided conversations and signposting to voluntary sector services to help improve patients sense of health and wellbeing.

• One of the GPs had developed and ran the Newton Abbot Frailty Service, a multi-disciplinary team providing intensive input for particularly frail and vulnerable patients in the locality to enable them to remain at home. The service offered both pro-active and emergency input similar to that offered in the monthly multidisciplinary team meetings but at a much more intensive level. Other GPs in the practice frequently referred patients to this service.

• The practice were also actively involved in the locality ‘8-8 initiative’, whereby local Newton Abbot GPs had been providing out of hours cover on the weekend for the top 2% most frail patients. The GPs had collaborated so that all the local GPs involved in this have access to the other practice’s computer databases, so were much more informed about the patients they were seeing, than Devon Doctors (the out of hours service provider) would be.

However there were areas of practice where the provider needs to make improvements.

The provider should:

Introduce a recruitment policy for staff to follow when recruiting clinical and non-clinical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice