Pathfields Medical Group

Updated 29 April 2024

Pathfields Medical Group is located in Plymouth at:

Plympton Health Centre

Mudgeway

Plympton

Plymouth

PL7 1AD

The practice has branch surgeries at:

Armada Surgery

28 Oxford Place

Plymouth

PL1 5AJ

Beaumont Villa Surgery

23 Beaumont Road

Plymouth

PL4 9BL

Crownhill Surgery

103 Crownhill Road

Plymouth

PL5 3BN

Efford Medical Centre

29-31 Torridge Way

Plymouth

PL3 6JG

Laira Surgery

95 Pike Road

Plymouth

PL3 6HG

During our inspection we carried out site visits of Plympton Health Centre and Laira Surgery.

The provider is a partnership registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services, treatment of disease, disorder or injury, family planning services, and surgical procedures. These are delivered from all sites.

The main practice is located in a shared health centre with another GP provider and delivers care within the Integrated Care System (ICS) for Devon to a patient population of about 30,000.

The practice is part of a wider network of GP practices that enables patients to access care through out of hours provision.

Information published by Office for Health Improvement and Disparities shows that deprivation within the practice population group is in the fourth lowest decile (4 of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is 95% White, 2% Asian, 2% Mixed, and 1% Black.

The age distribution of the practice population closely mirrors the local and national averages. There are more male patients registered at the practice compared to females.

The practice team comprises 142 staff:

• GPs:
  • 9 GP partners
  • 19 salaried GPs
  • 7 locum GPs
• Nursing staff:
  • 6 practice nurses
  • 1 advanced nurse practitioner (ANP)
  • 1 locum ANP
  • 1 nurse associate
• 8 healthcare assistants
• 6 paramedics
• 2 clinical pharmacists
• 2 pharmacy technicians and 1 trainee pharmacy technician
• 1 physiotherapist
• 1 phlebotomist
• 76 patient advisors and non-clinical staff, including a caretaker, cleaner, administrators, managers, and team leaders.

The main practice at Plympton Health Centre is open between 7.30 am and 6 pm on Mondays and Thursdays and between 8am and 6pm on Tuesdays, Wednesdays, and Fridays. Branch surgery opening times are available on the group website. Patients can choose to be seen at any site. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments. Extended access appointments can be made in advance and out of hours services are provided by the Practice Plus Group through the NHS 111 service.

Updated 29 April 2024

We carried out an announced focused inspection at Pathfields Medical Group on 28 November, 30 November, and 21 December 2023. Overall, the practice is rated as requires improvement. We rated the key questions:

Safe: Requires improvement

Effective: Good

Well-led: Good

Our previous ratings from October 2018 carry over as follows:

Caring: - not inspected, rating of good carried forward from previous inspection

Responsive: - not inspected, rating of requires improvement carried forward from previous inspection.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Pathfields Medical Group on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in response to concerns reported to us.

Our focus included:

• Safe, effective, and well-led key questions.
• A review of access.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• A site visit to the group’s main practice and to 1 branch surgery.
• Conducting staff interviews using video conferencing and in person whilst on site.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider and other organisations.

We found:

• The practice mostlyprovided care in a way that kept patients safe and protected them from avoidable harm and work was underway to improve practice in a number of areas
• Patients received effective care and treatment that met their needs.
• Staff involved patients in decisions about their care.
• Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• Safeguarding systems were in place and staff demonstrated a clear understanding of the reporting and escalation processes.
• The practice had a significant focus on data-driven care and was developing new ways of working with regional and national partners to improve health outcomes.
• Staff developed care strategies based on their knowledge and understanding of regional population health pressures, including by working with organisations in primary care, secondary care, and social care services.
• Services for people living with, or at risk of, frailty were advanced and part of an ongoing quality improvement programme.
• The main practice building needed improvements in infection prevention and control systems and processes. The senior leadership team had recognised this before our inspection and an improvement plan was underway.
• Care for patients living with complex long-terms conditions was in place and in almost all measures the practice performed better than the national average. The practice faced significant challenges in reaching patients who did not respond to recall messages.
• Staff felt supported and recognised by the senior leadership team. Leaders were focused on managing capacity and demand and ensuring staff were supported with a range of wellbeing, learning, and development opportunities.

We found 2 areas of outstanding practice:

• The practice had an extensive programme of data-driven care development. A GP partner had established data monitoring to help track demand and capacity based on disease prevalence and comorbidities. This was more extensive and up to date than national monitoring and meant the provider had a comprehensive, holistic understanding of regional population health.
• Frailty was a key focus for the practice and the frailty lead had established an evidence-based, multidisciplinary, system-wide programme of work to improve the lives and outcomes of patients. This had improved the accuracy of frailty coding on healthcare information systems, reduced the need for unplanned hospital admissions, and meant patients had access to more appropriate, individualised care.

Whilst we found no breaches of regulations, the provider should:

• Maintain measures to affectively engage with the most difficult to reach patients so that they access timely medicine and condition reviews and monitoring, particularly for those living with asthma
• Evaluate the effectiveness of the new approach to infection prevention and control and take steps that provide assurance of consistent standards of safety.
• Implement measures to consistently act on MHRA alerts.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care