Archived: West Hoe Surgery

Updated 10 December 2015

West Hoe Surgery was inspected on Wednesday 30 September 2015. This was a comprehensive inspection.

The practice provides GP primary care services to approximately 4600 people living in and around Plymouth City Centre. The practice has a Personal Medical Service (PMS).  They also offer Directed Enhanced Services, for example the provision extended hours to enable patients to consult a health care professional, face to face, by telephone, or by other means at times other than during core hours.

There are four GP partners and one salaried GP. The practice is registered as an under graduate teaching practice. Partners hold managerial and financial responsibility for running the business. The team are supported by a practice manager, two practice nurses, two health care assistants and additional administration staff.

The practice is open from Monday to Friday 8.30am to 6pm. Appointments are available between 08.30am and 5.30pm on Monday to Friday. There are extended appointment times on Monday evening until 8.45pm. Outside of these times there is a local agreement that the out of hours service (Devon Doctors Out of Hours Service) take phone calls and provide an out-of-hours service.

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 30 September 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 to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to equipment checks and recruitment checks. This relates to the formal recording of these processes.
• 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.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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, with urgent appointments available the same day.
• 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.

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

Importantly the provider should

• Maintain written records of all checks made on electrical equipment and clinical equipment, to show it has been checked and to ensure it is safe to use.

• Ensure recruitment records include all necessary written induction, training and competencies information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 December 2015

The practice is rated as good for the care of people with long-term conditions.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission due to their long term condition were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice employed two nurses that ran clinics for patients with diabetes, COPD (chronic obstructive pulmonary disease), asthma, heart failure, hypertension and high cholesterol.

They attended regular clinical updates to keep their clinical knowledge up to date. The practice also had a locum practice nurse who worked frequently who had extensive knowledge in the care of the diabetic patient. They saw diabetic patients with more complex needs and worked with the patient to provide detailed management care plans. Another nurse had a special interest in respiratory diseases and had a COPD diploma. She was skilled in spirometry and management of the patient with chronic respiratory problems

The practice had been working with one of the medicines optimisation pharmacists who had a specialism in respiratory disease. They facilitated joint GP, nurse and pharmacist reviews for patients. This provided a holistic team approach and helped ensure patients were prescribed the correct medicines in line with current guidance.

Updated 10 December 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up routine health screening for children living in disadvantaged circumstances, or those at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high and in line with national averages for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. A midwife visited one day a week to provide antenatal care and a health visitor ran an open clinic once a month.

The practice was a Chlamydia test and treatment centre (this was for patients aged between the ages of 15-24). Patients could be tested and provided with a course of treatment if required.

The practice had a reciprocal arrangement with a local practice to provide private immunisations to patients who do not fit NHS criteria. This was arranged in response to requests by patients to have their children immunised against Meningitis B outside the current schedules.

Updated 10 December 2015

The practice is rated as good for the care of older people.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. Pneumococcal, flu and shingles vaccines were provided at the practice for older people. Vaccines for older people, who have problems getting to the surgery, were administered by the GPs or Practice Nurse on a home visit.

All patients over 75 years of age had their own allocated GP. The practice worked well with the local pharmacy for the provision of prescriptions for patients. The local pharmacist provided blister packs when required for appropriate patients and delivered them to any patients that were house bound.

The practice had a carers register in place and were offering carers wellbeing checks.

Updated 10 December 2015

The practice is rated as good for working age people.Advance appointments (up to four weeks in advance) were available for patients to book. The practice offered an online appointment booking service. Extended hours were also available one evening a week so that patients that could not attend in their working day could see a nurse or GP. Book on the day appointments were also available every morning, five days a week.

Suitable travel advice was available from the GPs and nursing staff within the practice and supporting information leaflets were available within the waiting areas.

The staff were proactive in calling patients into the practice for health checks. This included offering referrals for smoking cessation, providing health information, routine health checks and reminders to have medicine reviews. This gave the practice the opportunity to assess the risk of serious conditions on patients which attend. The practice also offered age appropriate screening tests including cholesterol testing.

Updated 10 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 10 December 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

The practice were able to refer patients with alcohol addictions to an alcohol service for support and treatment. The support service visited the practice if required. The practice were also able to refer patients with depression/stress/anxiety to a service for support and treatment. One GP was a specialist in drug and alcohol misuse and had forged good links with the local Harbour Centre (the Harbour centre offered support and help to patients affected by the misuse of drugs and alcohol). A drug misuse support worker also regularly visited the surgery to see patients there.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

The practice were a member of the Safe Place Scheme. This was a nationally recognised scheme which helped people to deal with any incidents that take place when they are out in the community. The scheme is aimed at helping people feel confident and safe when in their community, knowing that assistance was available at the practice if required.