You are here

Archived: Beaumont Villa Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Beaumont Villa Surgery on 2 February 2016. 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 an effective system in place for reporting and recording significant events.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Risks to patients were assessed and well managed with the exception of the systems in place to manage some aspects of high risk medicines.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was consistently and strongly positive.

  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that 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.
  • 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 and complied with the requirements of the Duty of Candour.
  • The practice used innovative and proactive methods to improve patient outcomes. For example the practice had recently employed a mental health practitioner. This was a decision made by the GPs at the practice to meet the increasing needs for support for the patients with mental health problems.

We saw areas of outstanding practice:

  • In response to audit findings about increased numbers of patients being diagnosed with mental health problems the practice had employed a mental health worker. This benefitted patients with more complex mental health needs as they had immediate access to higher levels of mental health expertise and experience. The practice planned to increase the overall availability of appointments for all patients experiencing mental ill-health, raise the quality of mental health referrals, broaden the skill mix of the practice and upskill other members of staff in this area. An additional benefit was to free up GPs time, enabling them to deal with the complex presentations of mixed mental and physical health problems (functional illness) which required longer appointments.

  • There was a dedicated practice web site for the students. It is specifically designed for younger users and had a wealth of information and advice tailored to their needs: For example, sections on self-care for freshers, contraception and sexual health advice.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. Beaumont Villa covered a population with a very mixed socio-economic demographic and, for the southwest peninsula, an unusually diverse ethnic mix. It also had a high proportion of patients who were asylum seekers and refugees. Nearly all these patients required the use of the telephone translation service (Language Line). Data from Language Line showed that Beaumont Villa was responsible for more usage than any other practice in Devon, Cornwall and the Scilly Isles (DCIOS). Data showed 13.34% of calls made within DCIOS and 26.06% in Plymouth were made by the practice. The administration staff at the practice were experienced with helping patients who did not speak English as a first language. They offered double appointments for patients who spoke little or no English. They were aware of the other agencies that may be able to offer further help such as; Refugee Action, Devon and Cornwall refugee support. They signposted patients to other agencies when they needed help with translation, filling in forms and hospital appointment bookings.

The areas where the provider should improvement is:

  • Ensure there is a robust system in place for the recall and search of patients on high risk medicines to have the necessary blood tests before repeat prescriptions are given.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 March 2016

The practice is rated as good providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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 in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed with the exception of the lack of a robust system to manage and recall patients on high risk medicines that required blood monitoring.

  • Recruitment procedures and checks were completed as required to ensure that staff were suitable and competent.

  • There were suitable arrangements for the efficient management of medicines.

  • Health and safety risk assessments, for example, a fire risk assessment had been performed and was up to date.

  • The practice was clean, tidy and hygienic. We found that suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.

Effective

Good

Updated 17 March 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 17 March 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey July 2015 showed patients rated the practice higher than others for several aspects of care.

  • 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 easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Outstanding

Updated 17 March 2016

The practice is rated as outstanding for providing responsive services.

The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example the practice undertook a survey in 2015 that identified that the volume of mental health work the GPs were doing had significantly increased. In response to this the practice had employed a mental health worker. This meant that patients with more complex mental health needs had immediate access to higher levels of mental health expertise and experience. The practice aimed to increase the overall availability of appointments for all patients experiencing mental ill-health, raise the quality of mental health referrals, broaden the skill mix of the practice and upskill other members of staff in this area. It meant it would also free up GPs to deal with the complex presentations of mixed mental and physical health problems (functional illness) which required longer appointments

  • Patients said they found it easy to make an appointment with a named GP and that 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.

  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 17 March 2016

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 this.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 17 March 2016

The practice is rated as good for the care of patients 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. Individual clinics for the management of long term diseases were held. The practice also held consultant led community based virtual clinics where the consultant worked alongside the practice nurse staff to monitor and manage those patients who required additional care.

  • The practice had employed a pharmacist (due to start April 2016) to help manage the patients medicines and related issues.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Practice nurses also undertook reviews of housebound patients within their own homes. This could include mobile spirometry (a test to monitor lung function).

  • The practice worked with external agencies in other areas of long-term condition management such as diabetic retinopathy screening and podiatry.

    The practice was actively involved in research regarding the management of some long term conditions and patients who may benefit from exercise and activity. This was ongoing research as no preliminary results were available at the time of the inspection.

  • The practice nurses were all independent non-medical prescribers who prescribed medicines for patients with long term conditions within their areas of competence.

Families, children and young people

Good

Updated 17 March 2016

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

  • 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • The percentage of72.35% which was similar to the national average of

    75.35%

    Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

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

  • We saw positive examples of joint working with midwives, health visitors and school nurses. A midwife held a twice weekly clinic for patients. The practice worked with the midwife to share information between the various health professional involved with care

  • The practice had a dedicated team of receptionist/administrator and nurse who followed through the immunisation programme. They ran a dedicated clinic for immunisations. There was an active call and monitoring system in place for attendance, to ensure babies were appropriately protected and kept safe.

The practice had baby changing facilities and a quiet room available if mothers requested one to breastfeed.

Older people

Good

Updated 17 March 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. with a named GP for over 75 year olds. Care plans and reviews were in place for the frail and elderly. Data showed that 6.1% of the practices population of approximately 13000 were aged over 65 years, which was lower than the national average of 16.7%.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. Each GP was assigned a care home to look after to try to encourage continuity of care.This involved at least weekly visits to the home and regular ward rounds of all the patients. The care homes had the practice ex-directory number to contact the surgery in case of emergency. The practice worked closely with the care home staff to ensure the best care was provided for patients. For example, they had meetings involving the GP, some of the administration team from the practice and the staff at the care homes to improve the process of requesting medicines and prescribing them.

  • Pneumococcal and shingles vaccines were provided at the practice for older people.The GPs offered vaccinations at home if the patient was unable to come to the practice.The practice nurses visited elderly patients in their own homes to undertake long term conditions monitoring.

  • The practice worked well with other professionals such as the community matron and the elderly care team to provide continuity of care for the patients from all agencies.

  • All the GPs attended a weekly meeting where they had the opportunity to discuss more complicated cases with each other

Working age people (including those recently retired and students)

Outstanding

Updated 17 March 2016

The practice is rated as outstanding for the care of working age patients (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. Extended hours were offered on a Tuesday and a Friday morning 7:30am until 8am. They were also open every other Saturday 8am until 12 midday. These appointments were bookable in advance to allow easier planning around work. The Saturday appointments were longer (15minutes) to give patients longer to discuss their concerns.

  • Practice services included online appointments and online repeat prescriptions, telephone consultations and comprehensive information on the practice website to allow working people to easily access the service.

  • Beaumont Villa provided GP services to approximately half of the University of Plymouth’s students, many of its staff as well as students from other smaller colleges in the city. Data showed that the practice population for working people including those patients in full or part time education was 84.5% which was significantly higher than the national average of 60.2%.

  • An important outcome of this patient group was the type of appointments required by students. There was a proportionately lower demand for future appointments for chronic problems and a proportionately higher demand for same day (or more immediate) appointments. In 2013 the practice changed the mode of access as had struggled to meet demand whilst having high ‘did not attend’ (DNA) rates of appointments that had been booked a week or more earlier. They also recognized that many of the consultations were about seeking advice, requests for documentation and other problems which do not necessarily require a face to face appointment. Consequently the practice switched to telephone consulting as the first mode of access. Patients were able to speak to a GP on the day. There was flexibility about the call back time to work around lectures and they could be brought in to the practice for a face to face appointment if required.

  • The practice also provided alternative forms of GP access through systems such as “Web GP” (GP web). This system allowed patients to complete an on-line consultation at any time of the day and night and guaranteed a response within two working days.

  • There was a dedicated web site for the students. It is specifically designed for younger users and had a wealth of information and advice tailored to their needs: For example, sections on self-care for university fresher’s, contraception and sexual health advice.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 March 2016

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

The practice identified the increasing number of patients who required mental health intervention. The practice responded to the increased need of specialist mental health care by appointing a psychiatric nurse. This would allow the practice to give more complex patients immediate access to higher levels of mental health expertise and experience.

  • 92.65% of patients diagnosed with dementia that had had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84.01%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 17 March 2016

The practice is rated as outstanding for the care of patients who 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.

  • Beaumont villa covered a population with a very mixed socio-economic demographic and, for the southwest peninsula, an unusually diverse ethnic mix. It also had a high proportion of patients who were asylum seekers and refugees. Nearly all these patients required the use of the telephone translation service (Language Line). Data from Language Line showed that Beaumont Villa was responsible for more usage than any other practice in Devon, Cornwall and the Scilly Isles (DCIOS). Data showed 13.34% of calls made within DCIOS and 26.06% in Plymouth were made by the practice. The administration staff at the practice were experienced with helping patients who did not speak English as a first language. They offered double appointments for patients who spoke little or no English. They were aware of the other agencies who able to offer further help such as; Refugee Action, Devon and Cornwall refugee support. They signposted patients to other agencies when they needed help with translation, filling in forms and hospital appointment bookings.

The practice offered longer appointments for patients with a learning disability. They regularly worked with multi-disciplinary teams in the case management of vulnerable patients. The practice offered a flexible service to patients with learning disabilities. Through this flexibility they had provided annual checks to 81% of their learning disability patients each year.

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.

The practice had patients who were prescribed opiate substitute medicines and shared care for these patients with the local Harbour Drug and Alcohol Service. Five of the practices GPs had been specifically trained in working with these patients and attended annual refresher training days. The practice also had two members of the administration team dedicated to the safe production of the specialist prescriptions. The knowledge and skill sets of the staff benefitted these patients through the prompt provision of localised services.