Archived: Drs Twomey, Braddick, Griffiths, Fearon & Kirwan Also known as Chiddenbrook Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chiddenbrook Practice on 25 November 2014. This was a comprehensive inspection. The practice is based at Chiddenbrook Surgery and provides primary medical services to people living in the town of Credition and surrounding villages in Devon covering approximately 250 square miles. The practice provides services to a diverse population.

At the time of our inspection there were 7334 patients registered at the service with a team of six GP partners. GP partners held managerial and financial responsibility for running the business. In addition there was three registered nurses, two healthcare assistants, a phlebotomist, a practice manager, thirteen administrative and reception staff.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for all population groups. It required improvement for providing safe services.

Our key findings across all the areas we inspected were as follows:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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. Urgent appointments were available the same day and staff were flexible and found same day gaps for patients needing routine appointments.
• 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.
• There was a strong commitment to providing well co-ordinated, responsive and compassionate care for patients nearing the end of their lives. This included proactive management of emergency and short term pain relief medicine to counteract access to very limited out of hours pharmacist services in the practice area. This enabled carers to avoid having to travel long distances for these medicines.

We saw areas of outstanding practice:

• The practice had invested in various specialist equipment to facilitate early diagnosis and treatment. For example, equipment to diagnose the risk of deep vein thrombosis was being used, which meant patients could be diagnosed and treated quickly to reduce further health risks from developing. Patients with long term conditions were benefitting from specialist equipment that had been purchased so that blood screening was carried out at the practice for patients. For example, patients on blood thinning medicines needed regular blood testing to reduce potential risks to their health and ensure the dose was appropriate. Normally blood testing was done at the local hospital with results available the following day. However, the equipment that the practice had purchased meant that patient blood samples could be analysed and results were available immediately and discussed with patients. Immediate changes to their medicine dose could then be made in response and additional advice and support given where needed.
• The practice took an early intervention approach and had set up an educational programme for patients at risk of developing diabetes. This was run over a course of sessions in the evenings and helped patients change their lifestyles through the weight management or smoking cessation programmes where further advice and support was provided. Data showed 97% of patients who were current smokers with physical and/or mental health conditions whose notes contained an offer of smoking cessation support and treatment within the preceding 12 months. The national average was 96%.
• Vulnerable patients were referred to an innovative and successful community service, which engaged isolated adults in a rural area through stimulating, creative and social activities. A GP at the practice was one of the founding members and an active partner in this community service. The practice was also actively involved in the development of a community hub service in Crediton in partnership with other agencies.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must

• Ensure that patients are protected by gathering and reviewing the information in relation to people working at the practice. This concerns the recruitment of staff and the personnel information required including proof of identity, qualifications, employment history and relevant criminal record checks are carried out, if necessary to the role, and the relevant information retained as required by the legislation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice