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Inspection Summary


Overall summary & rating

Good

Updated 6 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Heavitree Practice on 17 March 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.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The practice was part of a pilot site for a pre-diabetic education project overseen by a local charity. The aim was to support patients and provide lifestyle education for patients recently diagnosed with or at risk of developing type two diabetes.
  • The practice had been part of 11 clinical research projects over the last two years. A current project involved identifying patients who may benefit from targeted exercises following a stroke to improve recovery.
  • Information about patients’ outcomes was used to make improvements; such as identifying patients with osteoporotic vertebral fracture as part of a pilot research project and then offering these patients focused physiotherapy rehabilitation courses.
  • 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.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, the practice benefitted from support services provided by the Friends of Heavitree Health Centre charity, which provided volunteer transport services for patients to secondary care health appointments.
  • The Friends of Heavitree Health Centre charity, based within the practice, also offered Tai Chi classes, shopping trips and social activities, which had reduced social isolation of vulnerable patients.
  • Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice offered pre-bookable early morning appointments from 7.40am on three mornings a week and evening appointments until 7.30pm on alternate Thursdays for working patients who could not attend during normal opening hours.
  • 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 sought feedback from staff and patients, which it acted on.
  • The practice worked in partnership with a local charity offering work placements to people who had learning disabilities and/or long term health conditions. Staff told us this helped them learn about the health and wellbeing needs for patients in the wider community and those registered at the practice with similar conditions.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice was an early initiator of the implementation of the NHS accessible information standard, which organisations must follow by 31 July 2016. The standard was intended to ensure that patients who have a disability, impairment or sensory loss get information that they can access and understand, and receive any communication support that they need. The practice had ensured progress by ensuring that the accessible information standard was discussed at all patient participation group, practice whole team and Exeter practice managers’ meetings.

The areas where the provider should make improvement are:

  • Include emergency medical equipment instructions in trainee GP staff induction sessions.
  • The practice should continue to review prescription pad security to ensure new processes are followed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 May 2016

The practice is rated as good for 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 things went wrong patients received reasonable support, truthful information, and a 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.

  • Emergency equipment was available at the practice, however not all trainee GP staff were aware of its location.

Effective

Good

Updated 6 May 2016

The practice is rated as good for providing effective services.

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

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

  • Clinical audits demonstrated quality improvement.

  • Information about patients’ outcomes was used to make improvements; such as identifying patients with osteoporotic vertebral fracture as part of a pilot research project and then offering these patients focused physiotherapy rehabilitation courses.

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

  • The practice was part of a pilot site for a pre-diabetic education project overseen by a local charity. The aim was to support patients and provide lifestyle education for patients recently diagnosed with or at risk of developing type two diabetes.

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

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 6 May 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey 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.
  • The practice, their patients and carers benefitted from support services provided by the Friends of Heavitree Health Centre charity, which provided volunteer transport services for patients to secondary care health appointments.
  • The Friends of Heavitree Health Centre charity, based within the practice, also offered Tai Chi classes, shopping trips and social activities, which had reduced social isolation of vulnerable patients.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 6 May 2016

The practice is rated as good for providing responsive services.

  • Practice staff 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 was retained by the nearby University campus to provide additional support for students who register as patients. This included identifying a lead GP, who was the named GP for all students. The GP held introductory sessions at the University and the practice provided accommodation for University appointed counsellors.

  • Patients said they found it easy to make an appointment with a named GP and 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

  • The practice offered pre-bookable early morning appointments from 7.40am on three mornings a week and evening appointments until 7.30pm on alternate Thursdays for working patients who could not attend during normal opening hours.
  • There were longer appointments available for patients with a learning disability.
  • Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice.
  • Same day appointments were available for children and those patients with medical problems that require same day consultation.
  • There were disabled facilities, a hearing loop and translation services available.
  • The practice was accessible for patients with mobility impairment with ground floor consulting rooms.
  • Reasonable adjustments were made and action was taken to remove barriers when patients found it hard to use or access services. For example there was a highly visible hand rail on the slope to entering the premises and tactile paving at the practice entrance to signpost the practice for people with visual impairment.
  • The practice worked in partnership with a local charity offering work placements to people who had learning disabilities and/or long term health conditions. Staff told us this helped them learn about the health and wellbeing needs for patients in the wider community and those registered at the practice with similar conditions.

Well-led

Good

Updated 6 May 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 it.
  • 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 notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels. For example, the practice was an early initiator of the implementation of the NHS accessible information standard, which organisations must follow by 31 July 2016. The standard intendeds to ensure that patients who have a disability, impairment or sensory loss receive information that they can access and understand, and any communication support that they need. The practice had ensured progress to achieving the accessible information standard was discussed at all PPG, practice whole team and Exeter practice managers’ meetings. The practice had consulted with patients and collated information about the resources available to meet patients’ particular communication needs.
  • The practice had been part of 11 clinical research projects over the last two years. A current project involved identifying patients who may benefit from targeted exercises following a stroke to improve recovery.
Checks on specific services

People with long term conditions

Good

Updated 6 May 2016

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

  • Nursing staff had received specialist training in order to offer a full leg ulcer dressing service.

  • Performance for diabetes related indicators, such as the percentage of patients on the diabetes register with a foot examination and identification of further risk through developing diabetes associated complications within the preceding 12 months was 95%. This was better than the national average of 88%.

  • Longer appointments and home visits were available when needed.

  • 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.

  • The practice was part of a pilot site for a pre-diabetic education project overseen by a local charity. The aim was to support patients and provide lifestyle education for patients recently diagnosed with or at risk of developing type two diabetes.

Families, children and young people

Good

Updated 6 May 2016

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

  • There were systems in place to identify and follow up children who were at risk, for example, children and young people who had a high number of A&E attendances.

  • Immunisation rates were relatively high for all standard childhood immunisations in line with the local CCG averages.

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

  • The practice’s uptake for the cervical screening programme was 77%, which was comparable to the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.

  • 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 and health visitors. Midwife clinics were held in the practice.

  • Same day appointments were available for children.

Older people

Good

Updated 6 May 2016

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

  • The practice offered personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments for those with enhanced needs.
  • The community matron and the district nurses shared premises with the practice. This meant communication between the practice and community nursing services was easily facilitated; ensuring patients current needs were regularly discussed.
  • The practice completed care plans for patients who had unplanned hospital admissions to ensure needs were met post-hospital admission.

Working age people (including those recently retired and students)

Good

Updated 6 May 2016

The practice 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 offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.

  • The practice had a GP who worked closely with students based at the nearby University campus and provided accommodation for student counsellors.

  • Extended opening times were available three mornings a week from 7.40am and alternate Thursday evenings until 7.30pm for the convenience of working patients.

  • Patients could self-check their blood pressure and women could complete a contraceptive pill health check without needing an appointment. Results were forwarded to their GP for review/follow up.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 May 2016

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

  • 91% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which compared favourably to the national average of 84%.
  • Performance for mental health related indicators better than the national average. For example, 100% of patients with severe mental illnesses had a care plan agreed with the patient in the preceding 12 months. The national average was 88%.
  • 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 and the practice was a member of Dementia Action Alliance; a charitable organisation with the aim of enabling people to live well with dementia and reduce the risk of crisis intervention. Practice staff had received ‘Dementia Friends’ training to be more skilled in supporting patients who had dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 6 May 2016

The practice 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, travellers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, the practice benefitted from support services provided by the Friends of Heavitree Health Centre charity, which provided volunteer transport services for patients to secondary care health appointments.
  • The Friends of Heavitree Health Centre charity, based within the practice, also offered Tai Chi classes, shopping trips and social activities, which had reduced social isolation of vulnerable patients.
  • 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.
  • Specialist nurse appointments, such as for blood monitoring or on-going medicines via injection were pre-bookable up to eight weeks in advance.
  • The practice worked in partnership with a local charity offering work placements to people who had learning disabilities and/or long term health conditions. Staff told us this helped them learn about the health and wellbeing needs for patients in the wider community and those registered at the practice with similar conditions.
  • The practice was an early initiator of the implementation of the NHS accessible information standard, which organisations must follow by 31 July 2016. The standard is intended to ensure that patients who have a disability, impairment or sensory loss get information that they can access and understand, and any communication support that they need.