Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cricketfield Surgery on Wednesday 27 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, safe, effective, caring and responsive services. We found the practice was good for providing services for patients with long term conditions, families, children and young people, working age people (including those recently retired and students), People experiencing poor mental health (including people with dementia) and patients who are considered vulnerable. We found the practice was providing outstanding services for older people.

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. The process of managing and learning from complaints and incidents was effective.
• Risks to patients were assessed and well managed. This included clinical risk and environmental risks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance including robust templates to guide staff.
• 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 could make a same day appointment but sometimes found it hard to get through on the telephone and make advance appointments at a time that suited them and hard to get an appointment with a GP of choice. The practice were aware of this feedback and had introduced ways to improve the system and get further feedback from patients.
• 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 saw areas of outstanding practice:

The nursing team had been proactive in conducting clinical audits of the care they provided.

The GPs had used and developed the computer system to improve patient care by introducing prompts which triggered the use of National Institute for Health and Care Excellence (NICE) guideline templates. One example had been introduced following a significant event and included the use of one of the NICE templates for treatment and diagnosis of children and babies with high temperature. The GPs had developed the computer system to include the NICE traffic light assessment and automated referral letters. The system also prompted staff to give parents the NHS Sepsis assessment and management (SAM) leaflet and UK Sepsis leaflet which gives guidance and advice on sepsis. This template had been identified by NHS England as good practice and was being shared with other practices.

Care of older people was outstanding. This can be demonstrated by:

• The practice had been instrumental in the development of a ‘1 care home, 1 practice’ model in Newton Abbot. The model allocated a designated GP who cared for the majority of residents in a named care home which meant the GP were able to offer regular review visits and develop strong relationships with the residents, managers and staff. The named GP for a care home for people with severe dementia often visited during quieter periods to give more time to the residents. She had given talks to relatives regarding the Mental Capacity Act and Best interest decisions. We spoke with two care home managers who were part of this initiative. One manager said they had found the GP and service ‘extremely supportive’ and ‘beneficial’ for residents with dementia who were able to see ‘the same face’ each time. Another care home manager described their relationship with the GP as ‘absolutely wonderful’ and said the residents were familiar to the GP and that the GPs approach to care of the elderly was ‘second to none’.

• The practice were taking part in a pilot project led by Age UK Devon whereby a health and wellbeing worker was based within the practice to work with their ‘pre-frail’ population, using guided conversations and signposting to voluntary sector services to help improve patients sense of health and wellbeing.

• One of the GPs had developed and ran the Newton Abbot Frailty Service, a multi-disciplinary team providing intensive input for particularly frail and vulnerable patients in the locality to enable them to remain at home. The service offered both pro-active and emergency input similar to that offered in the monthly multidisciplinary team meetings but at a much more intensive level. Other GPs in the practice frequently referred patients to this service.

• The practice were also actively involved in the locality ‘8-8 initiative’, whereby local Newton Abbot GPs had been providing out of hours cover on the weekend for the top 2% most frail patients. The GPs had collaborated so that all the local GPs involved in this have access to the other practice’s computer databases, so were much more informed about the patients they were seeing, than Devon Doctors (the out of hours service provider) would be.

However there were areas of practice where the provider needs to make improvements.

The provider should:

Introduce a recruitment policy for staff to follow when recruiting clinical and non-clinical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Cricketfield Surgery is a GP practice providing primary care services for people in and around Newton Abbot, Devon. The team of eight GPs and one trainee GP provide medical care at the practice supported by nurses and administrative staff on weekdays from 8am.  The practice closes at 6pm Wednesday to Friday. Alternate Mondays and every Tuesday appointments booked in advance are available from 6.30pm to 8.30pm. The phone lines open daily at 8:30am. Outside of these hours patients are advised to contact an Out of Hours service, which is delivered by another provider. 

During our visit we spoke with 12 patients who were using the practice. Four GPs were working on the day of our visit and we spoke with three of them. We also spoke with two nurses, one health care assistant and seven administrative staff including the practice operations manager and the practice business manager.

The practice was supported with the continuity of patient care through established working relationships with other agencies and services. This included a local agreement for sharing of patient records, for example, between the practice and the local hospital.

There were several areas where improvements must be made in relation to the management of the practice.  These related to assessing and monitoring quality of the service delivered and management of medicines and staff recruitment.

The practice had a higher proportion of older patients registered than the national average. Staff demonstrated competence in dealing with the health issues associated with old age. GPs had achieved the requirement for practices from April 2014, as part of the GP contract changes for 2014-2015, to ensure that each patient on their practice list aged 75 or over was assigned a named, accountable GP.

GPs and nurses provided routine appointments for the monitoring and treatment of patients with long term conditions. The practice provided family planning and maternity services such as post natal checks for mothers as well as children’s immunisations. Midwifery services were provided by the community midwifery team, accessed through the practice. Young people were able to access sexual health screening, advice and support from the GPs and nurses. Health checks were offered to patients between 40 to 75 years of age. The practice had working relationships with mental health teams to enable continuity of care and support for patients of all ages who may have mental ill health.

Cricketfield Surgery is a GP practice providing primary care services for people in and around Newton Abbot, Devon. The team of eight GPs and one trainee GP provide medical care at the practice supported by nurses and administrative staff on weekdays from 8am.  The practice closes at 6pm Wednesday to Friday. Alternate Mondays and every Tuesday appointments booked in advance are available from 6.30pm to 8.30pm. The phone lines open daily at 8:30am. Outside of these hours patients are advised to contact an Out of Hours service, which is delivered by another provider. 

During our visit we spoke with 12 patients who were using the practice. Four GPs were working on the day of our visit and we spoke with three of them. We also spoke with two nurses, one health care assistant and seven administrative staff including the practice operations manager and the practice business manager.

The practice was supported with the continuity of patient care through established working relationships with other agencies and services. This included a local agreement for sharing of patient records, for example, between the practice and the local hospital.

There were several areas where improvements must be made in relation to the management of the practice.  These related to assessing and monitoring quality of the service delivered and management of medicines and staff recruitment.

The practice had a higher proportion of older patients registered than the national average. Staff demonstrated competence in dealing with the health issues associated with old age. GPs had achieved the requirement for practices from April 2014, as part of the GP contract changes for 2014-2015, to ensure that each patient on their practice list aged 75 or over was assigned a named, accountable GP.

GPs and nurses provided routine appointments for the monitoring and treatment of patients with long term conditions. The practice provided family planning and maternity services such as post natal checks for mothers as well as children’s immunisations. Midwifery services were provided by the community midwifery team, accessed through the practice. Young people were able to access sexual health screening, advice and support from the GPs and nurses. Health checks were offered to patients between 40 to 75 years of age. The practice had working relationships with mental health teams to enable continuity of care and support for patients of all ages who may have mental ill health.

We reviewed the information available to us about Cricketfield Surgery on 25 April 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.