Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection report published

March 2015 – 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 Ide Lane Surgery on 14 November 2017. This was part of our scheduled inspection programme.

At this inspection we found:

• There were two areas where the provider could make improvements to infection control measures and information to patients about the complaint process.
• 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 and to meet the needs of the patient population registered at the practice.
• 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 continued to run a clinic providing effective treatment of leg ulcers, which also carried out preventative work with at risk patients to help avert the causes of leg ulcers.
• Inhouse developed IT systems continued to be used to identify and facilitate early intervention for patients at risk.

• The practice was one of only 12 research practices in the Southwest, supporting and recruiting patients for 36 research studies, 20 in a substantial way in the last three years.
• Staff were committed to working collaboratively using innovative and efficient ways to deliver more joined-up care to vulnerable patients who used services.

The areas where the provider should make improvements are:

• To review and update the infection control policy ensuring all aspects of the Code of Practice on the prevention and control of infections and related guidance are covered.
• To review the outcome letter sent following a complaint to include contact details and information about the Ombudsman service so patients are aware of how to escalate the complaint if they wish to.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Ide Lane Surgery was inspected on Tuesday 2 December 2014. This was a comprehensive inspection. Overrall we rated this practice as good

The practice provides primary medical services to people living in the area of Alphington, near Exeter and the surrounding areas. The practice provides services to a homogeneous population and is situated in a residential semi-rural location.

At the time of our inspection there were approximately 7,500 patients registered at the service with a team of four GP partners and three salaried GPs. There were four male and three female GPs. GP partners held managerial and financial responsibility for running the business. In addition there was a practice manager, a nursing team and 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.

Our key findings were as follows:

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

The practice valued feedback from patients and acted upon this. Feedback from patients about their care and treatment was consistently positive. We observed a patient centred culture. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Views of external stakeholders were positive and were aligned with our findings.

The practice was well-led and had a clear leadership structure in place whilst retaining a sense of mutual respect and team work. There were systems in place to monitor and improve quality and identify risk and systems to manage emergencies.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessment of a patient’s mental capacity to make an informed decision about their care and treatment, and the promotion of good health.

Suitable staff recruitment, pre-employment checks, induction and appraisal processes were in place and had been carried out. Staff had received training appropriate to their roles and further training needs had been identified and planned.

Information received about the practice prior to and during the inspection demonstrated the practice performed comparatively with all other practices within the clinical commissioning group (CCG) area.

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

Significant events, complaints and incidents were investigated and discussed. Learning from these events was communicated and acted upon.

The practice recognised the importance of patient feedback and had encouraged the development of a patient participation group (PPG) to gain patients’ views.

There were several areas of outstanding practice we identified. These included:

• The practice had responded to a complaint about leg ulcer treatment by setting up a specialist leg ulcer clinic with trained nursing staff. Not only does this clinic provide effective treatment of leg ulcers but it carries out preventative work with patients to help avert the causes of leg ulcers. The practice was targeting patients with a potential to develop leg ulcers.

• A GP at the practice had developed a computer software package which identifies whether patients currently taking anti-psychotic medicines have stopped taking them. This allowed GPs to arrange timely and successful interventions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit to the surgery we spoke with three patients, two of the eight GPs and a GP registrar, the practice manager, three of the seven practice nurses, an administrator and the chairperson of the PPG (Patient Participation Group).

Patients expressed satisfaction with the service they had received. One patient said "the GP takes time to explain so it is simple and understandable." Another patient said "I’ve been coming to this surgery for many years and to date I’ve never had any problems, excellent surgery". They told us they had a good service when they telephoned for an appointment and were given a slot at a convenient time. Another patient told us the practice had "always been excellent" and they "the nurses are lovely, I’m a regular". They said that the receptionists were polite and helpful. They told us they could see a doctor of their preference.

Patients were referred to other healthcare services when required. The provider maintained detailed consultation notes in order to ensure patients received appropriate care and treatment that met their needs in a timely way.

People's privacy, dignity and independence were respected. People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People who used the service told us that the GP explained treatment options and they felt involved and able to make informed choices. Records reflected this. One patient said "The doctor and I discussed my options and I got a choice of treatment options with the risks and benefits explained to me".

Staff were clear about what action they would take if they saw or suspected any bad practice or abuse. Staff had been given information and received formal training in this area.

There were effective systems in place to monitor the quality of the service provided and patients felt able to give feedback about the service they received which was listened to and acted upon.