Letter from the Chief Inspector of General Practice

This inspection of Ashburton Surgery was an announced focused inspection carried out on 12 October 2017 following information of concern provided by patients and also to confirm that the practice had carried out their plan to meet the areas requiring improvement that we identified in our previous inspection on 9 February 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The overall rating for the practice at the announced comprehensive inspection in February 2016 was good. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Ashburton Surgery on our website at www.cqc.org.uk.

At this inspection in October 2017 we looked at the Safe, Effective and Responsive domains.

Overall the practice is still rated as good overall.

The information received from patients included information about clinical care and care of patients with mental illness. We also looked at the areas requiring improvement set at the last inspection in February 2016 relating to record keeping for complaints and significant event processes. We also looked at the areas requiring improvement regarding the assessment of dispensary staff competencies and management of expiry dates on dispensary medicines.

Our key findings this inspection in October 2017 at were as follows:

• There continued to be an open and transparent approach to safety and a system in place for reporting and recording significant events. Significant event records continued to be clear but had been further improved to reflect more of the detail of discussion, action and learning that had taken place.
• Information about services and how to complain was available. The practice continued to maintain a complaints register and reviewed this regularly. Further improvements had been made to the annual complaints review register to reflect the outcome and learning that had taken place.
• Patients we spoke with said the care and service provided was excellent and found the staff professional, caring and attentive.
• Procedures and processes had been reviewed in the dispensary, which reflect national guidelines.
• Further systems to monitor safety and quality assurance in the dispensary had been introduced by the practice.
• The practice continued to use the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes. Mental health indicators between 2015 and 2016 were higher than local and national averages. Patients with mental illness were cared for in a sensitive, effective and responsive way. Systems were in place to monitor the physical and mental healthcare needs of this population group. Staff worked effectively with external healthcare professionals and referred patients to other services in a timely way.
• Records kept relating to patients were contemporaneous and contained detailed information of clinical action or treatment made and included a thorough assessment of the patients concerns and management plan.
• The practice was actively participating in research projects
• Since the last inspection, the practice had promoted the online services at the practice and had achieved a high number of patients signing up to online services For example, 39.8% of patients had signed up to online services.

We saw one area of outstanding practice:

• Practice staff encouraged seeking out and embedding new ways of providing care and treatment. For example, staff wanted to respond to a measles outbreak in the local community but acknowledging practice childhood immunisation rates were lower than national averages due to the alternative lifestyles of significant numbers of parents in the locality. Practice staff, in accordance with NHS E guidance, had targeted patients over the ages of 16 to receive an MMR (measles, mumps and rubella) vaccination to boost immunity in the community. The practice had so far immunised 319 patients (with two vaccines each).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashburton Surgery on Tuesday 9 February 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.

• 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.

• GPs at the practice made weekly visits to a local care home. This provided continuity of care, and developed strong relationships with the residents, managers and staff.

• Clinical risks to patients were assessed and well managed.

• The practice was a small practice and the staff knew patients well, and were familiar with their family situations, those who were socially isolated, and those who were carers. This enabled staff to recognise that something may be wrong at an earlier stage.

• 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.

• Staff said Ashburton surgery was a good place to work.

• Patient feedback was consistently good. 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 named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice provided proactive management for potential health crises, for example, patients with chronic obstructive pulmonary disease (COPD) had home action plans/rescue packs to assist them to recognise any deterioration in their condition.
• 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.

The areas where the provider should make improvement are:

• Review the competency assessment for dispensary staff to ensure it covers all aspects of the Dispensary Services Quality Scheme

• Ensure the records kept of significant events reflect the investigation, action and learning that took place.

• Review systems are in place to ensure that the process of monthly expiry checks in the dispensary are performed

• Ensure the complaints register reflects the outcome and learning that takes place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The Ashburton Surgery is located at 1 Eastern Road, Ashburton, Newton Abbot, Devon,TQ13 7AP. The practice provides health advice and treatment as well as referrals to other care agencies where necessary. The practice is open from 8:30am until 6pm Monday to Friday. A late evening surgery is available one evening a week for patients that find it difficult to visit the GP, nurse practitioner and nurse during the day. At weekends and when the practice is closed, patients are directed to the Out of Hours service delivered by another provider.

The practice has five GPs, a nurse practitioner, a practice nurse, an assistant practitioner and three phlebotomists (a person qualified to take blood). The GPs and nursing staff are supported by a team of administrative staff. They look after more than 6,000 patients in a rural area.

Staff were trained to support and work with vulnerable adults and children. There was appropriate equipment, medicines and procedures for managing patient emergencies. Staff were aware of policies and procedures for reporting serious events, accidents, errors, complaints, and for safeguarding patients at risk of harm. Incidents were investigated and acted on, and learning was shared with staff. Effective infection control measures were in place.

Patient care was delivered in line with best practice. Systems were in place to ensure the service was monitored and ways for improving the service for patients were explored. Systems were in place for recruiting new staff. The practice worked with other healthcare providers to ensure patients received effective care. Patients were offered advice, treatment and support for their health.

Patients described the staff as helpful and friendly. The receptionists had a warm and friendly approach to patients and visitors. They knew and understood the needs of patients who attended the practice regularly and their approach was kind. Patients told us they were involved in decisions about their treatment.

Patients were able to access the care they needed promptly and efficiently. The practice had systems to enable patients’ views to be listened to and acted on. Arrangements were in place to help the practice meet the demand and needs of patients with minimal delay. Staff told us they had access to appropriate equipment to attend to patient needs. Staff were aware of arrangements for responding to medical emergencies. The practice was accessible to patients with mobility difficulties and those with young children.

 A leadership structure and processes were in place to keep staff informed of any changes. The GPs and practice manager regularly reviewed complaints and significant events, to maintain and improve patient care. Staff felt valued and well supported. They were able to give their views on any improvements. The practice had responded to patients’ views and patients gave positive feedback about the care provided.