Old Farm Surgery

Updated 8 November 2017

Old Farm Surgery is a GP practice which provides a Personal Medical Service contract for approximately 4900 patients.

The practice is situated in a residential area of Paignton, Devon.

The practice is open Monday to Friday between 8.30am and 6pm. Calls before 8.30 and after 6pm are answered by local arrangement by the out of hours provider. Any urgent issues are transferred to the GPs. Patients phone and speak to a GP initially before receiving an appointment. Reception staff had guidance to follow when transferring these calls and can fast track where appropriate. Outside of these hours patients are directed to the local NHS out of hours provider (NHS 111). This information is displayed outside of the practice and on the practice website.

The practice population is in the third decile for deprivation. In a score of one to ten the lower the decile the more deprived an area is. For example, data from 2015/16 showed that 36% of the patient population were in paid work or full-time education compared to a local average of 57% and national average of 63%. Over half (57%) of the population had a long term condition. This was higher than the national average of 53%. There was an even practice age distribution of male and female patients. Average life expectancy for the area is similar to national figures with males living to an average age of 80 years and females living to an average of 84 years. There was a higher than average number of younger patients. For example 21% of the practice population were up to the age of 14 years compared to a 17% national average.

There are two GP partners (one male and one female) and one salaried GP (male). Together the GPs provide a whole time equivalent of 2.1 WTE and 17 sessions. The GPs are supported by a nurse practitioner, two practice nurses, a locum practice nurse and one health care assistant. The administration of the practice is managed by a practice manager and a team of five reception and administration staff who are managed by a team leader and operations manager.

The practice is a recognised training practice for doctors training to become GPs and had recently had a successful accreditation of their first ever ST3 Registrar in August 17. The practice is a teaching practice for 3rd, 4th and 5th year medical students from Plymouth university. The practice is also a research practice. The nursing team at the practice were leading on new local student nurse training in collaboration with Plymouth University.

The practice is registered to provide regulated activities which include:

Treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services and Diagnostic and screening procedures and operate from the main site of:

67 Foxhole Road

Paignton

Devon

TQ3 3TB

Updated 8 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced responsive inspection at Old Farm Surgery on Wednesday 13 September 2017. Overall the practice is rated as good.The practice had previously been inspected in January 2016. Since that time a senior partner and practice manager had left the management team.

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

• Morale at the practice remained high since the changes in leadership and the new staff team demonstrated they had the experience, capacity and capability to run the practice and ensure high quality care.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The practice had a proactive nursing team including a nurse practitioner to meet the needs of the local population.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Patients were satisfied with the care and treatment they received.
• A small number of practice staff and patients had been involved in a musical production locally to raise awareness about and fundraise for a local homelessness charity.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a GP and said 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 practice was a recognised training practice for doctors training to become GPs and had recently received positive feedback from the GP registrars and from the Quality Panel (QIP) of Health Education England.
• The practice had been a research practice for the last few years and were active in many studies with the Torbay Hospital Diabetic Research Team.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

• The practice had a strong emphasis on self-management and ethos of empowerment of the vulnerable patient population by supporting them to live healthier lives and obtaining the support they needed. For example, through the successful and popular detailed website and effective, proactive joint working with community groups including charities, counselling services, support groups and health and social care hubs.

The areas where the provider should make improvement are:

• Ensure systems are in place to ensure the patient voice is heard and considered. For example, with a patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 November 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. Patients were invited to annual birthday reviews; these were check-ups of long term conditions organised in the patient’s month of birth.

• The practice worked towards avoiding unnecessary hospital admission

• The GPs were part of the Brixham and Paignton Medical Association alliance who provide an intermediate care service. The GPs provided sessional cover and were involved in the development of this.

• Staff followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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.

• The practice had a health pod in reception which enabled patients to self-manage their conditions by regularly checking their own height, weight and blood pressure. This information was automatically fed through to their medical record and flagged an email message to the staff if any readings were out of range. These were then actioned by the nursing team.

• The practice website provided focused information and tools to enable patients to access health information and support groups. The website had been cited as an example of best practice in self-care by the clinical commissioning group’s (CCG) medicines optimisation team.

Updated 8 November 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

  Appointments were available outside of school hours and the premises were suitable for children and babies. The practice worked with midwives and health visitors to host weekly clinics and a five week course on parenting for parents.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, midwives and health visitors have access to the patients electronic records.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• Women were able to access a contraceptive implant service at the practice.

• Old Farm Surgery was accredited as "Young People Friendly.” This independent accreditation recognised the practice as being especially suitable and welcoming for people under 25. Practice staff helped teenagers access a range of services. For example, Checkpoint (a service for children’s rights, counselling, drug & alcohol support and sexual health) and organise appointments for them at the practice. Staff provided free condoms to teenagers with a C-Card (a local Torbay sexual health initiative).

• The practice website provided information specifically aimed at supporting families, children and young people. This included a variety of behaviour management resources, parenting and relationship resources. The practice actively promoted the SAM (Sepsis Assessment and Management) guidelines giving a traffic light approach for parents to monitor their children during illness and reinforce their knowledge of when to call for advice from healthcare in the practice or in the hospital.

• The practice had a comparatively high level of referral to paediatrics for behavioural and neuro-developmental concerns and recently participated in a pilot scheme which provided staff with access to a named paediatrician for advice and triage. This pilot came to an end, but had provided a lasting link with the paediatrician for timely advice by email and telephone.

Updated 8 November 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, the practice referred patients to the ‘Community Builder’, a Torbay council employee focussing on patients who were socially isolated to reduce risks associated with this and improve wellbeing.

Updated 8 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, all patients were offered a telephone consultation with a GP or nurse practitioner. Staff said the system meant that by dealing with straightforward things over the phone there were enough appointments on the same day or at a time that was convenient to the patient.

• Online appointments could be accessed outside normal working hours.

• Text message reminders were used and patients could request repeat prescriptions on line.

• Travel advice was available from the nursing staff.

• Practice staff worked effectively with other services and were able to refer patients to clinics held within the practice, for example smoking cessation. The practice also offered age appropriate screening tests including prostate and cholesterol testing.

• The practice promoted self-referral via their website to appropriate services such as physiotherapy, depression and anxiety services, the alcohol support team and the specialist drug service.

• The practice had a self-service health pod which enabled working patients to update their blood pressure, height and weight without the need for an appointment.

Updated 8 November 2017

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

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

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, blood tests were regularly performed on patients receiving certain mental health medicines and mental health medicine reviews were conducted to ensure patients were receiving appropriate medicines and no side effects.

• Patients had access to a self-referral service (DAS – Depression & Anxiety Service) if they were suffering with anxiety, stress or depression. The DAS team saw patients at the practice.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

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

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

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

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

Updated 8 November 2017

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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients who needed them.
• Same day appointments were valuable for supporting vulnerable patients and decreasing non-attendance rates. The team at Old Farm Surgery knew the most vulnerable patients and were vigilant when they contacted the practice. Medicines were closely supervised for the most vulnerable using an in house system run by prescribing clerks to ensure medicines were prescribed in a timely manner.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Staff were consistent and proactive in supporting people to live healthier lives and used every opportunity to identify where their health and wellbeing can be promoted. Old Farm Surgery had previously led on a supported self-care service for patients. Despite this service ending there continued to be a focus on early identification and prevention and on supporting people to improve their health and wellbeing by working with many voluntary services in the local community. These provided support to those in hardship, including food parcels, essential furnishing of accommodation, financial advice, emotional support and coaching to promote self-belief, independence and responsibility.
• The practice website informed vulnerable patients about how to access various support groups and voluntary organisations, including domestic violence support.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 were flexible about vulnerable patients remaining registered when they move out of area to see an episode of care through to completion if possible.