This practice is rated as Good overall. (Previous inspection February 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Good

We carried out an announced comprehensive inspection at Pathfields Practice, visiting only the location of Plympton Health Centre on 16 October 2018. The branch surgeries will be visited later in the inspection schedule. The inspection was a routine inspection as part of our inspection schedule.

At this inspection we found:

• Pathfields Practice had significantly increased its number of patients registered with the practice after merging with other practices three times since 2015 to create a GP at scale service.
• The practice was strongly focussed on safety and had clear systems to manage risk across the group so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved processes.
• Audit was embedded, with the practice routinely reviewing the effectiveness and appropriateness of the care it provided. Care and treatment was always delivered according to evidence-based guidelines.
• All the feedback from 42 patients at the inspection was positive about staff treating them with compassion, kindness, dignity and respect.
• People’s individual needs and preferences were central to the planning and delivery of flexible tailored services. For example, patients could attend any of the practice sites in Plymouth for an appointment at a time to suit them.
• Patient feedback about the appointment system had been listened to. The practice had significantly increased patient access to appointments employing a varied skill mix of staff and increasing the number of appointments available. Extended hours were available across all sites enabling working patients and school children to access a range of services from the multi-disciplinary team. Further improvements were in the process of being introduced.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Proactive succession planning based on staff development and training of future GPs, doctors and practice nurses was evident at this training practice.
• Pathfields clinicians shared their learning and approach to delivering a safety culture through membership of the South West Academic Heath Science Network and published articles in national Primary Care journals since 2016.
• There was a proactive approach to preventing development of long term health conditions. For example, 786 patients within the pre-diabetic range received support and advice and were reviewed twice a year. Early diagnosis and treatments were put in place for 17 patients identified through these checks reducing the health risks associated with this condition.
• Pathfields practice employed a paediatric advanced nurse practitioner (ANP) partly as a result of learning from a significant event. They worked from two of the sites which was a conscious decision in line with deprivation, patient compliance and public transport facilities. The ANP worked with children up to 14 years of age accounting for nearly 20% of the total patient population. Their role was to triage all calls and requests for an appointment. Patients and parents benefitted from a bespoke and responsive service meeting their needs.
• The practice implemented the recommendations of Cancer Research with GP endorsement to increase eligible patient uptake of bowel screening by 5%. Through audit activities the practice had increased patient uptake of those eligible for bowel cancer screening above the national performance level of 54.6% to 74% at Plympton Health Centre.

We saw two areas of outstanding practice:

• The practice ran a functional disorders and chronic pain clinic for 250 patients aimed at improving their quality of life by using non-medical interventions to reduce pain. The service was evaluated with patients whose feedback was strongly positive and led to significant reduction in pain and risks associated with long-term use of prescribed opiate medicines for 41 patients.
• There was a proactive approach to early identification and support for carers, including young people in this role. The practice had identified 6% of the patient population as a carer or patient being cared for and was constantly monitoring this.

The areas where the provider should make improvements are:

• Take action to increase the uptake of reviews of patients with long-term conditions to avoid exception reporting (excluding patients from health reviews) where possible.

• Continue to implement improvements to increase patient access to appointments across Pathfields Practice group.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Pathfields Practice is a GP practice providing primary care services for people in and around Plymouth. It provides services from three premises located at Laira Surgery, 95 Pike Road, Plymouth PL3 6HG; Efford Medical Centre, 29-31 Torridge Way, Plymouth PL3 6JG; Plympton Health Centre, Mudge Way, Plympton PL7 1AD. We carried out an announced inspection across the three sites on 11 and 12 December 2014.

When the practice is closed patients are advised to contact the Out of Hours service, which is operated by a different provider.

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 had a patient-centred focus without judgment or bias.
• Patients felt they were treated with dignity and respect and in a professional manner that showed kindness and care towards them.
• Patients were able to see a GP or have a telephone consultation on the day of requesting an appointment.
• The practice had a clear strategic vision for its future and providing integrated care for its patients based on local needs and within the community.

We saw areas of outstanding practice including:

• One GP partner visited patients in care homes one day a week. This was part of a developing care home project, aiming to be able to provide a GP or nurse practitioner and a prescribing pharmacist, whose work would entirely focus on patients residing in care homes.

However, there were also areas of practice where the provider needs to make improvements. The provider should:

• Put in place a clear system to check that GPs and nurses have current registrations with their respective professional bodies.
• Set up a comprehensive training plan for non-clinical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice