Yelverton Surgery

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