Pinhoe Surgery Also known as Pinhoe & Broadclyst Medical Practice

Updated 14 September 2016

The Pinhoe and Broadclyst Medical Practice was inspected on Tuesday 28 November 2015. This was a comprehensive inspection. The practice operates across two sites, the main site being located in Pinhoe and the branch surgery being in The Hellings, Broadclyst.

The practice provided GP primary care services to approximately 11,000 people living in and around the area of Pinhoe on the outskirts of the city of Exeter.

The practice has a Primary Medical Service (PMS) contract and also offers Directed Enhanced Services, for example the provision of minor surgical procedures for patients and also offered local enhanced services which included full family planning for its patients.

There are seven GP partners, three male and four female. The practice is registered as a GP teaching practice for under graduate medical student’s education. Partners hold managerial and financial responsibility for running the business. The team are supported by a practice manager, one nurse practitioner, two practice nurses, a health care assistant, a dispensary team and additional administration staff.

The practice has a dispensary at the Broadclyst surgery. A dispensing practice is where GPs are able to prescribe and dispense medicines directly to patients who live in a rural setting. The Broadclyst practice dispensed to patients who did not have a pharmacy within a mile radius of where they lived.

Patients using the practice also had access to community nurses, midwives, community mental health teams and health visitors who visit the practice.

The practice is open from Monday to Friday 8am to 6.30pm. Appointments are available between 8am and 5.30pm Monday to Friday. Outside of these times there is a local agreement that the out of hours service (Devon Doctors Out of Hours Service) take phone calls and provide an out-of-hours service.

We inspected the practice in November 2015 and found improvements were needed in the overview of safety systems and processes. The provider sent us an action plan which detailed the steps they would take to meet the breaches in regulation. During our latest inspection on 1 August 2016 we found the provider had made the required improvements.

Updated 14 September 2016

Letter from the Chief Inspector of General Practice

We carried out a desk top review of Pinhoe Surgery on 1 August 2016. This review was performed to check on the progress of actions taken following an inspection we made on 28 November 2015. Following that inspection the provider sent us an action plan which detailed the steps they would take to meet the breaches in regulation. During our latest Inspection on 1 August 2016 we found the provider had made the required changes.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published on 3 March 2016. This can be done by selecting the 'all reports' link for Pinhoe Surgery on our website at www.cqc.org.uk

Our key findings at this inspection were as follows:

• The practice had improved health and safety for patients by implementing robust arrangements for managing medicines, including vaccines, in regard of their recording, handling, storing and security.

• Improvements to patient safety had been made by ensuring robust arrangements were in place for Patient Group Directions. These had been adopted by the practice to allow nurses to administer medicines in line with legislation..

• The practice had improved health and safety for patients by implementing safe infection control procedures including an audit of all areas, updating the infection control policy and protocols. All clinical staff had training updates planned to reinforce the measures already taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice employed experienced nurse practitioners who ran chronic disease clinics.The Practice nurses had completed all levels of leg ulcer dressings and had good access to tissue viability specialists for support and guidance.

• The practice provided enhanced services for near patient testing including in-house International Normalised Ratio monitoring (INR). This reduced the burden on hospital clinic waiting times and providing a more cost-effective and convenient service for patients in their local health communities. This had proved very popular with patients prescribed warfarin as they could be tested and received their ongoing dose regime at the same appointment.

• Nurses were trained in the care of patients with indwelling intravenous lines used for prolonged treatments. For example, chemotherapy, long term antibiotics and intravenous feeding. Patients were normally required to go to hospital for management of this intravenous line. However, staff at the practice had completed extended training to enable patients to receive care locally, at the practice.

Updated 3 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 people who had a high number of A&E attendances. Immunisation rates were good for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. However, there was minimal health promotion information available for younger people to signpost them to support groups or provide them with information in areas that maybe specific to them. For example sexual health or chlamydia testing.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice always offered same day GP appointments to children when requested. There were after school appointments with a nurse for children and young people who need immunisations or asthma reviews.

• We saw good examples of joint working with midwives, health visitors and school nurses. A community midwife ran a weekly clinic from the practice. They had access to the clinical system and was able to liaise with GPs as required.

• Meetings were held with health visitors and school nurses every 6 months to ensure that information was appropriately shared and that any families at risk were identified and supported.

Updated 3 March 2016

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

• The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

• Comprehensive support was available for older people aimed at reducing the risks associated with social isolation and lowering unplanned hospital admissions. Home visits, if necessary were provided for frail people as well as rapid access appointments for those with enhanced needs. Named staff had link roles to adult social care homes to provide continuity of care and treatment for patients living there. The practice had frequent contact with community teams and participated in weekly meetings with other healthcare professionals to discuss any concerns. Innovative support systems were in place run through a charity set up and chaired by a senior GP at the practice. These included a befriending service, patient transport and access to the local day centre.

Updated 3 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.

Updated 3 March 2016

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

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

• It 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.

• It 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 people with mental health needs and dementia.

• Two depression and anxiety counsellors visited the practice weekly so that patients could get rapid access in a more convenient location.

Updated 3 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 people, and those with a learning disability. It offered longer appointments for people with a learning disability. There was a person centred approach, which ensured people with communication needs received information in a format that was most appropriate for them. The practice had completed 93% of annual health checks for people with a learning disability.

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

• It had told 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.