Westbank Practice

Updated 14 December 2017

Westbank Practice is situated in South Devon. Westbank Practice is comprised of two sites; Starcross Surgery and The Limes Surgery.

The deprivation decile rating for this area is nine (with one being the most deprived and 10 being the least deprived). The practice provides a primary medical service to approximately 8,663 patients of a diverse age group. The 2011 census data showed the majority of the local population identified themselves as being White British.

There is a team of four GP partners, three female and one male; the partners are supported by four salaried GPs and one GP registrar. The whole time equivalent is five. The GP team are supported by a practice manager, a data manager, a reception manager, four practice nurses, one nurse practitioner, two phlebotomists, and additional administration staff.

Patients using the practice also have access to health visitors, midwives, counsellors, district nurses, and physiotherapists who work from the practice. Other health care professionals visit the practice on a regular basis.

The practice is open from 8.30am to 6pm Monday to Friday. Appointments are offered between those times. Extended hours are worked at Starcross Surgery on Wednesdays from 7am to 8am and at Exminster Surgery on Monday from 6pm to 7.30pm. The practice also offers weekend opening as part of Exeter Primary Care federation, approximately once or twice a month. Outside of these times including from 8am to 8.30am and 6 to 6:30pm, patients are directed to contact the out of hour’s service and the NHS 111 number. This is in line with local contract arrangements.

The practice offers a range of appointment types including face to face same day appointments, telephone consultations and advance appointments (four weeks in advance) as well as online services such as repeat prescriptions.

The practice has a Personal Medical Services (PMS) contract with NHS England.

This report relates to the regulatory activities being carried out at the following two sites:

Starcross Surgery

Church Street

Starcross

Devon EX6 8PZ

The Limes Surgery

Church Stile

Exminster

Devon EX6 8DF

We visited both sites during our inspection.

Updated 14 December 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection November 2014 rated Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Westbank Practice on 7 November 2017 as part of our planned inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• 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.

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

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2015

The practice is rated as good for the population group of people with long term conditions.

All patients with long term conditions formed part of the practice’s core planning and recall system, so that patients with long term conditions were continually reviewed and appropriate changes made to their treatment if required. All patients in this population group were seen by a GP at least once a year for a review or more frequently as appropriate.

Patient health questionnaires at the practice included questions on patient’s weight, alcohol, cigarette intake and other health risk factors. These details were checked at review and entered on the practice computer system encounter screen and appropriate action taken where required.

The practice audited the results of reviews and records of patients in this population group. Between April 2013 and March 2014 the practice had completed reviews on 83% of patients with diabetes, 70.4% of patients with asthma and 93.5% of patients with chronic obstructive pulmonary disease (COPD).

Emergency processes were in place and Consultant referrals were made for patients in this group who had a sudden deterioration in health. When needed longer GP appointments and home visits were available. All patients identified with long term conditions had a named GP and structured annual reviews to check their health and medicine needs. 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.

Updated 31 March 2015

The practice is rated as good for the population group of families, children and young people.

An example of good practice was how the practice implemented a records alert system of regular cards from child health immunisations. This system triggers a request to invite the child and their parent or guardian in after three failed encounters, and contact is made with the health visitor to follow up. GP’s told us they also opportunistically bring this up at consultations.

Systems were in place for identifying and following-up children living in disadvantaged circumstances and who were judged to be at risk. The practice supported patients in this population group by monitoring accident and emergency department visits made. If the number of visits made met or exceeded three visits within a twelve month period, the GP requested an appointment with the patient and their parent or guardian.

The practice ensured that all childhood injuries or accidental ingestion of substances were discussed with the Health Visitor. Appointments were available outside of school hours and the premises was suitable for children and babies. The practice worked closely with the on-site midwife and health visitor to ensure clinics took place regularly and a tailored service was offered to patients.

Updated 31 March 2015

The practice is rated as good for the population group of Older Patients over 75.

The practice maintained close links with a local day care centre and a community matron. Core group meetings were held to support this liaison. For example, the GPs attended gold standard framework monthly meetings, aimed at enabling generalist frontline staff to provide a gold standard of care for patients nearing the end of life. Evidence of this was shown in minutes of these meetings on the practice intranet.

The reception and administrative staff supported patients in this population group through the provision of a system known as ‘choose and book’ referrals. Administrative staff supported patients by helping them to use computer systems to select and book appointments at a time and on a day convenient to them.

The practice maintained liaison with the local Clinical Commissioning Group (CCG) regarding this population group, through a clinical forum group. The practice ensured that the practice website was accessible to older patients and facilitated links to local charities.

GPs at the practice ensured that end of life care plans also known as treatment escalation plans (TEP) forms were provided for all patients if requested, faxed to the out of hours service provider and the Ambulance Service so older patients at the end of their life received a streamlined service.

The practice provided hospital discharge summaries to keep GPs up to date with their patients and arrange follow up visits with them if required. The practice had a system in place to be notified if any of the patients were admitted to hospital in an emergency.

Medicine reviews were done continuously on every repeat prescription to help ensure patients in this population group were receiving the optimum levels and types of medicines.

Updated 31 March 2015

The practice is rated as good for the population group of working age people.

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 an online appointments booking service together with an online facility to order repeat prescriptions. GPs offered telephone consultations to patients especially those giving up smoking after surgery, or sooner if more urgent.

Health promotion leaflets relevant to issues affecting this population group were on display in the waiting room and on the visual display unit available for viewing in the patient waiting area. This information was discussed at reviews and opportunistically by GPs with patients.

The practice offered NHS Health Checks to patients aged 40-75. The practice had 3,868 patients in this group and had sent out 576 invites in the last 12 months. The capacity of the practice to offer health checks was then reached. Of these, 178 patients took up the offer of the health check. This represented 4.6% of the total number of patients in this age group. A GP showed us how patients who had risk factors for disease identified at the health check were followed-up within 10 days and were scheduled for further investigations.

Acupuncture, physiotherapy and complementary therapy were all services offered by the practice which had proved very popular with patients in this population group. The practice had also successfully referred many patients in this population to a gym and exercise facilities.

Updated 31 March 2015

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

Patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice had in place advance care planning for patients with dementia.

The practice offered the availability of longer appointments as appropriate. The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations including national mental health charities and CAMHS (Child and adolescent mental health services) a mental health crisis team and memory services for older people. The practice provided a room for mental health support clinics at the practice.

The practice supported patient’s mental well-being and access and the recovery and independent living with clear signposting to support groups. The practice maintained a carer’s register and carer’s support network for patients. Staff had received training on how to care for people with mental health needs and dementia. A dementia support worker had met with practice staff in July 2014 to discuss the needs of patients with dementia.

Updated 31 March 2015

The practice is rated as good for the population group of people living in vulnerable circumstances.

The practice had undertaken to provide primary medical services to a local travelling community who had been refused treatment at other practices which were closer to their location. Their circumstances made them a difficult to reach and potentially vulnerable group. Staff at the practice had discussed and agreed to provide services to this group which showed an outstanding level of caring and responsiveness.

The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with learning disabilities. The practice provided services to patients who lived on boats in the local area, and who had no traditional fixed abode.

The practice supported two nearby learning disability homes with their care plans and also provided a primary care link nurse for patients with learning disabilities. The practice had carried out annual health checks for people with learning disabilities and ensured these patients had received a follow-up. This service included more frequent reviews if needed. The practice offered longer appointments for people with learning disabilities. The practice plan to use updated computer alerts on their computerised patient records, once the system is in place, to improve their monitoring and support for patients in this population group.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. For example they had sign-posted vulnerable patients to various support groups and third sector 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 and out of hours.