Yelverton Surgery

Updated 5 July 2017

Yelverton Surgery is located in the village of Yelverton, Devon and covers a large rural area extending from the north of Plymouth across to Dartmeet and Hexworthy in the east and Grenofen to the west. Yelverton Surgery provides a personal medical service (PMS) which provides a service to approximately 7,250 patients. 800 of these patients usually see a GP at the branch surgery in Princetown and approximately 750 of these 800 patients use the dispensing service provided.

The practice population is in the eighth decile for deprivation. In a score of one to ten the lower the decile the more deprived an area is. There is a practice age distribution of male and female patients equivalent to national average figures. Average life expectancy for the area is similar to national figures with males living to an average age of 79 years and females living to an average of 84 years.

The practice has five GP partners, three of which are female and two are male and two GP registrars, both of which are female. (Whole time equivalent of 4.5 GPs) The GPs are supported by two practice nurses, a health care assistant, a practice business manager and a practice operations manager as well as additional administration and reception staff.

Patients using the practice also have access to community staff including community nurses, who are based at the practice, podiatrist and a physiotherapist. Other visiting staff use the facilities at the practice. For example, in house counsellor and drug and alcohol support worker.

Yelverton Surgery is a training practice and has doctors training to become GPs working at the practice. There are three GPs who support trainee GPs and registrars. One GP is shortly to qualify as an academic tutor. The GPs also teach 3rd and 4th year medical students. Two named GPs are responsible for this teaching

The Yelverton Surgery practice is open between 8am and 6pm Monday to Friday. Appointments are available from 8.30am to 10.30am every morning and 3pm to 5pm daily. Extended hours appointments are offered most Saturday mornings from 8.30am until 10.30am with practice nurses providing a Saturday morning clinic every five weeks.

A GP telephone call back service is available every morning between 8.00am and 10.00am. Daily telephone consultations are available to discuss routine problems including test results and referrals. These can be booked in advance between 11.30am and 12.30pm. Routine appointments can be booked up to three months in advance. A ‘duty’ GP works at the practice each day.

The practice has a branch Surgery in Princetown Village Centre which is open between 8.30am and 9.40am every Monday, Wednesday and Friday. Patients can book one of the four pre bookable appointments or can ‘sit and wait’ to be seen. The GPs see approximately 15 patients per session at this branch. There is a dispensary at Yelverton and a very small dispensary at Princetown surgery. Both dispensaries provide a service for Princetown patients only.

During evenings and weekends and when the practice is closed, patients are directed to dial NHS 111 to talk to an Out of Hours service delivered by another provider.

The following regulated activities are carried out at the practice; Treatment of disease, disorder or injury; Surgical procedures; Family planning; Diagnostic and screening procedures; Maternity and midwifery services.

The main practice is located at: Yelverton Surgery, Yelverton, Devon, PL20 6AS

The branch surgery operates out of rooms in the Princetown Community Centre, 1 Moor Crescent, Princetown, Yelverton PL20 6RF.

Updated 5 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Yelverton Surgery on 6 June 2017. 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 a system in place for reporting and recording significant events. This included learning from significant events that had occurred externally to the practice. For example, from parliamentary ombudsman investigation findings.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of and used current evidence based guidance. Staff had been recruited, appraised and trained to provide them with the skills and knowledge to deliver effective care and treatment.

• There was evidence of effective communication at the practice. The practice held daily ‘coffee mornings’ where staff, including district nurses and other staff were invited to discuss clinical issues, teaching needs, emotional issues, management issues and review workloads.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Feedback from health professionals and care home staff was consistently good.

• 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 appreciated the telephone call back system used and 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 was clean, well maintained, had good facilities and was well equipped to treat patients and meet their needs.
• Practice staff offered a family planning clinic which enable patients to be seen locally which saved a 20 mile round trip to the Plymouth family planning clinic or a 12 mile round trip to the Tavistock family planning clinic.
• There was a clear supportive leadership and management structure in place. The leadership team had developed a culture of inclusion, support and care for the staff group and other staff based at the practice.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The practice referred patients to external organisations effectively. For example, the local Memory Café, bereavement service and citizen advice bureau.
• The practice worked effectively with charities to ensure patients received the service they needed. For example, Yelvercare and Tavistock Area Support Services (TASS); two charities run by volunteers who offered transport and social events for patients.
• 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 were committed to working collaboratively to ensure patients at the end of their life received coordinated care and ensured that care took into account their needs and preferences. For example, three of the GPs had previously worked within a hospice environment and were experienced in working with end of life patients and their families. Health care professionals said the GPs were proactive in providing appropriate symptom and pain relief medicines. GPs discussed patients who were at the end of their life during daily meetings, complex care meetings and met with a multidisciplinary team at least every two months. The practice were able to identify patients who were at the end of their life through ‘pop up’ information screens on patient records. The practice also offered a buddy system so if the named GP was unavailable the buddy GP would know about the patients care needs. The end of life lead GP performed an audit of deaths each year. The audit in March 2017 showed that 83% of all patients had died in their preferred place and 94% of these were at home.

The areas where the provider should make improvement are:

• Review systems for recording patients’ consent to care and treatment to bring it in line with legislation and guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 July 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.
• The practice 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.
• Palliative Care meetings were held every six to eight weeks and two GPs shared the lead role of end of life care.
• Health care professionals were invited to speak with GPs at any time including the morning coffee meeting at the practice.

Updated 5 July 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 relatively high for all standard childhood immunisations. An administrator worked with the practice nurse, who then liaised with health visitors to identify those children who miss immunisation appointments. Practice staff met with the Health Visitor and School Nurse every six to eight weeks to discuss families at risk, and to identify late/missed baby checks or 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, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people.
• A quiet room was available if mothers wished to breastfeed in private.
• Practice staff communicated with young people through the website, health information corner and leaflets provided in the toilets. Chlamydia testing was offered in a discreet and sensitive way.
• Young carers were identified in the same way as adult carers and through close working with the multi-disciplinary team.
• Practice staff offered a family planning clinic which enabled patients to be seen locally which saved a 20 mile round trip to the Plymouth family planning clinic or a 12 mile round trip to the Tavistock family planning clinic.

Updated 5 July 2017

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

• The practice had 777 patients over the ages of 75 years and had, so far, undertaken 734 face to face consultations or telephone consultations with these patients (94%).
• The practice cared for 107 older patients across five nursing and care homes in the area. Named GPs were allocated to those care homes to provide consistency.
• 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.
• Older patients were discussed at coffee time, each day to identify care needs and prompt learning.
• 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. For example, Treatment Escalation Plans (TEP) forms were in place and reviewed with patients and their families.
• 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. For example, the practice used ADASTRA (a system used by Devon Doctors out of hours provider) to share information with clinicians. Information on the ADASTRA system was regularly reviewed and updated by the practice.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice worked with Yelvercare and Tavistock Area Support Services (TASS); two charities run by volunteers who offered transport and social events for patients. Representatives from TASS attended the practice regularly to offer a “drop in” service.
• The practice referred patients to the local Memory Café, bereavement service and citizen advise bureau.
• The practice were committed to working collaboratively to ensure patients at the end of their life received coordinated care and ensured that care took into account their needs and preferences. As a result in March 2017 83% of all patients had died in their preferred place and 94% of these were at home.

Updated 5 July 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, extended hours appointments, use of the on line appointment and repeat prescriptions system, text reminders and telephone consultations.
• Saturday morning practice nurse appointments were offered every five weeks.
• 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.

Updated 5 July 2017

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

• Double appointments (or longer if necessary) were offered to patients with mental health issues to enable them time to discuss issues.
• 100% of patients on the practice mental health register had a health check and care plan review in the last year.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice offered a room for mental health professionals, counsellors and depression and anxiety counsellors to use.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Practice staff referred patients to the Young Devon Counselling Services, counselling at schools through school nurses, and to the RISE (Recovery and Integration Service -local drug and alcohol team)
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients living with dementia.
• 88% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average.
• The practice were working towards becoming a Dementia Friendly practice with several staff having become Dementia Friends. The practice had also applied to join the Plymouth and West Devon Dementia Alliance.
• Patients at risk of dementia were identified and offered an assessment.

Updated 5 July 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.
• All patients with a learning disability had received a health check in the last year.
• 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 many were visited in their homes by a GP and health care assistant. A small number of patients could also be seen by two GPs where the patient had complex care needs.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• The practice offered a room for patients to meet with the Drug and Alcohol team rather than them having to travel a 104 mile round trip to similar services in North Devon.
• 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 used ‘pop up’ notes to remind staff of specific information. For example if a patient was deaf or where there was a safeguarding concern or risk of domestic violence or violence in the practice. Pop ups were also used where patients should only be seen by the GP rather than GP registrars.