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Inspection Summary


Overall summary & rating

Good

Updated 15 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chelston Hall Surgery on 3 June 2015. At that inspection the overall rating for the practice was good. The five domains of safe, responsive, caring, effective and well led were rated as good. All inspection reports for Chelston Hall Surgery can be found by selecting the ‘all reports’ link for Chelston Hall Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 October 2017 to confirm that the practice had continued to meet legal requirements and to identify additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings across the Well Led domain we inspected were as follows:

  • The practice maintained an open and transparent approach and systems were in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had introduced innovations and pilot schemes with a view to improving the way care and treatment was delivered to patients, such as the introduction of a GP Unit at Torbay Hospital.
  • The practice had introduced e-consultation which enabled patients to contact GPs online via email and receive a response from a GP within 48 hours.
  • 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.


Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 November 2017

Effective

Good

Updated 15 November 2017

Caring

Good

Updated 15 November 2017

Responsive

Good

Updated 15 November 2017

Well-led

Good

Updated 15 November 2017

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. The practice had considered NHS England’s Five Year Forward View and incorporated this into their strategy.
  • There was a clear leadership structure set out in charts which were on display for all staff, together with photographs of staff. Staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider had a system to handle complaints appropriately and was aware of the requirements of the duty of candour. The practice had received 58 complaints in the last 12 months.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.
  • The practice had introduced a health navigation service which directed patients to the most appropriate clinical treatment for their condition.
  • The practice had launched an “On the Day” team to provide treatment for any patient who needed immediate attention.
  • The practice had introduced e-consultation which enabled patients to contact GPs online via email and receive a response from a GP within 48 hours.
Checks on specific services

People with long term conditions

Good

Updated 13 August 2015

The practice is rated as good for providing services to patients with long term conditions.

The practice identified patients who were vulnerable, had chronic disease management requirements or long term needs. The practice offered an annual review for all such patients created for each person’s needs rather than using a disease clinic approach. The practice had links to relevant outside agencies should the need arise including mental health teams and community provider services.

Patients with any combination or single long term condition were invited for an annual review. Attending the annual review appointment conditions specific metrics were recorded, advice and changes to management plans discussed. The practice had attracted positive feedback on their annual review clinic programme with recognition nationally from the Department of Health, national media and GP press. Within the last 12 months 97% of patients had attended their appointment, which was timed to coincide with their month of birth.

Nurses attended educational updates to ensure their skills are up to date for supporting patients in this population group. The practice involved healthcare specialists for advice where appropriate, such as diabetic and respiratory condition (Chronic Obstructive Pulmonary Disease - COPD) specialists. The practice proactively utilised community resources such as the COPD specialist nurse which supported the care of patents with long term conditions.

The practice offered annual chronic disease reviews to all patients including housebound, nursing and residential home patients. Housebound patients received a visit from the community nursing team and a practice GP visited the patient based on the outcome.

The practice signposted patients to services including physiotherapy and depression and anxiety which allowed patients to self-refer. The practice had produced and displayed an ‘Easy access to your services’ information leaflet which was available at reception or on the website.

The practice worked with a local care home for patients with severe learning disabilities, offering a monthly ward round by a practice GP, alongside normal patient care.

Families, children and young people

Good

Updated 13 August 2015

The practice is rated as good for providing services to families, children and young people.

The practice provided a room and facilities for the local health visiting team to be housed within the practice. This facilitated good communication between the practice and the health visitors and enabled a deep understanding of the practice profile and population. Chelston Hall patients could access the health visitor’s resident there five days a week.

The practice conducted weekly baby and childhood immunisation programs together with weekly checks for both mother and child. In addition health visitors held drop in clinics in the purpose built mother and baby suite. Health visitor and midwife teams had full access to relevant patient records.

Systems were in place to alert health visitors when children had not attended routine appointments and the practice also advised health visitors of any new children aged under five who were registered at the practice.

In 2014 the practice held a flu vaccination party at a large local venue for all children aged under five years. Due to the success of the event the practice planned to offer the same service in 2015. The event offered flu vaccinations as part of a fun day including face painting and a bouncy castle.

The practice provided written evidence of monthly safeguarding meetings. These included discussion of vulnerable children and families, especially those subject to child protection plans, children in need and vulnerable mothers to be. Meetings were attended by a GP, midwives and health visitors. Management staff told us that the format of the practice child safeguarding meetings was being replicated locally by other practices.

Ante-natal care was provided by a team of community midwives who also attended safeguarding meetings and ensured GP’s were informed of any potential issues. Midwives were an integral part of the team and joined the GPs and staff for lunch which provided networking opportunities.

Women had access to a full range of contraception services and sexual health screening.

There were private areas in the practice made available for women to use when breastfeeding. Signage to advertise this service was displayed at the practice.

Older people

Good

Updated 13 August 2015

The practice is rated as good for providing services to older patients.

The practice had a high proportion of patients in this population group. The practice had responded positively to legislation which requested that patients aged 75 years or over were to be allocated a named GP. From April 2014 the practice communicated the information via its website and brochure and also written to all patients aged over 75 informing them of their named GP.

Patients aged over 75 have the choice of an appointment with any of the practice GP’s or had the choice of changing their named GP should they wish to do so.

Through close liaison with the local clinical commissioning group (CCG), the practice had identified a focused group of local residential care homes to work with. This allowed a greater understanding of patient needs, improved communication links and training support from the practice to care staff at these homes.

The practice continually identified and monitored older, frail or vulnerable patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care. To aid the practice with identification of this group of patients the practice used nationally recognised predictive risk models which ensured proactive care.

The practice worked to help patients remain at home and avoid unnecessary unplanned hospital admissions through regular liaison with other health care professionals in the community. This included regular meetings, good communication and the use of special messages to out of hour’s providers.

The practice employed a carer’s support worker who was available by telephone five days a week and one day a week at the practice. Their role was to identify carers within the practice population, offer them help and support, and understanding the physical and emotional pressures of being a carer. The care support worker provided information about practical support and could refer carers to the appropriate agencies for benefits advice, links to local Carers Support groups and respite care.

GPs had direct access to a consultant geriatrician for advice and treatment with the aim of keeping the patient in their home or community placement according to patient need.

The practice website included links to information about the promotion of health for conditions which affect older and potentially frail people.

Working age people (including those recently retired and students)

Good

Updated 13 August 2015

The practice is rated as good for providing services to patients of working age and those recently retired.

Patients were able to book up to six weeks in advance with a mixture of face to face or telephone consultations. The practice offered pre-bookable Saturday morning appointments which were intended for patients in this population group.

The practice offered a range of services including travel advice, sexual health with access to other important services such as mental health or drug and alcohol community services.

Patients who were of working age or who recently retired were pleased with the care and treatment they received according to the results from the last three months analysis of the practice Friends and Family test. Previous patient surveys showed an equally positive response to the service offered.

The practice was proactive in offering patients NHS health checks which focused on well patients aged between 40-74 years.

The practice offered an electronic prescribing service which was recognised as a benefit to patients with busy working lives. 80% of the patient population received their prescription this way, which was an above average achievement.

Patients could drop in, email or use the new online service to request prescriptions.

The practice had recently introduced a GP Surgery pod. This was in a private room with facilities which allowed patients to monitor their own height, weight, body mass index (BMI) and blood pressure. The results were recorded on a computer system. Any results that were outside the normal range, for example, high blood pressure readings, triggered a response by the practice nurses. This also offered patients the opportunity of immediate appointments without the need to book for the measuring of BMI, medicine checks and several chronic diseases. This new service was aimed at patients in this population group.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 August 2015

The practice is rated as good for providing services to patients experiencing poor mental health, including people with dementia.

Clinical staff identified patients with depression, mental health and dementia. The practice invited patients with these conditions for an annual review and patients that raised concerns with clinicians were discussed at multi-disciplinary team meetings.

Patients could be referred or could self-refer themselves to the local anxiety and depression service. For patients with a mental health problem the practice referred to community services provided by the Devon Partnership Trust. Similar services were available for patients with dementia and memory loss.

The practice worked closely with the local dementia group and received regular updates and training from the Alzheimer's Society. Many staff had become dementia befrienders.

The practice used nationally recognised examination tools used for people who displayed signs of dementia or memory loss.

People whose circumstances may make them vulnerable

Good

Updated 13 August 2015

The practice is rated as good for providing services to patients whose circumstances may make them vulnerable.

Practice GPs meet on a weekly basis to review any patient that they had concerns over. Any concerns that needed to be raised with the wider team were discussed at one of the monthly multi-disciplinary team meetings.

All patients with learning disabilities or vulnerable patients with chronic disease had been invited in for an annual review in their month of birth.

The practice had access to services for patients suffering from mental health and addiction problems and in terms of medication, GPs were very aware of the potential risks of prescribing medication of an addictive nature. One of the practice GPs had a lead role specialising in drug and alcohol addiction. Staff knew who this lead GP was in order to obtain guidance. The lead GP worked closely with a local drug and alcohol treatment centre.

The practice had recorded evidence which demonstrated that a high proportion of its local population may be vulnerable. Practice multi-disciplinary team meetings and safeguarding meetings were tailored towards vulnerable patients with communication between clinicians and other service providers supporting the effective delivery of services.