Leatside Surgery

We carried out an announced comprehensive at Leatside Surgery on Wednesday 6 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

We have rated this practice as Outstanding overall -Good in the Safe, Effective and Caring key questions and Outstanding in the Responsive and Well led key questions. (Previous rating October 2015 – Outstanding overall )

At this inspection we found:

• Feedback from patients about the staff, care and treatment was positive. National patient survey results regarding staff, care, treatment and the service were consistently higher than local and national averages.

• Patients appreciated the appointment system and ‘same day’ service and said it was easy to use. Patients reported that they were able to access care when they needed it.

• There was a stable leadership team. Leaders communicated well with each other and with the team. They were knowledgeable about issues and priorities relating to the quality and future of services and participated in external groups to ensure they understood the local changes and challenges. The partners and general manager were instrumental in setting the practice strategy, so it was in line with health and social care priorities nationally and across the local area.

• The practice worked effectively with other practices in the locality and involved in the future of General Practice nationally and within South Devon. The new practice manager had conducted a review and updated the governance process to meet the latest guidance.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice recognised where systems and processes had worked well and improved their processes where appropriate.

• The practice had established and embedded systems in place to assess, monitor and manage risks to patient safety.

• There was a strong commitment for staff to develop their skills, competence and knowledge through weekly mentoring, supervision, support and additional learning programmes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines which contributed to improvements for patient outcomes.

• The practice had identified higher than average exception reporting rates for mental health indicators and lower than average childhood immunisation rates and had taken action regarding these. Rates were starting to improve.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• There was a strong focus on continuous learning and improvement at all levels of the organisation. Staff said the practice was a good place to work and added that the leadership team were supportive and encouraged career development and learning which impacted positively on the quality of care offered to patients.

• There was evidence of systems and processes for learning, continuous improvement and innovation. The practice had been pivotal in several local pilots and schemes which tested new processes and systems designed to improve the patient experience. For example, the practice had worked with the rotary club to host a ‘Know Your Blood Pressure Day’ and had supported the charity ‘Supporting Cardiac Risk in the Young’ by providing free premises for their checks over a weekend.

• Practice staff provided dedicated medical support for the local Health and Wellbeing Team (HWBT) comprised of community health and social care teams which were based at Totnes Hospital. This collaborative group enabled patients to remain at home with enhanced care needs, offering an alternative to being in hospital and so support a reduction in hospital based care through admission avoidance and supported hospital discharge.

• The practice had responded to feedback of patients with regard to access to appointments by the introduction of an Advanced Nurse Practitioner and implementation of health navigators to direct patients to the most appropriate source of support. This had resulted in quicker appointment access, increased patient satisfaction, reduction of staff stress and the delivery of a safe ‘on the same day’ appointment system.

• Providing practice staff for pulmonary rehabilitation classes for patients in the community.

We found areas of outstanding practice:

The practice took a leadership role in the local health and social care community to identify and proactively address challenges and meet the needs of the practice population. For example,

• in response to a local incident the practice worked closely with a local school to equip pupils and parents with basic life support and first aid skills’

• The practice work closely and effectively with the support of the ‘Caring Town Rough Sleepers’ group and had secured a community drug and alcohol practitioner to run an outreach clinic in Totnes. This removed the need for these patients to travel to Newton Abbot for this service and meant they could access support and treatment. Patients were encouraged to use the practice address for correspondence.

• providing a dedicated integrated GP for Totnes Community Hospital to provide ongoing support enabling patients in the community to be cared for closer to home and being a contributing factor for shorter in patient stay during the busy winter period.

Instigating and now supporting the Totnes Caring charity to meet unmet need in the community in relation to home help, transport, befriending and social activities.

The practice had a dedicated early visiting GP with the aim of avoiding admissions or reducing the wait for elderly patients in the emergency department. An audit of the project set up in Autumn 2018 showed that the practice had received 50 requests for visits. Of these 37 visits had been completed, resulting in 11 early admissions and 5 avoided admissions. The practice estimated that this had saved the Clinical Commissioning group £12,500 in admission costs.

There were consistently high levels of constructive engagement with staff, stakeholders and people who used the services. Rigorous and constructive challenge was welcomed and seen as a vital way of holding services to account and improving services. For example, when implementing the Advanced Nurse Practitioner role and changing the premises.

There was a deeply embedded system of leadership development and succession planning, which aimed to ensure that the service was not disrupted, and staff received the support required. Often this involved overlapping roles at considerable expense to the practice.

The areas where the provider should make improvements are:

• Continue to review, monitor and address Quality Outcome Framework (QOF) exception reporting rates, immunisation rates and cervical screening rates and continue to review and action alternative approaches to reach the non-engaged population.

• Should continue to monitor and take actions to reduce the rate of antibiotic prescribing in line with national guidance.

• Continue to review, monitor and take actions to reduce the rate of prescribed hypnotic medicines.