Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingsteignton Medical practice on 24 June 2015.

Overall the practice is rated as outstanding.

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

• There was a strong commitment to providing co-ordinated, responsive and compassionate care for patients, particularly older people who are frail and at risk of social isolation.
• Urgent appointments were available the same day but not necessarily with a GP of the patient’s choice.
• The practice had good facilities including disabled access and recognised there were areas of the building which could be improved in consultation with disabled patients. Signage was improved immediately following the inspection.
• Information about services and how to complain was available. The practice actively sought patient views about improvements that could be made to the service and worked with the patient participation group (PPG) to do this.
• The practice proactively sought to educate their patients to manage their medical conditions and improve their lifestyles. Additional in house services were available and delivered by staff with advanced qualifications, skills and experience.
• There were systems in place to reduce risks to patient safety for example, infection control procedures.
• Patients’ needs were assessed and care was planned and delivered following current practice guidance. Staff had received training appropriate to their roles.
• The practice used audits and had shared information from one of their audits with other practices to promote better patient outcomes.

We saw areas of outstanding practice:

• The practice had a strong vision which had quality and effective care and treatment as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles and with external agencies.

• The practice had been proactive in recognising the pressures on the NHS and adult social care services. The practice was one of six in the Newton Abbot area taking part in a community pilot hub, which will influence future national policy thinking. The aim of the community hub was to provide a ‘one stop shop’ to reduce inequality and increase patient support so patients are able to better manage their conditions. Kingsteignton Medical Practice had taken this concept further by setting up a charity called Kingscare, which is chaired by a GP partner. The practice provided accommodation for the charity so that patients had immediate and easy access to the support it provided. This included information, support and social activities for vulnerable patients living in the community. For example, older patients with limited mobility and unable to use public transport were offered transport assistance for hospital and GP appointments in a specially adapted vehicle.  A minibus had also been purchased through fundraising and used for group outings which staff at the practice were involved in. Over 300 patients are supported each year by this service.

• All staff were actively engaged in activities to monitor and improve quality and health outcomes for people. GPs held advanced qualifications and had expertise to deliver in house monitoring and treatment normally provided at hospital. Data showed that the practice referral rates to hospital were significantly lower for patients with respiratory, endocrinology, cardiac and diabetic care and treatment. Patients with heart disease were benefitting from the expertise of a GP working part time in the hospital cardiology service. Cardiac monitoring and initiation of treatment regimes were done in house.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Kingsteignton Medical Practice is a GP practice providing NHS primary care services for approximately 10,663 patients. The practice is in the town of Kingsteignton in Devon. The practice has a total of nine GPs who are supported by a nursing team and an administrative team. Opening hours are between 8am to 6pm Monday Friday. The practice provides extended opening hours on Monday, Wednesday and Fridays with pre bookable appointments from 7.00 am. Outside normal surgery hours the emergency cover is provided by a Out of Hours service.

Kingsteignton Medical Practice has one location at The Surgery, Whiteway Road, Kingsteignton, Devon TQ12 3HN. We carried out our announced inspection on Wednesday 9 July 2014 of the practice .

Before the inspection, we asked other organisations to share what they knew about this practice. We looked at information from NHS England, South Devon and Torbay Clinical Commissioning Group (CCG), Torbay Healthwatch and the local Health and Scrutiny Board. We talked with 14 patients on the day of our inspection and they were all satisfied with the standard of care, service and treatment they received at the practice. A further 26 patients gave written feedback in comment cards and by email. Patient comment cards were very positive with a recurring themes of safe, effective and responsive care. Staff were said to be kind and caring.

Older patients told us the practice was caring, responsive and attentive to their needs.

Patients with long term conditions highlighted the many clinics held at the practice. Patients talked about feeling involved in their care and treatment and were able to make choices about their care and had been given suitable advice.

Mothers and babies and young patients were pleased with the care and treatment their families received. Parents told us their care and that of their children was thorough at the practice.

Patients of working age population or those recently retired felt recent changes to the appointments system meant it was easier to see a GP when it suited them.

Patients in vulnerable circumstances who may have had poor access to primary care were closely monitored by the practice team. Initiatives such as the partnership with a local patient support group provided patients with additional support when needed. This included assistance with transport, befriending and help with shopping or collecting medicines. Patients experiencing mental health problems told us they felt listened to and supported when they most needed help. Carers of relatives with dementia type illness told us the day to day challenges of this role were recognised and the team at the practice were proactive in offering them support.

Based on patient experiences at Kingsteignton Medical Practice, we concluded the practice was well led, with clear leadership and governance structures in operation. Patients told us they felt the practice was safe, caring and responsive. The practice was effective in the way it provided care to patients. Information we saw and comments we received demonstrated good working relations with other health professionals, organisations and local authorities. Supporting data and documentation we reviewed about the practice demonstrated the practice performed very well when compared with all other practices within the CCG area.

There were two areas for improvement, these relate to risk assessment of administrative staff who may be involved in chaperone duties and access to Mental Capacity Act (2005) training and the content of the adult safeguarding policy.