Glendevon Medical Centre

Updated 14 January 2016

The Teign Estuary Medical Group) was inspected on Tuesday 24 November 2015. This was a comprehensive inspection.

The main practice (Glendevon Medical Centre) is situated in the Devon town of Teignbridge and the branch surgery (Riverside Surgery) is situated in the small town of Shaldon. Patients are able to have appointments at either practice. The Teign Estuary Medical group provides a primary medical service to approximately 4000 patients of a diverse age group. We did not inspect Riverside Surgery on this visit.

There were three GP partners who held managerial and financial responsibility for running the practice. They were supported by two salaried GPs. There were two male and three female GPs at the practice. The team were supported by a practice nurse, nurse practitioner, practice nurse, a trainee assistant practitioner, two health care assistants, a phlebotomist and additional administration staff. Patients also had access to community nurses, health visitors and midwives.

The practice was a training practice for medical students and GP trainees.

The practice is routinely open from Monday to Friday – 8.30am to 6pm. The practice offer a ‘Dr First’ telephone system, which means all patients who contact the practice are then phoned back the same day by the GPs who then either provides consultation over the phone, or if the patient prefers or needs to be seen, an appointment is made for the patient to come into the practice at a time to suit them. There are two late evening appointment sessions for people who work full-time - these are on Tuesday and Wednesday, one at each site and the practice offer early morning appointments on a Tuesday morning from 7.30 – 8.30 at Glendevon.

Outside of these times there is a local agreement that directs patients to contact the out of hours service (Devon Doctors) by using the NHS 111 number.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Glendevon Medical Centre on Tuesday 24 November 2015. 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 an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 the telephone call back service useful and said there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 and complied with the requirements of the Duty of Candour.

We saw an area of outstanding practice:

• The practice worked closely with other organisations and the local community to plan and improve services. GPs had provided health education sessions in local schools. The practice also provided carers checks, not only from their own patient list, but also on behalf of other practices. A second member of staff had been appointed to carry out carer checks using a flexible approach, which gave people the choice of being seen at the practice, or at home during the evening or weekend. This had resulted in a significant rise in the numbers of carers seen, for whom health and wellbeing had improved.

The areas where the provider should make improvement are:

• Systems should be introduced to ensure that all equipment in doctor’s bags is included in the scheduled programme of checks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines 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.
• The practice had participated in a pilot scheme where a practice pharmacist was employed for four sessions a week to undertake medicine reviews, optimisation and reconciliation. The pharmacist had also managed medicine queries from patients and had facilitated communication between the clinical commissioning group and practice.
• The practice were a named hearing aid battery centre and offered this service to other practices in the town.
• Falls risks were proactively managed and included in-depth assessment, GPs had expertise in joint injections, osteoporosis assessments and rapid access to physiotherapy services.

Updated 14 January 2016

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.
• Preconception advice was offered and screening for perinatal mental health performed. Also postnatal checks and depression screening was offered at six weeks after birth.
• We saw good examples of joint working with midwives, health visitors and school nurses. For example, one of the GPs had attended meetings at the local school and had undertaken health promotion talks for the pupils.Two GPs had diplomas in family planning and reproductive health.
• Sexual health promotion was offered to young people and included chlamydia screening and smoking cessation advice.
• The practice offered a full range of contraceptive services

Updated 14 January 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• One of the GPs had a diploma in geriatric medicine and this had promoted expertise within the team which was particularly relevant given the high number ofolder patients registered at the practice..
• The practice had designated care homes who they provided a primary medical service to. For example, weekly homes visits.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice worked with other health and social care professionals and held monthly multidisciplinary meetings to coordinate care and reduce risk of hospital admission.
• End of life care was coordinated with community nurses, hospice care staff and the local community hospital.
• The practice worked with and referred patients to a Volunteering in Health’ (VIH) group for befriending, sitting, transport and shopping service.

Updated 14 January 2016

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 offered extended hours appointments with the GPs at the practice and branch surgery.
• Telephone calls were offered at a time which suited the patient including during work coffee and lunch breaks.
• 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. Prescriptions could be sent to a pharmacy of the patients choice and could be out of the area if this suited their work location.
• Communication to patients included the use of a social media site, newsletter and on the practice website.

Updated 14 January 2016

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

• The practice maintained a register of those with severe mental ill health. All of these patients were offered an annual physical health review and had a personalised care plan.
• Patients had access to an in house counsellor – who worked in the practice every week.

• 90% of people diagnosed with dementia in the last year had received a review of their care reviewed in a face to face meeting.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 14 January 2016

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, fairground staff and travellers.
• The practices cared for patients with unconventional addresses. For example, riverboats, and other premises with no postcode.
• It offered longer appointments for people with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It 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.
• Learning disability patients were offered an annual check and they had personalised care plans. The practice had special easy read documents for patients with a learning disability or patients who lacked the capacity to fully understand. For example easy reading material available for cervical screening.