Pembroke House Surgery

Letter from the Chief Inspector of General Practice

This practice is rated as good overall and outstanding in well led. The previous inspection was in October 2015 where the practice was rated as– Good with outstanding in the responsive domain.

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? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia)-- Good

We carried out an announced comprehensive inspection at Pembroke House Surgery on 9 January 2018. The reason for the inspection was as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, there was a genuinely open culture in which all safety concerns raised by staff and people who use services were highly valued as opportunities for learning and improvement.

• 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.

• The practice understood the needs of its population and tailored services in response to those needs. For example, the nursing team had introduced a ‘drop in’ flu clinic for patients who could not attend the routine flu clinics.

• The practice made reasonable adjustments when patients found it hard to access services. For example, the practice worked with other GPs in the area and provided treatment to patients in 16 local residential and nursing homes and offered a winter pressures GP home visiting service to nine care homes with the most vulnerable patients in Paignton & Brixham.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.The leaders used feedback from staff and patients to achieve growth and positive change.

• The practice was organised, efficient and supported effective governance processes. Leadership was clear, supportive and encouraged creativity.

• Evidence based techniques and technologies were used to support the delivery of high-quality care and staff were consistent and proactive in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health. For example, the use of a telephone system which tracked calls, patients who used online services, a detailed self-service health pod, GPs use of clinical templates and the use of electronic correspondence with acute hospitals and out of hour’s providers.

• The leadership and culture of the practice are used to drive and improve the delivery of high-quality person-centred care.

• There had been many organisational changes and an increase in patient population in the last two years. Despite this, the provider had maintained positive patient outcomes, positive feedback from patients and provided a popular place for staff to work.

We saw two areas of outstanding practice:

The involvement of other organisations in the local community and innovative approaches to providing integrated person-centred care meant that patients received flexible, responsive care. For example, the practice had set up and continued to fundraise and support a patient support group called Karing. The practice had helped to relaunch the charity when it moved offices to be closer to the practice. The group had invited a celebrity, who is nationally known for charity work with the vulnerable elderly and used this to raise the profile of the service. The practice and volunteers had recognised the change in patient need and as a result there had been a changed of focus of the group to concentrate more on social activities and befriending to reduce social isolation. The staff and their families had joined with patients to put on a concert at the Palace Theatre Paignton, to help raise awareness of Karing. The feedback received from patients was that it brought back a real sense of community and reduced social isolation. The practice staff and some patients had organised a ‘sell out’ show which raised £3000 towards the charity.

There were consistently high levels of constructive staff engagement and innovative approaches to gather feedback from people who use services and the public. For example:

• Action had been taken as a result of staff and patient feedback and detailed extensive public engagement, which had been recognised as good practice by NHS England.

• Many changes had occurred to benefit patients following engagement with staff. For example, streamlining the prescription, scanning and medical report processes which ensured patients received a more efficient service, changes to the length of some appointments patients did not feel rushed and improving the way samples were received from patients to reception staff to reduce the spread of infection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice