Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection October 2014 – 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 Castle Gardens Surgery on 8 March 2018. This was a routine inspection 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.

• The staff were knowledgeable about their patients putting reasonable adjustments in place, where necessary, to ensure they did not experience discrimination.For example, the staff continued to work closely with the community learning disability team providing information for patients in appropriate formats, flexible appointments and continuity of staff. Patients with complex needs were able to have appointments in a place and time that suited them.

• Patients found the appointment system easy to use and reported that they were able to access care on the day when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

The delivery and advancement of knowledge and skills at the practice is highly developed and strongly focussed on delivering a responsive service to meet the needs of patients. For example, emergency life support training is delivered more frequently and was role specific.

The practice has been proactive ensuring patient views are heard in the development of Great Torrington becoming a dementia friendly town, providing opportunities for support, companionship and activities for vulnerable people.

The area where the provider should make improvements is:

Continue to monitor newly implemented governance systems to track action taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Castle Gardens Surgery was inspected on Monday 13 October 2014. This was a comprehensive inspection.

Castle Gardens Surgery provides primary medical services to people living in the town of Great Torrington and surrounding villages in Devon covering approximately 100 square miles. The practice provides services to a diverse population. At the time of our inspection there were approximately 6,600 patients registered at the service with a team of five GP partners.

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.

The practice is rated as good . Our key findings were as follows:

• Patients reported having good 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.
• The practice valued feedback from patients and acted upon this. Feedback from patients about their care and treatment was consistently positive. The culture of the practice was patient centred. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Views of external stakeholders were very 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.

• Information received about the practice prior to and during the inspection demonstrated the practice performed comparatively and in some instances better when compared with all other practices within the clinical commissioning group (CCG) area.

• Patients told us they felt safe, that staff were professional and they felt confident in clinical decisions made. There were effective safeguarding procedures in place.

• Significant events, complaints and incidents were investigated and discussed. Staff learned from these events and shared their learning within the team, although the written evidence for this process did not always consistently show what learning and actions had taken place following such investigations.

We saw areas of outstanding practice including:

• The practice was responsive and innovative in the way it engaged with people with learning disabilities with complex communication needs. For example, staff responsible for annual health checks had made several out of hours visits to a care home where these patients lived. Information for patients was in an easy read format so they were fully involved in making decisions about their health. This meant patients were able to get to know the staff from the practice in a place where they felt at ease. At the same time, practice staff learnt from care home staff how best to meet the complex communication needs of each patient, which was then put in place at Castle Gardens Surgery. Important screening was carried out successfully, which included blood tests and cervical smears to manage ongoing health, because of the time taken to prepare patients and reduce their anxieties.

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

Importantly, the provider must:

• Keep dispensed high risk medication and stamped prescription pads secure at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice