Background to this inspection
Updated
26 January 2018
Chiddenbrook Surgery a GP practice which provides its services under a Personal Medical Service (PMS) contract for approximately 7,179 patients. The practice is situated in Crediton, Devon, a semi-rural area which covers 250 square miles.
Chiddenbrook Surgery is open between Monday and Friday: 8.30am until 12.45pm and 1.45pm until 6pm. Phone calls between 8am and 8.30am and 12.45pm and 1.45pm are answered by the Out of hours message handling service by patients dialling the NHS 111 service. Urgent calls are passed to the GP. Outside of these hours a service is provided by an out of hours health care provider.
The practice offers extended hours two times a week starting from 7.30 am and between 6.30pm and 7.30pm. The days of these extended hours appointments vary and are shared with patients when they contact the practice to book an appointment.
Routine appointments are available daily and are bookable up to three weeks in advance for the GP and a month for the nurse. Urgent appointments are made available on the day and telephone consultations also take place.
The practice population area is in the seventh decile for deprivation. In a score of one to ten, the lower the decile the more deprived an area is. There is a practice age distribution of male and female patients equivalent to national average figures. Average life expectancy for the area is similar to national figures with males living to an average age of 81 years and females living to an average of 86 years.
There is a team of six GPs (three female and three male). Of the six GPs, five are GP partners. Together they provide a whole time equivalent (WTE) of 4.5 GPs. The team of GPs are supported by two registered nurse prescribers, a practice nurse two phlebotomists and two health care assistants. The clinical team are supported by a practice manager and a team of administration and reception staff.
Patients using the practice have access to community staff including community nurses who are based at the adjacent Crediton Hospital. Patients can also access the services of counsellors, podiatrists and midwives at the practice. There is an independent pharmacy on the same site as the practice.
The practice is a teaching practice for year three medical students.
The GPs provide medical support to four residential care homes and two supported living homes for patients with learning disabilities.
The practice is registered to provide regulated activities which include:
Treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services and Diagnostic and screening procedures and operate from the location of:
Chiddenbrook Surgery
Threshers
Crediton
Devon
EX17 3JJ
Updated
26 January 2018
Letter from the Chief Inspector of General Practice
This practice is rated as good overall. (The previous inspection of Drs Twomey, Murphy, Braddick, Griffiths, Fearon and Kirwan (known as Chiddenbrook Surgery) took place in November 2014. At the November 2014 inspection the practice was rated as Good.
At this inspection we have rated the practice as good.
At this inspection in December 2017 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 Good
We carried out an announced comprehensive inspection at Chiddenbrook Surgery on Wednesday 20 December 2017. We carried out this comprehensive inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
At this inspection we found:
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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.
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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.
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Clinical audit was used at the practice influenced changes to the care and treatment of patients. For example, the practice had looked at the use of patients with atrial fibrillation (AF) on warfarin (blood thinning medicine) to ensure they had blood clotting test results (INR) within normal range. The results demonstrated a reduction from 23% of patients with poor control to 8% and a subsequent risk reduction of patients developing a stroke.
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Staff involved and treated patients with compassion, kindness, dignity and respect.
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Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
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Patients with diabetes received evidenced based care and services to meet their needs. This included quarterly virtual diabetic clinics held in partnership with colleagues from secondary care and informal education session for all newly diagnosed ‘at risk of diabetes’ patients. An audit sample of these patients showed better diabetic control.
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The practice had a six monthly link with Queen Elizabeth Community College boarders via the patient group and liaison with pupils via citizenship classes.
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GPs at the practice had acted as trustees, referred to and been proactive in supporting a local charity called ‘Upstream’ who delivered community-based services for patients who were mentally, physically or socially isolated.
We saw one area of outstanding practice:
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Effective and well embedded systems were in place to proactively share new national guidance, audit findings, clinical data and tools both within and outside of the practice ensuring patients received the most effective care. For example, reception staff had been provided with a detailed triage protocol to assist with non-urgent, routine and emergency presentations, including national guidance regarding the management of suspected sepsis. These included directing patients to a pharmacist, asthma nurse, GP, practice nurse or 999. The document had been recognised as being an effective reference tool and had been shared with other local practices.
The areas where the provider should make improvements are:
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
Working age people (including those recently retired and students)
Updated
26 January 2018
People experiencing poor mental health (including people with dementia)
Updated
26 January 2018
People whose circumstances may make them vulnerable
Updated
26 January 2018