This practice is rated as Good overall. (Previous rating November 2014 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Exmoor Medical Centre on 19 June 2018 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. The systems such as the cancer significant event audit and the range of multi-disciplinary meetings led to improved, consistent high-quality care. When incidents did happen, the practice learned from them and improved their processes.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• The practice undertook additional patient surveys such as individual GP feedback and bereaved family’s surveys following end of life care. They used colleague feedback surveys. These along with the national GP patient survey (2017) showed above average positive patient feedback.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

The practice had received accreditation for high quality end of life care and implementation of the Gold Standard Framework (GSF). The practice demonstrated innovative best practice and improvements in local care standards through implementation of the GSF for all patients with cancer and additional patient population groups. As a result, they could demonstrate improvements in quality of care provided.

The areas where the provider should make improvements are:

• Review the security of blank prescriptions within clinical rooms so that it is in line with national guidance.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Exmoor Medical Centre (Dr Trill and partners) on Wednesday 5 November 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing caring, effective, safe and well led services. They were good for providing services for the patients experiencing mental health problems, families, children and young patients, older patients, working age and retired patients and patients’ with long term conditions. They were outstanding for providing responsive services and for providing services for patients living in vulnerable circumstances.

Our key findings were as follows:

• The practice prided itself in offering same or next day appointments to all patients. If patients were unable to visit particular times of the day the GPs would try to accommodate the patient on an individual case basis so they were seen.
• 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.
• 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 praised staff highly for their compassion, respect and efficiency and had confidence in their ability to diagnose and treat their problem effectively and appropriately.
• The practice had good systems to communicate with patients, online services, such as a patient blog and newsletters and an active patient participation group.
• The practice had effective communication and liaison systems in place with local community support, health and advice services.
• 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
• 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.

We saw several areas of outstanding practice including:

• The practice dispensing staff contacted every patient within a week of being discharged from hospital to check and review their prescription medicines and any additional support required. GPs would contact the patients for any complex medical concerns.

• The practice had well developed links with the community and was involved in fundraising for improving patient care in the local area. This included setting up a patient funded volunteer group to deliver prescriptions to patients’ homes in the area and also to four set locations within nearby villages. They also had an active involvement in the community such as through fund raising events and support of fitness programmes and updated patients through their practice website on a patient blog.

• Additionally we were told staff would go above and beyond their duty to help and support patients, when required. Staff had been known to drop prescriptions off to patients on their way home from work and take patients home from appointments. Also, found temporary accommodation for a homeless person who had mental health problems and ensure another patient who needed to be admitted to hospital went in a dignified manner. Staff had also recognised when a carer had to be admitted to hospital that arrangements were in place to assist their partner in their absence.

• The practice coordinated a benefits advisory service once a week in the practice, for patients to use free of charge. The practice demographic was in the middle range for deprivation. This service enabled patients to get the advice they needed from a local centre, which may be difficult for some patients to gain this advice normally because of where they live and travel barriers.

• The practice had a comprehensive contingency plan to deal with the challenges the practice faced in bad weather, such as snow. The practice had arrangements with local services, such as the local bed and breakfast to provide accommodation for a GP and farmers to help deliver critical medicines, or take GPs for home visits to their most vulnerable patients using their tractors or quad bikes. Pre-planning arrangements were in place for patients to collect two month’s supply of prescriptions over the winter period.

• The practice has recently recruited an educational psychologist to provide advice and support for children and families who require additional support. The local child and adolescent mental health service normally see referred patients with complex mental health problems. The practice will be providing a service for its patients who need lower level support.

• There was a lead member of staff who was a carer champion to help support registered carers. Also, the practice facilitated the local carers group at the practice where 10-15 carers attended each month along with the practice carers champion.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice