Devon Square Surgery

Updated 8 October 2015

Devon Square Surgery was inspected on Wednesday 12 August 2015. This was a comprehensive inspection.

The main practice is situated in the Devon town of Newton Abbot. The practice provides a primary medical service to approximately 8,500 patients of a diverse age group but with a higher percentage of older people. The practice was a training practice for doctors who are training to become GPs and for medical students from the Penninsula medical school.

There was a team of four GP partners and one salaried GP within the organisation. Partners hold managerial and financial responsibility for running the business. There were three male and two female GPs. The team were supported by a practice manager, an office manager, three practice nurses, two health care assistants and additional administration staff.

Patients using the practice also had access to community staff including community matron, district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

The practice is open from Monday to Friday. The reception teams take phone calls between 8:30 and 6pm. Outside of these times there was a local agreement that the out of hours service would take phone calls. Appointment times are 7am - 12:30 and 3pm -5.45pm on Mondays and Wednesdays and 9am – 12.30 and 3pm -5.45pm on Tuesday, Thursday and Fridays. GPs also perform home visits and telephone consultations between 12.30 and 3pm.

When the practice was shut he practice directed patients to an out-of-hours service. This local agreement was also used for training days held at the practice. However, the GPs at the practice was actively involved in a local ‘8-8 initiative’, whereby local Newton Abbot GPs provide an out of hours cover on the weekend for the top 2% most frail patients.

The practice offered a range of appointment type. Half of the appointments were 'book on the day' appointments, 30% were pre bookable and the rest were reserved for telephone consultations. Telephone consultations could be booked well in advance if needed. The practice ran a personal list system, which meant that wherever possible patients would see the GP of their choice. However, if that GP was not available, patients were able to see one of the other GPs.

Updated 8 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Devon Square Surgery on Wednesday 12 August 2015. Overall the practice is rated as good.

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

• There was a safe track record and 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.
• Risks to patients were assessed and well managed. Medicines were well managed and the practice had good facilities and was well equipped to treat patients and meet their needs
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• 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 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.
• There were clear recruitment processes in place. Staff had received training appropriate to their roles and any further training needs had been identified and planned
• The practice was well organised and there was a clear leadership structure. The practice proactively sought feedback from staff and patients, which it acted on.

We saw two areas of outstanding practice for older patients and those identified as being frail:

• The practice had been instrumental in the development of a model in Newton Abbot named ‘1 care home, 1 practice’ . The model allocated a designated GP who cared for the majority of residents in a care home which meant the GP were able to offer regular review visits and develop strong relationships with the residents, managers and staff. Care home staff said this had improved communication between the GP and care home and had given patients reassurance that they knew the GP that visited them.

• The practice were also actively involved in the locality ‘8-8 initiative’, whereby local Newton Abbot GPs had been providing out of hours cover at nights and during 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 records, meaning they provided a greater continuity of care and were more informed about the patients they were seeing. Anecdotal evidence was that this scheme had reduced hospital admissions. Formal data was being collated.

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

Importantly the provider should:

• Provide evidence of a system to ensure that curtains in consulting rooms are cleaned or changed at least once every 6 months.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 8 October 2015

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

Longer appointments and home visits were available when needed. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority and monitored more closely. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met.

For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Should these patients be identified as being frail the GPs provided out of hours cover on the weekend as part of the 8-8 initiative.

Updated 8 October 2015

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 living in disadvantaged circumstances and 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. 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.

Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 8 October 2015

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

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

The practice took part in a scheme in Newton Abbot named ‘1 care home, 1 practice.’ The model allocated a designated GP who cared for the majority of residents in a care home which meant they were able to offer regular review visits and develop strong relationships with the residents, managers and staff. Feedback from care homes showed that continuity of care and communication had improved as a result of this.

Updated 8 October 2015

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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Working age people were able to access appointments from 7am in the morning and told us they found this useful.

Updated 8 October 2015

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

Data showed that 94% of people experiencing poor mental health had received an annual physical and mental health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Staff carried out care planning for patients with dementia to ensure details of their specific care needs were discussed and recorded.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 8 October 2015

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 and those with a learning disability. Staff had carried out annual health checks for people with a learning disability and 95% of these patients had received a follow-up. Longer appointments were offered to patients who may need more time to discuss or understand their care, such as some people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and had told vulnerable patients about how to access various support groups and voluntary organisations. 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.