This practice is rated as Good overall. (Previous rating July 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Topsham Surgery on 24 July 2018 as part of our 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 worked closely with a local charity and one of the practice GPs chaired the local Estuary League of Friends which offered befriending and support for patients without family or friends and helped them access benefits and arrange social or personal care.
• The practice provided care plans and annual reviews to patients at a local drug and alcohol dependency unit which housed approximately 35 patients.
• The practice participated in the clinical commissioning group Referrals Enhanced Service. This was a service which provided reasons for referrals, examined any outliers and offered specialist support as a result. For example, a musculoskeletal (MSK) specialist had visited the practice to give a presentation to GPs following high numbers of referrals to a MSK specialist.

We saw two areas of outstanding practice:

• There was supported housing for survivors of domestic abuse and a home for patients with long term mental illness within the practice area. The nurse manager provided in-house training for staff at these homes, as well as providing appropriate vaccinations and regular health checks.
• The practice provided a weekly surgery at the West of England School for the blind and partially sighted. This provided a high level of care and treatment for around 40 children and young adults with complex special needs and complex prescribing.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced inspection at Topsham Surgery on 14 July 2015. The practice is rated as good. Specifically, it was good for providing safe, effective, caring, responsive and well led services. It was good for providing services for all the population groups, older people, children and young people, people with long term conditions, people experiencing poor mental health, people in vulnerable circumstances and people who are working age or recently retired.

Our key findings were as follows:

• Outcomes for patients were positive, consistent and met expectations. Patients confirmed they were seen or spoken with on the same day if they had an urgent need. GPs kept individual lists so all patients had a named GP.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Reliable systems were in place to maintain safety throughout the practice.

• There was up to date IT support to enable staff to manage patient records well and provide them with the latest NICE guidance.

• Treatment rooms and public areas were clean and there were systems in place to ensure hygienic conditions and equipment.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice