Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tavyside practice on 26 May 2015. The practice is based at Tavyside Health Centre and provides primary medical services to a diverse population living in the town of Tavistock and surrounding villages in Devon. This includes shared responsibility for monitoring in-patients at Tavistock Hospital.

At the time of our inspection there were 8834 patients registered at the service with a team of six GP partners and one GP retainer (The retainer scheme enables GPs to maintain their skills and development with a view to returning to NHS GP practice in the future). Tavyside is a training practice, with four GP partners qualified as trainers. When we inspected there were three GP registrars on training placements at the practice.

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.

Overall the practice is rated as GOOD.

Specifically, we found the practice to be outstanding for well led. The practice was good for providing effective, caring and responsive services. There were areas of the safe domain which require improvement. It was outstanding for providing services for vulnerable people. The practice was good for providing services to older people, and people with mental health needs including dementia, people with long term conditions, families, babies children and young people and working age people.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was a strong commitment to providing well co-ordinated, responsive and compassionate care for patients.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available the same day and staff were flexible and found same day gaps for patients needing routine appointments.
• 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.
• Audits were used by the practice to identify where improvements were required. Action plans were put into place, followed through and audits repeated to ensure that improvements had been made.

We saw areas of outstanding practice including:

• The practice was innovative in supporting vulnerable people. For example, a lead GP and health care assistant routinely carried out reviews with patients at their own home. Information was sent to patients in accessible formats that suited their needs, for example in easy read or picture formats. This promoted a trusting rapport with patients and had increased patient involvement in the management their health and well-being and resulted in 100% of patients having been reviewed and followed up
• The practice was innovative involving the association to hold health promotion events every few months. For example, the association had been made aware of a scheme to promote independence for older people. As a result of this, the association with support from the practice had run a ‘driving longer, safer course’ and another one was planned for June 2015 due to the success of the previous one. Other examples of awareness events held covered living with diabetes, prostate cancer and promoting altruistic kidney donation

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

Importantly the provider must:

Establish and operate effective recruitment procedures to ensure that information regarding pre-employment checks is kept

The provider should:

Record when the performers list has been checked

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

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

We carried out an announced comprehensive inspection at Tavyside Health Centre on 13 and 18 June 2018. The inspection was a routine inspection as part of our inspection schedule carried out over two days. We visited the main site and branch surgery at Lifton, which had a dispensary.

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 processes.
• Staff were caring and patient focussed.
• People’s individual needs and preferences were central to the planning and delivery of flexible tailored services. All patient feedback highlighted ease of access to the appointment system, on the day assessment and minor injuries services. Extended hours were available every day enabling working patients and school children to access a range of services from the multi-disciplinary team.
• As a training practice, 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.
• Tavyside Health Centre had successfully registered additional patients in 2016/17 when the practice merged with Lifton Surgery. Patient feedback shared with us by patient representatives at Lifton Surgery was positive about the changes being made there.

We saw an area of outstanding practice including:

The practice had extended their tailored learning disability service, which had increased to 35 patients within this population group. A lead GP and senior health care assistant did domiciliary visits to patients at their own home. Staff used advanced total communication skills such as makaton signing and easy read letters with patients so they were fully involved in their health assessment and care planning.

The areas where the provider should make improvements are:

Review the infection control processes to include hand hygiene audits to identify competency issues and training gaps for staff.

Review the prescription authorisation process to ensure changes implemented are embedded practice.