Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection October 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at 9 January 2018 as part of our planned inspection programme.

At this inspection we found:

• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• 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 was above average for its satisfaction scores on consultations with GPs and nurses. For example, 99% of patients who responded said the GP was good at listening to them compared with the clinical commissioning group (CCG) average of 93% and the national average of 89%.
• There was an active patient participation group and a separate Friends of Redfern Centre (FORC) fund raising support group. The practice provided these groups with rooms and refreshments for their quarterly meetings.

We saw areas of outstanding practice:

• The practice had set up a co-ordinated care arrangement with the local food bank to support the most deprived members of the practice population. The local food bank provided the practice with food bank vouchers. The practice then made informed decisions to provide these food bank vouchers to those patients most in need. This had a positive impact on approximately 1% of the practice population, providing healthy nutritious meals and essential supplies for these patients and their families.
• The practice provided a wide range of portable technological devices to patients for home use and for use at the practice. These included heart monitors, blood pressure monitors, a spirometer (used to monitor lung function) and audiometers (used to monitor hearing). The benefit and positive impact on patients from these devices enabled accurate diagnosis and also reduced the inconvenience to patients of having to make a 50 mile round trip to Derriford hospital for a specialist referral for any conditions relating to these monitoring devices. Using these technological devices had a positive impact on approximately 300 patients, which was approximately 6% of the practice population.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Redfern Health Centre was inspected on Wednesday 1 October 2014. This was a comprehensive inspection.

Redfern Health Centre provides primary medical services to people living in the town of Salcombe, Devon and the surrounding areas. The practice provides services to a homogeneous population group and is situated in a rural location.

At the time of our inspection there were approximately 4,450 patients registered at the service with a team of three GP partners. GP partners held managerial and financial responsibility for running the business. In addition there were three state registered nurses, a phlebotomist, a practice manager, and seven administrative and reception staff.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

We rated this practice as good.

Our key findings were as follows:

The practice was clean, well organised, had well maintained facilities and was well equipped to treat patients. There were robust infection control procedures in place. Patients had relatively easy access to appointments at the practice and liked having a named GP which improved their continuity of care.

Feedback from patients about their care and treatment was positive. The practice encouraged a non-discriminatory, patient centred culture. Practice staff were trained and experienced. They provided compassionate care to their patients. External stakeholders were very positive about the practice.

The practice was well-led and had a clear leadership structure in place. Checks were in place to improve quality and identify risk and systems to manage emergencies.

Patient’s needs were assessed and care planned and delivered in line with current legislation. This includes assessment of a patient’s mental capacity to make decisions about their care and treatment, and the promotion of good health.

Recruitment of staff, pre-employment checks, induction and appraisal processes were effective. Staff had received training appropriate to their roles and further training needs had been identified and planned.

Information about the practice provided evidence that the practice performed comparatively with all other practices within the clinical commissioning group (CCG) area.

Patients felt safe in the hands of the staff and confident in clinical decisions made. There were effective safeguarding procedures in place.

Evidence showed that significant events, complaints and incidents were investigated. Improvements made following these events were discussed and communicated with staff.  

Staff told us homeless patients could access the practice as there was no requirement for patients registered at the practice to have a fixed home address.

We saw an area of outstanding practice:

• The practice provided joint GP and health visitor appointments for mothers with babies. This joined up approach enabled effective care of mothers and their babies, direct joint working between health professionals promoted an holistic approach and provided a convenient service to mothers with babies who would otherwise need separate appointments to see either a GP or a health visitor.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice