Tiverton District Hospital

Updated 30 April 2019

Royal Devon and Exeter NHS Foundation Trust is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury. These are delivered from the registered location of Tiverton Community Hospital. On site there is a GP service known as ‘Castle Place practice’, which was inspected on 15 January 2019 as part of the Tiverton Community Hospital inspection taking place over several days.

The GP service is situated within the Northern, Eastern and Devon Clinical Commissioning Group (CCG) and provides services to patients under the terms of a personal medical services (PMS) contract for which Royal Devon and Exeter NHS Foundation Trust is accountable for. This is a contract between providers and NHS England for delivering services to the local community. There are clear reporting systems in place at the practice with governance arrangements overseen by the NHS Trust to ensure the contract is fulfilled.

Royal Devon and Exeter NHS Foundation Trust employs 8.7 whole time equivalent (WTE) associate GPs at Castle Place Practice. The GPs were supported by a pharmacist independent prescriber and the nursing team. There were 5.2 WTE practice nurses and health care assistants and several administration staff. Castle Place practice is currently part of a federation of GP practices in the Mid Devon area.

The National General Practice Profile states that 98.4% of the practice population is white with 1.6% of the patient population originating from black, mixed or other non-white ethnic groups. Information published by Public Health England, rates the level of deprivation within the practice population group as four. Level one represents a high level of deprivation and level ten the lowest. Male life expectancy is 79 years and the same as the national average of 79 years. Female life expectancy is 84 years compared to the national average of 83 years.  

Updated 30 April 2019

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

Updated 30 April 2019

Updated 30 April 2019

Updated 30 April 2019

Updated 30 April 2019

Updated 30 April 2019

Updated 30 April 2019