College Surgery Partnership

Updated 29 October 2015

College Surgery Partnership was inspected on Wednesday 12 August 2015. This was a comprehensive inspection.

The practice provides GP primary care services to approximately 16,800 people living in and around the area of Cullompton covering an area of approximately 120 square miles. College Surgery is the main practice working alongside four branch surgeries in Bradninch, Uffculme, Willand and Sampford Peverell.

There are 12 GP partners, seven male and five female and one female salaried GP. Each week collectively the GPs work the equivalent of approximately 10 full time GPs.

The practice is registered as a GP teaching and training practice for under and post graduate education. There are three GP trainers and nine approved medical student assessors.

The team are supported by a practice manager, an operations manager, finance and data manager, two nurse practitioners, three practice nurses, three health care assistants and two phlebotomists. The clinical team are supported by additional reception 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 offers appointments from Monday to Friday between the hours of 8.30am and 6.30pm. It also offers extended hours four evenings a week for those people and a same day service for patients that have more urgent needs.

Outside of the above opening hours the practice directs patients to a Devon Doctors the Out-of-Hours service.

Updated 29 October 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of College Surgery Partnership on 12 August 2015. Overall, we rated the practice as outstanding. Specifically, we found the practice to be good for providing caring, safe services and effective services and outstanding for providing, responsive and well led services.

We also found the practice outstanding for providing services to older people and good for people with long term conditions, poor mental health including people living with dementia, working age people (including those recently retired and students) and families, children and young people and people whose circumstances make them vulnerable.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• There were arrangements in place to respond to the protection of children and vulnerable adults and to respond to any significant events affecting patients’ well-being.

• The practice worked well with other health care services to enable a multi-disciplinary approach in meeting the health care needs of patients receiving a service from the practice.

• The practice managed complaints well and took them seriously. Information about how to complain was available and easy to understand.

• There was a clear management structure with approachable leadership. Staff were supported and had opportunities for developing their skills, were well supported and had good training opportunities.

• The practice had modern central facilities designed with patients and staff for future population growth.

• The practice had a vision and informal set of values which were understood by staff. There were clear clinical governance systems.

We saw several areas of outstanding practice including:

• The practice had increased the flexibility of access to appointments and could demonstrate the impact of positive patient survey results. The practice offered a same day service (SDS) for patients who had more urgent problems; this was facilitated by two GPs. The practice also offered appointments outside of core hours on four days per week.

• The practice had reached out to the local community by supporting people who were vulnerable by facilitating a walking group, vegetable growing at the practice and ‘knit and natter’ a social group held at the café on site, this increased wellbeing amongst patients who said they really enjoyed taking part.

• The practice has an extremely engaged and active patient participation group (PPG) with over 200 members participating remotely, as well as regular face to face engagement. We saw examples of the PPG being able to influence practice behaviour to benefit patients, for example by continually campaigning to keep the branch surgeries open. They also organised health promotion events.

• The practice was fully committed to working in partnership with the other stakeholders and has recently been part of a two year research project led by the University of Westminster with the aim of improving the health outcomes for those patients with Type 2 Diabetes and those at risk of developing Diabetes. The project, led by the health facilitator, showed clear evidence of health gains for diabetics with reduced HbA1c (a blood test which showed lowered blood sugar levels) reduced weight and waist measurements. This was undertaken over nine months and involved 124 patients. This evidence has led NHS England to sponsor the health facilitator for more work in this area.

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

Importantly the provider should:

• Formally record Hepatitis B status within the personal files of staff.
• Ensure cleaning schedules are signed and dated as tasks are completed, so that equipment is known to be ready for use.
• Ensure robust systems are in place to ensure communications are promptly seen by the GP.
• Review procedures for blank prescription forms kept at branch surgeries.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 October 2015

The practice is rated as outstanding 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. Longer appointments and home visits were available when needed. These patients had a named GP and a structured annual review to check that their health and medication needs were being met.

Health promotion and self-help was given as a top priority alongside clinical treatment with many health promotion initiatives in place. We saw evidence that the practice continued to develop and improve services for people with long term conditions. For example the practice was engaged with Westminster University in a research project to improve the health outcomes for patients with Type 2 diabetes and those at risk of diabetes.

Updated 29 October 2015

The practice is rated as outstanding 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.

Children and young people were treated in an age-appropriate way and were recognised as individuals. We saw that staff dealing with young people 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 and health visitors who were based at the practice. Health visitors had access to the clinical system so notes could be made on records, or progress checked, easily.

Immunisation rates were in line with local averages for all standard childhood immunisations. For example, vaccination rates for five year old children were 95%. 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 and health visitors. Cervical screening rates for women aged 25-64 were 83.44%, which was comparable to the CCG average of 81.88%.

Updated 29 October 2015

The practice is rated as outstanding for the care of older people.

Nationally reported data showed that outcomes for patients were good for medical conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in their population.

Every patient had a named GP so they received continuity of care. Alongside this there was a system of ‘microteams’ of four GPs who covered cover each other in an effective way to ensure that when the patients named GP was not available that another would be familiar to the patient.

Appointments were pre-bookable at all 5 practice sites, double appointments and telephone appointments were available. The practice offered a same day service (at Cullompton) for urgent problems, Duty Doctors accessed reserved surgery/telephone appointments with patient’s named GP/team GPs, who know the patient. Extended hours four days a week facilitated working family members (or carers/support workers) accompanying elderly relatives needing transport/support to attend the practice. The practice had access to a volunteer car service for hospital/GP appointments.

Clinics were held at the practice which made access for elderly and more vulnerable patients easier. For example on-site Geriatrician clinics (Care of the Elderly) were held bi-monthly at the practice also audiology, physiotherapy and, retinal screening.

The practice worked hard to support those patients who were socially isolated. They used innovative and proactive methods to improve patient outcomes, for example, they funded and facilitated several activities aimed at improving the patients’ health and wellbeing, including a walking/exercise for health group, a gardening club, the ‘knit and natter’ group, a cookery club and vegetable growing which was situated in the car park, The organic fruit and vegetables and herbs garden were often used at the six weekly cookery demonstrations for diabetics provided in the onsite café. Other initiatives included patient led health activities such as “disease of the month” and health and “question time”.

Staff were responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 29 October 2015

The practice is rated as outstanding 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. For example the practice offered evening appointments from Monday to Thursday with the last appointment being 7.15pm. Early morning appointments were available from 7.30am on Wednesday mornings. The practice was proactive in offering online services for repeat prescriptions and as well as a full range of health promotion advice and support.

Updated 29 October 2015

The practice is rated as outstanding for the care of people with poor mental health (including patients with dementia). The practice held a register of patients experiencing poor mental health and there was evidence they carried out annual health checks for these patients. The practice regularly worked with the multi-disciplinary teams in case management of people experiencing poor mental health, including those with dementia; this ensured patient care was communicated and delivered most effectively.

Patients had continuity of care by having their named GP and preferred nurse. One GP had a special interest in mental health and was the lead in this area of care. The practice had told patients experiencing poor mental health about how to access various support groups and mental health charities including national organisations such as MIND and SANE. Patients were also signposted to a local memory café, and local support groups such as ‘singing for the brain’ and ‘upstream’.

They had systems in place to follow up patients who had attended Accident and Emergency (A&E). All staff had received training on how to care for people with dementia.

Updated 29 October 2015

The practice is rated as outstanding 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. Longer appointments and home visits were available when needed.

The practice was accessible for any vulnerable group. The practice had identified patients with learning disabilities and treated them appropriately. Patients were supported to participate in health promotion activities, such as breast screening, and smoking cessation. The practice funded a health facilitator to meet the needs of their patients to improve mobility and health management. A hearing loop was available for patients who had hearing impairments.

The practice had an Increasing numbers of Eastern European patients, employed in local agriculture and meat processing industries. Also some Asian families mainly in hospitality and care work. The practice used Language line, booked translators and had patient information in other languages to help facilitate the language barrier.