At Tiverton District Hospital, day surgery, including exploratory procedures were available for adults assessed as fit for surgery in a community setting. On the day of our visit one theatre was being used. There were no scheduled investigations for the endoscopy unit. Our focus of this inspection was day surgery and we did not look at maternity services during this visit.

We met and spoke with eleven staff, which included the Trust’s head of governance, the day theatres manager, two consultant surgeons, one consultant anaesthetist, theatre practitioners, registered nurses and heath care assistants. We met and spoke with three patients having surgery. From our conversations it was evident there was effective team working among the theatre staff, many of whom had worked at the unit for several years. Patients told us they had discussed their surgery with the hospital staff and had been given adequate and sufficient information about their procedure, including likely recovery time.

We looked in detail at an action plan the Trust had produced in response to a review of surgical procedures at the Trust’s community hospital theatres. We checked upon and found that the recommendations made in the report had been implemented in full at Tiverton District Hospital. Patient surgery was planned and carried out in a safe and effective manner.

We carried out an announced comprehensive inspection at the GP service known as ‘Castle Place Practice’ at Tiverton Community Hospital on 15 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The GP service at Castle Place practice was run by the Royal Devon and Exeter NHS Trust. The Trust had clear governance arrangments with the practice facilitating the oversight of performance, safety and management of risks which were adhered to.
• Integrated health and social care was strongly advocated and the practice has driven innovation through the integration of services with the Royal Devon and Exeter NHS Foundation Trust.
• Feedback from all of the 34 patients we spoke with or who provided feedback, who used the service, family members and carers, and stakeholders was continuously positive about the way staff treated them. This reflected the results seen in the GP patient survey where 100% of patients had confidence and trust in staff.
• Community engagement was a high priority with patient representatives seen as critical partners actively involved in developing services for people living in and around Tiverton.
• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs. The practice was performing higher than the local and national averages for cervical screening.
• Health promotion was prioritised with the practice being responsible for 10% of all Devon referrals to the ‘One small step’ resources available for patients.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care. Working as a network of commercial, community, acute and primary care pharmacy the practice had reduced over the counter medicines by increasing patient awareness and had reduced risks with 90% of all patient medicines being prescribed electronically.

We saw an area of outstanding practice:

Castle Place practice was one of three pilot sites working with Exeter University to deliver funded psychological therapies for young people (eight to 18 years old) closer to home. Young people who did not reach the threshold for psychological support from the Child and Adolescent Mental Health Services (CAMHS) were now able to access counselling close to home.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice