We carried out an announced comprehensive inspection at Chilcote Surgery on 22 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all domains, and all population groups as good apart from vulnerable people which we rated as outstanding.

We found that:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• 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 provided additional care and support for the vulnerable homeless population of Torquay through the provision of three GP and one nurse clinic a week at the local homeless centre.
• The practice had successfully identified 5.3% of its patient population as being carers and employed a carer support worker to help them accordingly.
• 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 practice offered improved access extended hours through working in partnership with the other practices across Torbay. These included weekend appointments.

Whilst we found no breaches of regulations, the provider should:

• Review the audit system in place for prescription pads and prescription papers.
• Review the process for monitoring the use of shared care high risk medicine to ensure these patients received monthly health checks.
• Ensure that dates for six monthly disposal were displayed on the disposable privacy curtains in use in most of the treatment rooms.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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 Chilcote Surgery. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 GP appointments available the same day using a Dr First system.
• 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.

We found areas of outstanding practice:

The practice was part of a local social prescribing scheme. This involved setting up a children’s hub in parts of Torquay with high levels of deprivation and large numbers of young families. This developed into supporting older people too. The practice involved the healthy lifestyle team. The practice provided support such as referrals to befriending services, walking groups, depression and anxiety services.

The practice had instigated an outreach programme to help Torbay’s homeless population. Providing four clinics a week at a local homeless hostel, the practice adjusted clinic times to be in line with the hostel’s breakfast club, in order to see more of these potentially vulnerable patients. The practice had carried out research which found average life expectancy in this group was 47 years and that these patients often suffer multiple complex medical conditions affecting their health. In the last 12 months the practice GPs and nurses had carried out over 1,000 consultations at these clinics. The homeless outreach programme worked closely with a weekly drop in session at a local church to provide medical care for vulnerable women.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Chilcote Surgery, is located close to Babbacombe in Torquay and provides services to 10,776 patients. A branch practice, Chatto Surgery is located about 10 minutes walk away. The practice has ground level access and is located on a main bus route making services accessible to people of all abilities. Both surgeries are registered with the Care Quality Commission with the registered manager having responsibility for both sites. Patients can see their preferred GP at either site.

We found the practice had taken steps to ensure their practice was safe for the patients it provided services to as well as to the staff employed there. There were systems in place to ensure effective patient care and we heard positive patient satisfaction with the services provided. Patients were cared for and treated with dignity and respect in an environment which was accessible and ensured their privacy. The practice was responsive in the way it provided services and responded positively to patient feedback. Appointments were available at times which suited the majority of patients, the practice used a very effective appointment system which placed the patient first. In the event of patients requiring to be seen urgently there was provision to accommodate their needs. Information was available for patients who required out of hours care on the providers website, in the practice and on their telephone system. The practice was well led by the registered manager, their partner GPs and nursing team. They were supported by a proactive practice manager and engaged staff team.

We talked with all staff employed in the practice who worked on the day of our inspection, this included four GPs and a locum GP, a practice nurse, a phlebotomist / health care assistant, the practice manager and six administrative staff. Two nurses from Torbay Hospital were also visiting the practice to carry out a national NHS screening programme. We spoke with 19 patients and received comment cards from a further 22 patients, this included speaking with three representatives of the patient consultation group of which there were about 600 members. The views expressed by these people about the practice were very positive with a collective view that patients were at the centre of the practice’s service delivery.

Our GP specialist advisor spoke with the GPs about the following patient groups, older people, people with long-term conditions, mothers, babies, children and young people, the working-age population and those recently retired, people in vulnerable circumstances who may have poor access to primary care and people experiencing a mental health problem.

They told us they recognised these groups as being important to the NHS and that they provided services to all of these groups. They provided us with examples of how they supported patients, these included, falls clinics for older people, prescribed fitness courses for people with long term conditions, weekly mother and baby clinics, extended working hours to support the working age population, clinics in a local homeless service four times a week, three clinics by GPs and one by a nurse for people in vulnerable circumstances, and working closely with the local crisis team to improve access to services for people experiencing a mental health problem.

The provider cited their flexible appointment system, working with the homeless organisation and their patient consultation group as being strong examples of their approach. Other examples included vaccination services, diabetes services, extended opening hours, and access to a GP of choice and gender through GPs providing services at two practice locations.