Dr Hall, Hillman, Macartney, Mr Smith-Avery, Dr Garstang, Dr Mair & Dr Lindsay Also known as Knowle House Surgery

Updated 17 March 2016

Knowle House Surgery was inspected on Tuesday 1 March 2016. This was a comprehensive inspection.

The practice is situated in the city of Plymouth and provides a primary medical service to approximately 12000 patients of a diverse age group. The practice operates across two sites, the main site being located at Knowle House, Meavy Way, Plymouth and the branch surgery being in Tamerton Folliot. We did not visit the branch surgery at this inspection.

The practice is a training practice for doctors who are training to become GPs and for medical students. The practice also hosts a Japanese exchange medical student for a week every year.

There is a team of six GPs partners, three male and three female and one non clinical partner who is also the practice manager. Partners hold managerial and financial responsibility for running the business. The team are supported by a salaried GP, five practice nurses, three health care assistants and additional clerical and reception staff.

Patients using the practice also have access to community nurses, midwives, mental health teams and a counsellor on site.

The practice is open from 8am to 6pm Monday to Friday. Early evening clinics are offered until 7:30pm on Tuesdays and 8pm on Thursdays. There is also a nurse led clinic available every Thursday until 7:30pm. Outside of these times patients are directed to contact the Devon doctors out of hour’s service by using the NHS 111 number.

The practice provides regulated activities from its primary location at 4 Meavy Way, Plymouth, PL5 3JB and its branch surgery at Tamerton Surgery, Harwood Avenue, Tamerton Foliot , Plymouth ,Devon, PL5 4NU.

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at on Tuesday 01 March 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. Chronic disease was managed well, for example, the care of people with diabetes.

The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.liaised with the NHS screening programme. The screening was facilitated by the practice and patients from neighboring practices were also offered access to screening at Knowle Surgery

There were six care homes in the practice area. There was a named GP for each home to ensure continuity of care. Two GPs undertook twice weekly ward rounds within one of the larger homes, staff at the home communicated directly with those GPs, to provide proactive and personalized care.

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 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 proactively sought feedback from staff and patients, which it acted on.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2016

The practice is rated as good 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. Long term conditions were managed by the practice nursing team. The nurses had expertise in diabetes management and managed insulin conversions for the patients. The practice also ran virtual diabetic clinics with the diabetes consultant to discuss and support those patients with more complex needs.

• The practice held a diabetic focus group with their patients and discovered they had received no structured education programme about the disease which would support and help them. As a result the practice had been trying to source an independent company that could introduce such a service and provide further education or the patients.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice had good relationships with members of the community teams. For example, the GPs liaised well with the long term conditions matron to support those patients with chronic diseases and avoid hospital admissions.

• The practice maintained robust registers and provided appointments for patients with long term conditions. QOF results indicated an efficient management of chronic disease management with maximum points achieved in the last few years.

• One of the practice nurses ran a patients walking group, any patient could be referred to join.

Updated 17 March 2016

The practice is rated as good 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Childhood flu clinics were undertaken at half term and after school hours.

• We saw positive examples of joint working with midwives, health visitors and school nurses. The midwife held a regular clinic at the practice.

• Safeguarding was discussed at significant events meetings within the other professionals form the community. The practice had a protocol that identified all patients who attended under the age of 18 and information was collected about who was accompanying the young person and whether they had capacity to consent as outlined in the Gillick competence framework, in addition to details of how to contact and inform the young patient if necessary after any tests.

Updated 17 March 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. All patients over 75 had a named GP. The most vulnerable frail elderly had care plans in place. Over 75 health checks were provided.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• Monthly meetings were held where patients at risk of unplanned admission were discussed and plans made for good coordinated care. These plans were agreed with the patient.

• There were six care homes in the practice area. There was a named GP for each home to ensure continuity of care. Two GPs undertook twice weekly ward rounds within one of the larger homes, staff at the home communicated directly with those GPs, to provide proactive and personalized care. The GPs also regularly visited to ensure that all chronic disease management was up to date and that these patients were not disadvantaged by not being able to attend the practice.

• The practice nurses performed complex leg ulcer dressings in the practice following extended training. This meant that patients were able to receive this complex treatment at the practice avoiding the need to attend the leg ulcer clinic at Derriford Hospital.

• Deaf and hard of hearing patients were identified by the practice and were given face to face appointments without prior telephone triage. There was a hearing loop installed in the waiting room. One GP was experienced in sign language for those patients that were hard of hearing and could sign.

Updated 17 March 2016

The practice is rated as good 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.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Extended hours appointments were available until 730pm on a Tuesday and 8pm on a Thursday for a GP appointment, and a nurse clinic ran until 730pm on a Thursday.

• The practice liaised with the NHS Abdominal Aortic Aneurysm (AAA) screening programme. This was a way of detecting a dangerous swelling (aneurysm) of the aorta (the main artery of the body). The screening was facilitated by the practice and patients from neighbouring practices were also offered access to screening at Knowle Surgery

• The practice offered the Fit for Work scheme. This was a new support service, designed to help working people who face long-term sickness absence return to work more quickly.

Updated 17 March 2016

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

• 78.87% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84.01%.

  The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia. Any relevant information for at risk patients in this group were shared with out of hours providers to provide continuity of care.

• The practice had informed 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.

• The practice had good relationships with community teams to support patients at home. For example, the practice had a named community psychiatric nurse (CPN) that offered support to patients and provided continuity of care. The consultant psychiatrist and community psychiatric nurses (CPNS) held clinics at the practice and they also had an in-house counsellor available for patients.

Updated 17 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless patients, and those with a learning disability. The practice offered longer appointments for patients with a learning disability and double appointments were offered to travellers. One GP and a nurse undertook annual health reviews for patients with learning disabilities who lived in local care homes.

• 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.