Archived: Cherrybrook Medical Centre

Updated 31 March 2016

Cherrybrook Medical Practice was inspected on Tuesday 2 February 2016. This was a comprehensive inspection.

The practice is situated in the coastal town of Paignton, Devon and is federated with Mayfield Medical Centre in Paignton. The practice provides a primary medical service to approximately 14,140 patients and is a teaching practice for year three and four medical students.

The practice serves a mixed urban and rural area. Paignton itself has a population of approximately 50,000 which expands during the summer tourist season.

There is a team of six GP partners and four salaried GPs with a whole time equivalent of 8.63 due to some full time and some part time working (five GPs are female and five are male). Partners held managerial and financial responsibility for running the business. The team were supported by a practice manager, deputy practice manager, accountant business manager, health and safety manager, two female nurse practitioners, four female practice nurses, two female health care assistants and two phlebotomists. The clinical team were supported by additional reception, secretarial and administration staff.

Patients using the practice also have access to community staff including community matron, district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

The practice is open from 8am to 6.30pm Monday to Friday in line with NHS contracted hours. The practice has a contract with Devon Doctors to respond to patient calls from 6pm to 6.30pm. Appointments are available from 8am to 5.30pm. There are no extended hours offered. Data from the January 2016 GP Patient Survey patient showed that 81% of 117 patients who responded were happy with the practice’s opening hours. This was higher than the national average of 76%.

The practice has an established patient representation group (PPG). This is a group that acts as a voice for patients at the practice.

The practice has opted out of providing out-of-hours services to their own patients and referred them to another out of hour’s service.

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

Cherrybrook Medical Practice provides regulated activities from Cherrybrook Drive, Paignton, TQ4 7SH. We visited this location during our inspection. The practice is federated with Mayfield Medical Practice, 37 Totnes Road, Paignton, which we inspected on 24 June 2015 and awarded a rating of good.

Updated 31 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cherrybrook Medical Centre on 2 February 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 implemented suggestions for improvements and made changes to the way it

delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• The provider was aware of and complied with the requirements of the Duty of Candour.

We found areas of outstanding practice:

• Patients with atrial fibrillation (irregular heart beat) were able to have an echo cardiogram at the practice, which monitored their heart rhythm. This provided a colour video of the patient’s heart in action, to see how their heart was working, and assisted health professionals in making recommendations for medicines and treatment changes. Approximately 647 patients had used this service in the last 12 months. This specific service had saved many of these patients the inconvenience of being referred to secondary care at hospital. The service was provided every day from 8am to 12 noon and 3.30pm to 7pm. Patients had provided positive feedback about the service.

• Patients who lived in nursing homes had twice yearly reviews of their care undertaken by their GP visiting them at the home.as well as visiting when requested.
• Patients deemed at risk of social isolation were offered referral to social services, or to the practice’s local voluntary team, called the Cherryaiders. Cherryaiders offered transport to the practice or to local clinics, organised coffee mornings and social events, and held a book stall at the practice.
• To reduce the inconvenience to patients of being subject to an unplanned hospital admission, the practice contacted speciality duty consultants to review appropriateness of the admission on a case by case basis, and referred patients to the community intermediate care beds where appropriate. The practice liaised with the local community matron frequently who managed the care of these patients.
• Patients with atrial fibrillation could have an echo cardiogram (ECG) which monitored their heart rhythm. This provided a colour video of the patient’s heart in action, to see how their heart was working, and assisted health professionals in making recommendations for medicines and treatment changes. Approximately 647 patients had used this service in the last 12 months. This service had saved many of these patients the inconvenience of being referred to secondary care at hospital. The service was provided every day from 8am to 12 noon and 3.30pm to 7pm. Patients had provided positive feedback about the service.
• Smoking cessation statistics for the practice showed that 185 patients had been referred to the stop smoking support service and 96 had successfully stopped smoking in the last 12 months. This was a success rate of 52%.

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 patients with long-term conditions.

• Patients with atrial fibrillation could have an echo cardiogram (ECG) which monitored their heart rhythm. This provided a colour video of the patient’s heart in action, to see how their heart was working, and assisted health professionals in making recommendations for medicines and treatment changes. Approximately 647 patients had used this service in the last 12 months. This service had saved many of these patients the inconvenience of being referred to secondary care at hospital. The service was provided every day from 8am to 12 noon and 3.30pm to 7pm. Patients had provided positive feedback about the service.
• The practice also provided patients with mobile heart rate monitors, which patients took away and wore for 24 hrs, following which their results were examined and any appropriate treatment changes made.
• Nursing staff had lead roles in chronic disease management through which patients at risk of hospital admission were identified as a priority.
• The practice had clinics for asthma and chronic lung disorders and used spirometry, a lung capacity test, as part of its service to assess the evolving needs of this group of patients. The practice also promoted independence and encouraged self-care for these patients.
• There were weekly clinics to treat and support patients with diabetes which included education for patients to learn how to manage their diabetes through the use of insulin. Health education was provided on healthy diet and life style.

• Yearly home visits and medicines reviews were arranged for housebound patients with long term conditions. Patients who lived in nursing homes had twice yearly reviews of their care undertaken by their GP visiting them at the home.as well as visiting when requested.
• The practice worked closely with the community matrons for patients who had acute conditions to prevent hospital admissions. Patients who were on the unplanned admissions register were contacted following being discharged from hospital to identify any changes to care and treatment required and reviews of care were discussed at practice meetings.
• Clear alerts were placed on the appointment system highlighting vulnerable patients to ensure reception staff acted in a timely manner and allocated same day appointments or home visits. A recall system was in place for patients with chronic diseases.
• The percentage of patients diagnosed with diabetes, on the register, who had received a diabetes review including a foot examination and risk classification in the last 12 months was 86.65% which was comparable with the national average of 88%.

Updated 31 March 2016

The practice is rated as good for the care of families, children and young patients.

• Systems were in place for identifying and following-up vulnerable families who were at risk.

• Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals, we saw evidence to confirm this. We saw that staff dealing with young patients under 16 years of age without a parent present were clear of their responsibilities to assess Gillick competency. Sexual health, contraception advice and treatment were available to young people including chlamydia screening.

• Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. Immunisation rates were high for all standard childhood immunisations.

• All of the staff were very responsive to parents’ concerns and ensured parents could have same day appointments for children who were unwell.

• Staff were knowledgeable about child protection and proactive in raising concerns with the safeguarding lead to follow up on any identified. One GP had the lead role for safeguarding within the practice; they worked with the local authority and other professionals to safeguard children and families.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening review had taken place within the last 12 months was 80.89%, this was comparable with the national average of 81%.

Updated 31 March 2016

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

• Nationally reported data showed the practice had better than average outcomes for conditions commonly found amongst older people. The practice had a register of all patients over the age of 75 and these patients had a named GP. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in relation to caring for patients with dementia, shingles vaccinations program and end of life care.

• The care for patients at the end of life was in line with the gold standard framework. This meant they worked as part of a multidisciplinary team and with out of hour’s providers to ensure consistency of care and a shared understanding of the patient’s wishes.

• The practice was responsive to the needs of older people, GPs, nurses and health care assistants provided home visits and rapid access appointments for those with enhanced needs. We saw care plans were in place for patients at risk of unplanned hospital admissions, and those aged 75 and over who were vulnerable had care plans in place.

• Patients who lived in nursing homes had twice yearly reviews of their care undertaken by their GP visiting them at the home.as well as visiting when requested.
• To reduce the inconvenience to patients of being subject to an unplanned hospital admission, the practice contacted speciality duty consultants to review appropriateness of the admission on a case by case basis, and referred patients to the community intermediate care beds where appropriate. The practice liaised with the local community matron frequently who managed the care of these patients.

Updated 31 March 2016

The practice is rated as good for the care of working-age patients (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 staff were proactive in calling patients into the practice for health checks. This included offering referrals for smoking cessation, providing health information, routine health checks and reminders to have medicines reviews. The practice also offered age appropriate screening tests including prostate and cholesterol testing.

• Patients who received repeat medicines were able to collect their prescription at a place of their choice. The staff often posted the prescription to a pharmacy of the patient’s choice, which may be convenient to their work place.

• Smoking cessation statistics for the practice showed that 185 patients had been referred to the stop smoking support service and 96 had successfully stopped smoking in the last 12 months. This was a success rate of 52%.

• 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. There was an Armed Forces Covenant policy, posters in the waiting room and a computer read code to facilitate this.

Updated 31 March 2016

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

• The practice held a register of patients living in vulnerable circumstances including those with learning disabilities. The practice had offered annual health checks for patients with learning disabilities and 100% of these patients had been offered one. Those that declined were offered again. The practice offered longer appointments for patients with learning disabilities and recognised their individual needs. For example, they used the same members of practice staff and visited the patient at home if required so that any unnecessary stress was avoided..

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

• The percentage of patients diagnosed with mental health issues who had their care plan reviewed in the last 12 months was 92.93% which was better than the national average of 88.47%.

• 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.

• 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 patients 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.