Cheriton Bishop & Teign Valley Practice

Updated 24 September 2015

Cheriton Bishop & Teign Valley Practice was inspected on Wednesday 15 July 2015. This was a comprehensive inspection.

The main practice is situated in the rural village of Cheriton Bishop, Devon and had a branch surgery in the village of Christow. We did not inspect the branch surgery on this occasion. The practice provides a primary medical service (PMS) across 80 miles to just under 5000 patients of a diverse age group. The practice are a training practice for doctors who are training to become GPs, for junior doctors and for medical students.

There was a team of two GP partners, two salaried GPs and one GP registrar. Partners hold managerial and financial responsibility for running the business. There were two male and three female GPs. The team were supported by a practice manager, two practice nurses, two health care assistants and administration staff.

Patients using the practice also had access to a community matron, district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

The practice is open from Monday to Friday from 8am to 6pm. Appointments are available between these times and could be booked up to six weeks in advance. There is a walk in appointment system each weekday morning. Tuesday evening routine appointments until 8pm are available for people unable to access appointments during normal opening times. GPs also offered patients telephone consultations, ring backs and performed home visits where appropriate.

The practice had opted out of providing twenty four hour services to their own patients and when closed referred them by answer phone message to an out of hours GP provider.

Updated 24 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cheriton Bishop & Teign Valley Practice on 15 July 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing responsive and caring services. It was good for being safe, effective and well led. It was outstanding for all six population groups.

Our key findings across all the areas we inspected were as follows:

• 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 were involved in decisions about their treatment. Information was provided to help patients understand the care available to them.
• Patients’ needs were assessed and care was planned and delivered following current guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• The practice worked closely with other organisations, charities and with the local community in planning how services were provided, to ensure that they meet patient need.

• The practice had implemented improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG).

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as the top priorities. A business plan was in place, this was monitored regularly and reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

Unannounced role play training had been additionally provided for staff to practice and review their response and skills when dealing with emergencies.

The practice reached out to the community and supported and worked in partnership with a local charitable community support service (ACORN). The practice offered office space and resources to this charity who provided transport and prescription delivery in a rural area and offered services such as lunch clubs, coffee mornings and trips to the supermarket which reduced social isolation. The practice invited the coordinator of Acorn to the monthly multidisciplinary team meetings where the pastoral care, equipment provision and monitoring of vulnerable patients was coordinated.

The practice was exceptionally caring. Patients said that staff went the extra mile and the care they received exceeded their expectations, this was in line with the practice track record of consistently being above national average data scores for patient care and treatment. Patients repeatedly referred to the service as being caring, respectful, exceptional, efficient and outstanding and shared many examples which supported that staff had gone above and beyond what was expected.

Patients described the practice as being very responsive to their needs. Services were tailored to meet the needs of patients and were delivered in a way to ensure flexibility, choice and continuity of care. This responsive service had resulted in excellent survey results and significantly lower Accident and Emergency attendance rates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 September 2015

The practice is rated as outstanding for the care of people with long-term conditions.

The practice ensured annual checks, follow ups and reviews were offered at a time of the patient’s choice. The nurses ran chronic obstructive pulmonary disease (COPD), asthma, diabetes, and leg ulcer clinics and had equipment to assist with diagnosis and monitoring, such as spirometers and doppler machines.

There were also recall systems for chronic disease and treatment monitoring investigations such as arthritis and long-term mental health. Patients prescribed medicines for long term conditions had regular medicine reviews to ensure they were receiving a therapeutic dose. The dispensary team flagged up any overdue medicine reviews to the GPs so that none were missed. The dispensary team also monitored for any over or under use of medicines which would then be communicated to the GPs.

Patients with long term conditions were always reviewed following discharge from hospital. This was undertaken by the usual GP either by phone or visit. Appropriate information was uploaded to the OOH computer system.

The practice actively promoted health education about long term conditions and encouraged self-help; they performed well in all vaccination schemes.

The practice maintained an up to date carers’ register, invited carers annually for a health check and linked them to the practice carer support worker.

Updated 24 September 2015

The practice is rated as outstanding for the care of families, children and young people.

Antenatal clinics were held in the practice and the GPs worked closely with the midwives. There was good communication with midwife and health visitor during the antenatal and postnatal period.

There were alerts and systems in place for the patient’s GP to contact or visit in the immediate post-natal period.

There was a health visitor based at the practice; this meant that there was effective communication with the health visitor regarding children and families with on-going problems. The health visitor was involved with children of all ages and not just those under five years old.

There was an effective recall system and follow up regarding childhood immunisations and catch up immunisations. Immunisation rates had been consistently good over the last two years.

Young patients were actively and sensitively encouraged to partake in chlamydia screening, with information available in the treatment rooms and on the website.

The practice had improved access to this group with the on-line booking and prescription service.

Safeguarding systems were in place and discussion at clinical meetings for on-going problems occurred monthly and whenever required.

Updated 24 September 2015

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

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients.

Patients were allocated a named GP upon registration but were able to choose whom they felt most comfortable as their usual GP. The practice fostered an ethos of continuity of care and as such encouraged patients to see their usual GP. There was a practice policy for patients to be seen or spoken to on the day, if possible, with their usual GP.

There was a register of vulnerable older patients who were at risk of admission to hospital. This was populated by internal practice discussion and use of a risk stratification tool. If older patients were at risk of admission, they had a care plan of on-going wishes and care needs. Patients then consented to relevant information being added to the software system, so GPs they saw out of hours (OOH)could provide continuity of care. There was a monthly multi-disciplinary team (MDT) meeting to discuss older patients most at risk, such as those with on-going problems or who had been admitted or discharged from hospital. Patients who had been in hospital were highlighted for an early GP review. The local care home said the GPs visited any patient who had been discharged from hospital without prompting.

The practice worked with the local hospice. Patients in need of palliative care had care plans and were discussed at MDT meetings. These care plans were also added to the OOH system, which promoted continuity of care. The practice aimed to care for patients at home where possible and worked with the primary health care team to achieve this. The GPs sometimes visited end of life patients at weekends to offer continuity of care and reassurance.

All older patients on regular medication had an annual review of their health including a dementia screen. This was prompted by their medication review date and followed up by the dispensary team too. The dispensary team alerted the GPs to patients who were over-due a review. Other patients were picked up opportunistically if they attended the practice.

The practice worked proactively with Acorn, a charitable local community support service. The practice invited the coordinator of Acorn to monthly MDT meetings where the pastoral care, equipment provision and monitoring of vulnerable older patients was coordinated. The result of this integration provided older patients with social support, reduced isolation, and offered transportation of patients to both medical and social appointments thus promoting their health and well being. Geographically isolated older patients could have their prescriptions delivered.

The local care home had been given a named GP for all patients to aid continuity. The care home were very complimentary about the prompt, caring and respectful service the practice provided.

The practice used specific templates for older person health checks that prompted a falls assessment, dementia screen, carer details and offered carers wellbeing/health checks.

Updated 24 September 2015

The practice is rated as outstanding for the care of working-age people.

The practice population group included a large group of patients who work or attend schools and colleges. There was also a retirement complex of mobile homes in a nearby village.

The practice offered a walk in clinic from 8am Monday to Friday and also late nights 6.30 - 8.pm on Tuesday evenings.

Patients were also able to contact the practice by e mail to gain advice regarding minor issues. The practice actively promoted health checks opportunistically in this age group.

Access to prescriptions was either arranged at the practice or a pharmacy of the patient’s choice. Systems were in place to enable prescriptions to be picked up out of standard practice hours at a number of other locations.

.

Updated 24 September 2015

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

The practice told us they had a relatively low prevalence of patients with severe mental illness. The GPs had a good working relationship with the local psychiatrist, had access to rapid telephone support and had a detailed mental well-being resource directory, so staff could easily access relevant services. The practice staff also worked with and referred patients to other agencies, such as alcohol services and mental health crisis teams, and encouraged use of the practice for appointments as required. The GPs ensured continuity of support for this patient group with an active recall system to ensure both mental and physical monitoring and reviews occurred regularly.

The practice worked with an allocated depression and anxiety service worker who visited the practice each week to provide any intervention needed.

The practice had a relatively high dementia detection rate among the elderly population. The GPs were linked to the memory team in Crediton and worked alongside the community psychiatric nurses and dementia support workers. There were systems in place to maintain regular reviews of patients with dementia to ensure physical mental and social factors were monitored and then linked to appropriate services. The practice referred patients to the village memory café which was run by the charity Acorn. Patients with increasing needs were linked to the complex care team.

Updated 24 September 2015

The practice is rated as outstanding for the care of working-age people.

The practice population group included a large group of patients who work or attend schools and colleges. There was also a retirement complex of mobile homes in a nearby village.

The practice offered a walk in clinic from 8am Monday to Friday and also late nights 6.30 - 8.pm on Tuesday evenings.

Patients were also able to contact the practice by e mail to gain advice regarding minor issues. The practice actively promoted health checks opportunistically in this age group.

Access to prescriptions was either arranged at the practice or a pharmacy of the patient’s choice. Systems were in place to enable prescriptions to be picked up out of standard practice hours at a number of other locations.