Letter from the Chief Inspector of General Practice

We carried out an announced responsive inspection at Old Farm Surgery on Wednesday 13 September 2017. Overall the practice is rated as good.The practice had previously been inspected in January 2016. Since that time a senior partner and practice manager had left the management team.

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

• Morale at the practice remained high since the changes in leadership and the new staff team demonstrated they had the experience, capacity and capability to run the practice and ensure high quality care.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The practice had a proactive nursing team including a nurse practitioner to meet the needs of the local population.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Patients were satisfied with the care and treatment they received.
• A small number of practice staff and patients had been involved in a musical production locally to raise awareness about and fundraise for a local homelessness charity.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a GP and said there was continuity of care, with urgent appointments available the same day.
• 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.
• The practice was a recognised training practice for doctors training to become GPs and had recently received positive feedback from the GP registrars and from the Quality Panel (QIP) of Health Education England.
• The practice had been a research practice for the last few years and were active in many studies with the Torbay Hospital Diabetic Research Team.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

• The practice had a strong emphasis on self-management and ethos of empowerment of the vulnerable patient population by supporting them to live healthier lives and obtaining the support they needed. For example, through the successful and popular detailed website and effective, proactive joint working with community groups including charities, counselling services, support groups and health and social care hubs.

The areas where the provider should make improvement are:

• Ensure systems are in place to ensure the patient voice is heard and considered. For example, with a patient participation group.

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 Old Farm Surgery on Wednesday 20 January 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Practice staff reviewed the needs of its local population and engaged with external stakeholders and organisations to secure improvements to services where these were identified.

• The practice had developed an effective website for patients to access health information videos, ‘apps’, web links and referral links. This had been identified by the Clinical Commissioning Group (CCG) as an example of good practice.

• GPs at the practice provided daily medical support to inpatients at Paignton Community Hospital. This included liaising with staff, patients, carers, social services and the voluntary sector to ensure patients once well enough to be discharged, do so in a more timely, safe manner. This work involved complex case management and was also an educational opportunity for the GPs to improve their skills through closer working with the care of the elderly consultants.

• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 get through to the surgery on the telephone and to speak with a GP. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear supportive leadership structure who encouraged the staff group to develop their confidence and scope of practice. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice had reduced the demand for primary and secondary care services for patients with long term conditions by increasing self-management strategies and decreasing anxiety about their condition. The self-management techniques included setting goals, challenging beliefs, empowerment and acceptance which were led by the patient with support from life coaches provided by the practice. Patients described the benefits and explained the coping mechanisms they had developed. An audit of ten patients from the practice who had taken part in the scheme showed that over the 12 months there had been a reduction from 96 face to face appointments to 28 face to face appointments and a reduction from 334 telephone consultations to 195. There had also been reductions in nurse and health care assistant appointments and out of hours contact made by these patients making more appointments available for other patients.

The areas where the provider should make improvement are:

• Review the process for regular fire drills

• Review the process for health and safety risk assessment and fire risk assessments.

• Review the consent form used for minor surgery to ensure it provides patients with all the information they need to make an informed choice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice