Letter from the Chief Inspector of General Practice

This practice is rated as good overall and outstanding in well led. The previous inspection was in October 2015 where the practice was rated as– Good with outstanding in the responsive domain.

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? - Outstanding

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 Pembroke House Surgery on 9 January 2018. The reason for the inspection was 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, there was a genuinely open culture in which all safety concerns raised by staff and people who use services were highly valued as opportunities for learning and improvement.

• 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.

• The practice understood the needs of its population and tailored services in response to those needs. For example, the nursing team had introduced a ‘drop in’ flu clinic for patients who could not attend the routine flu clinics.

• The practice made reasonable adjustments when patients found it hard to access services. For example, the practice worked with other GPs in the area and provided treatment to patients in 16 local residential and nursing homes and offered a winter pressures GP home visiting service to nine care homes with the most vulnerable patients in Paignton & Brixham.

• 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 leaders used feedback from staff and patients to achieve growth and positive change.

• The practice was organised, efficient and supported effective governance processes. Leadership was clear, supportive and encouraged creativity.

• Evidence based techniques and technologies were used to support the delivery of high-quality care and staff were consistent and proactive in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health. For example, the use of a telephone system which tracked calls, patients who used online services, a detailed self-service health pod, GPs use of clinical templates and the use of electronic correspondence with acute hospitals and out of hour’s providers.

• The leadership and culture of the practice are used to drive and improve the delivery of high-quality person-centred care.

• There had been many organisational changes and an increase in patient population in the last two years. Despite this, the provider had maintained positive patient outcomes, positive feedback from patients and provided a popular place for staff to work.

We saw two areas of outstanding practice:

The involvement of other organisations in the local community and innovative approaches to providing integrated person-centred care meant that patients received flexible, responsive care. For example, the practice had set up and continued to fundraise and support a patient support group called Karing. The practice had helped to relaunch the charity when it moved offices to be closer to the practice. The group had invited a celebrity, who is nationally known for charity work with the vulnerable elderly and used this to raise the profile of the service. The practice and volunteers had recognised the change in patient need and as a result there had been a changed of focus of the group to concentrate more on social activities and befriending to reduce social isolation. The staff and their families had joined with patients to put on a concert at the Palace Theatre Paignton, to help raise awareness of Karing. The feedback received from patients was that it brought back a real sense of community and reduced social isolation. The practice staff and some patients had organised a ‘sell out’ show which raised £3000 towards the charity.

There were consistently high levels of constructive staff engagement and innovative approaches to gather feedback from people who use services and the public. For example:

• Action had been taken as a result of staff and patient feedback and detailed extensive public engagement, which had been recognised as good practice by NHS England.

• Many changes had occurred to benefit patients following engagement with staff. For example, streamlining the prescription, scanning and medical report processes which ensured patients received a more efficient service, changes to the length of some appointments patients did not feel rushed and improving the way samples were received from patients to reception staff to reduce the spread of infection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pembroke House Surgery on 6th October 2015.

Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• Feedback from patients about their care was consistently and strongly positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We identified areas of outstanding practice. For example;

The practice ran an organisation called “Karing” which had they had relaunched in 2015 with a programme of social events to meet the health and social needs of the higher than average proportion of older people in the local population. Older patients we spoke with told us this service had a positive impact on their outlook and improvements in their feelings of health and wellbeing.

The practice had launched an ophthalmology service to meet the needs of patients with eye problems in the area. The ophthalmology service treated on average 100 patients a quarter, of whom 50% could continue to be treated at the practice, removing the need for onward referral to secondary care.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Pembroke House Surgery is situated in Preston, Paignton. The practice was purpose built and had the facilities to meet the needs of its patients with disabilities. The practice served approximately 10,000 patients. The main services provided include; long term condition care, minor surgery, contraceptive care, baby clinics, well person checks and travel immunisations.

During our inspection we heard from 35 patients including 26 views gained from completed comment cards left by us in the practice. The nine patients spoken with on the day included three members from the patient panel, who assist the practice with views of the service so improvements to the service could be made. All the views expressed by patients about the practice were very positive with a collective view that patients were at the centre of the practice service delivery.

We found the provider had taken steps to ensure the practice was safe for patients as well as to the staff employed there. There were systems in place to ensure effective patient care and we heard about a high level of patient satisfaction with the care and treatment provided. Patients were treated with dignity and respect in a purpose built environment which was accessible and ensured their privacy. The appointment system enabled patients to be seen quickly for the amount of time their needs required. The practice was responsive to the needs of the patient and continuously strived to improve the service it provided through active engagement with the patient group. The practice was well led by the practice manager and their partner GPs. They were supported by an engaged practice nursing and staff team.

Patients over the age of 75 had been allocated a dedicated GP to oversee their individual care and treatment requirements delivered in the practice or in the patients own home.

Mothers, babies, children and young people had access to dedicated specialised staff as well as dedicated practice clinics, such as child immunisations.

The practice made provision for the working-age population and those recently retired with running Saturday clinics as well as telephone consultations.

Patients in vulnerable circumstances who may have poor access to primary care were provided with services by the practice.

Patients experiencing poor mental health were supported by the practice and had close links to the local mental health crisis team to ensure prompt referrals, when necessary.