The Heavitree Practice

Updated 6 May 2016

The Heavitree Practice is situated in Exeter, close to the University campuses and major hospitals. The city has good public transport facilities and there is parking at the practice. There were 7288 patients registered with the practice on the day of our inspection. Approximately 7% of the list are students and 8% of patients are aged over 75 years.

There are five GP partners and one salaried GP. Four of the GPs are female and two are male. Four nurses are employed at the practice, one health care assistant and one phlebotomist (a staff member trained to take blood). The clinical team is supported by a practice manager, deputy practice manager and administration/reception staff.

The Heavitree Practice is a teaching and training practice for medical students and qualified Doctors training to become GPs.

The practice opens for appointments between 8am and 6pm Mondays to Fridays. In addition there are appointments until 7.30pm on alternative Thursdays. Pre-bookable early morning appointments are available on Mondays, Wednesdays and Thursdays from 7.40am.

Outside normal surgery hours the practice had an arrangement with the Devon Doctors on-call service. This service has an out-of-hours treatment centre where GPs see patients if requiring urgent medical care. For advice or treatment when the practice is closed, patients were directed to the NHS Direct 111 telephone service.

All regulated activities were provided from one location:

Heavitree Health Centre

Exeter

Devon

EX1 2RX.

Updated 6 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Heavitree Practice on 17 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice was part of a pilot site for a pre-diabetic education project overseen by a local charity. The aim was to support patients and provide lifestyle education for patients recently diagnosed with or at risk of developing type two diabetes.
• The practice had been part of 11 clinical research projects over the last two years. A current project involved identifying patients who may benefit from targeted exercises following a stroke to improve recovery.
• Information about patients’ outcomes was used to make improvements; such as identifying patients with osteoporotic vertebral fracture as part of a pilot research project and then offering these patients focused physiotherapy rehabilitation courses.
• 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.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, the practice benefitted from support services provided by the Friends of Heavitree Health Centre charity, which provided volunteer transport services for patients to secondary care health appointments.
• The Friends of Heavitree Health Centre charity, based within the practice, also offered Tai Chi classes, shopping trips and social activities, which had reduced social isolation of vulnerable patients.
• Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice offered pre-bookable early morning appointments from 7.40am on three mornings a week and evening appointments until 7.30pm on alternate Thursdays for working patients who could not attend during normal opening hours.
• 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 sought feedback from staff and patients, which it acted on.
• The practice worked in partnership with a local charity offering work placements to people who had learning disabilities and/or long term health conditions. Staff told us this helped them learn about the health and wellbeing needs for patients in the wider community and those registered at the practice with similar conditions.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice was an early initiator of the implementation of the NHS accessible information standard, which organisations must follow by 31 July 2016. The standard was intended to ensure that patients who have a disability, impairment or sensory loss get information that they can access and understand, and receive any communication support that they need. The practice had ensured progress by ensuring that the accessible information standard was discussed at all patient participation group, practice whole team and Exeter practice managers’ meetings.

The areas where the provider should make improvement are:

• Include emergency medical equipment instructions in trainee GP staff induction sessions.
• The practice should continue to review prescription pad security to ensure new processes are followed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 May 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.

• Nursing staff had received specialist training in order to offer a full leg ulcer dressing service.

• Performance for diabetes related indicators, such as the percentage of patients on the diabetes register with a foot examination and identification of further risk through developing diabetes associated complications within the preceding 12 months was 95%. This was better than the national average of 88%.

• 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 was part of a pilot site for a pre-diabetic education project overseen by a local charity. The aim was to support patients and provide lifestyle education for patients recently diagnosed with or at risk of developing type two diabetes.

Updated 6 May 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 who were at risk, for example, children and young people who had a high number of A&E attendances.

• Immunisation rates were relatively high for all standard childhood immunisations in line with the local CCG averages.

• 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.

• The practice’s uptake for the cervical screening programme was 77%, which was comparable to the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors. Midwife clinics were held in the practice.

• Same day appointments were available for children.

Updated 6 May 2016

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

• The practice offered personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments for those with enhanced needs.
• The community matron and the district nurses shared premises with the practice. This meant communication between the practice and community nursing services was easily facilitated; ensuring patients current needs were regularly discussed.
• The practice completed care plans for patients who had unplanned hospital admissions to ensure needs were met post-hospital admission.

Updated 6 May 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 offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice had a GP who worked closely with students based at the nearby University campus and provided accommodation for student counsellors.

• Extended opening times were available three mornings a week from 7.40am and alternate Thursday evenings until 7.30pm for the convenience of working patients.

• Patients could self-check their blood pressure and women could complete a contraceptive pill health check without needing an appointment. Results were forwarded to their GP for review/follow up.

Updated 6 May 2016

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

• 91% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which compared favourably to the national average of 84%.
• Performance for mental health related indicators better than the national average. For example, 100% of patients with severe mental illnesses had a care plan agreed with the patient in the preceding 12 months. The national average was 88%.
• 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.
• The practice had told 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 and the practice was a member of Dementia Action Alliance; a charitable organisation with the aim of enabling people to live well with dementia and reduce the risk of crisis intervention. Practice staff had received ‘Dementia Friends’ training to be more skilled in supporting patients who had dementia.

Updated 6 May 2016

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

• The practice held a register of patients living in vulnerable circumstances including, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, the practice benefitted from support services provided by the Friends of Heavitree Health Centre charity, which provided volunteer transport services for patients to secondary care health appointments.
• The Friends of Heavitree Health Centre charity, based within the practice, also offered Tai Chi classes, shopping trips and social activities, which had reduced social isolation of vulnerable patients.
• 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.
• Specialist nurse appointments, such as for blood monitoring or on-going medicines via injection were pre-bookable up to eight weeks in advance.
• The practice worked in partnership with a local charity offering work placements to people who had learning disabilities and/or long term health conditions. Staff told us this helped them learn about the health and wellbeing needs for patients in the wider community and those registered at the practice with similar conditions.
• The practice was an early initiator of the implementation of the NHS accessible information standard, which organisations must follow by 31 July 2016. The standard is intended to ensure that patients who have a disability, impairment or sensory loss get information that they can access and understand, and any communication support that they need.