Archived: Withycombe Lodge Surgery

Updated 31 March 2016

Withycombe Lodge Surgery was inspected on Tuesday 5 January 2016. This was a comprehensive inspection.

The main practice is situated in the coastal town of Paignton, Devon. The practice provides a primary medical service to 2,595 patients of a diverse age group. The practice is a teaching practice for medical students and a training practice for trainee GPs.

There was a team of two GPs partners, one female and one male. The whole time equivalent was 1.75. There was also one full time trainee GP in their final year. Partners hold managerial and financial responsibility for running the business. The team were supported by a practice manager, one practice nurses, two health care assistants and additional administration staff.

Patients using the practice also have access to community nurses, mental health teams and health visitors, midwives and other health care professionals who visit the practice on a regular basis.

The practice is open between the NHS contracted opening hours 8am - 6.30pm Monday to Friday. Appointments are offered anytime within these hours. Extended hours surgeries are offered on Tuesdays until 7.45pm.

Outside of these times patients are directed to contact the Devon doctors out of hour’s service by using the NHS 111 number.

The practice offered a range of appointment types including book on the day, telephone consultations and advance appointments.

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

Updated 31 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Withycombe Lodge Surgery on 5 January 2016. 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.
• 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 it easy to make an appointment with a named GP and that 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 found an area of outstanding practice;

The practice manager had instigated the Tic Tac scheme in 1998 (teenage information centre – teenage advice centre) which had since been adopted across Devon. The practice had won an NHS Beacon Award in 1998 for excellence in primary care for this scheme. [HD1]The scheme was based on site at Paignton Sports and Community College and provided health information and advice for students. Tic Tac was staffed by youth workers, health visitors, GPs, family planning services and other relevant health professionals. Tic Tac provided support on eating disorders, sexual health, teenage pregnancy, depression and anxiety, bullying, drug and alcohol addiction. Tic Tac provided support to 1,800 students at this college.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 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.

• Data indicated that patients with long term conditions were treated according to their needs. For example,

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

Updated 31 March 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.

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  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.

• The practice cervical screening rate had been 100% for the last two years. This was higher than the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• Ante-natal care was provided by a Community Midwife on a weekly basis at the practice.

Updated 31 March 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 patients in its population.

• The practice identified older, frail or vulnerable patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care. To aid with the identification of this group of patients the practice utilised the Devon predictive risk model and software which ensured proactive rather than reactive care.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice employed a Carer Support Worker (CSW) jointly with three other local practices. The CSW offered carers help and support, inclusion on the local carers register, and provided information about practical support such as benefits advice, links to local agencies and respite care.

Updated 31 March 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 an electronic prescribing service (EPS). Approximately 80% of patients received their prescription this way. Patients could drop in, email or use a new online service to request prescriptions.

• 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.

• The practice had systems in place to identify military veterans and ensure their advanced access to secondary care in line with the national Armed Forces Covenant. The practice had a military veteran’s protocol which had been reviewed in the last 12 months.

Updated 31 March 2016

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

• 99% of patients diagnosed with a mental health issue had received a face to face review in the last 12 months.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice 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.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Patients could be referred, or self-refer, to the local anxiety and depression service (DAS). The practice also accommodated a Drug and Alcohol service counsellors for one day a week on a permanent basis. Patients with mental health issues could be referred to community services provided by the Devon Partnership Trust.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 31 March 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, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• The practice informed 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.

• One of the practice GPs had a specialist interest in drug and alcohol treatment. They spent one day a week working with the local drug and alcohol addiction team.