Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Moretonhampstead Health Centre on Tuesday 4 April 2017. Overall the practice is rated as Outstanding.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Patients said the staff had a common caring ethos going over and beyond to ensure that patients are receivingoutstanding care.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a GP but added they had to sometimes wait to see a named GP. Patients said there was continuity of care, with urgent appointments available the same day. Patients could access ‘drop in’ appointments on a Friday or access appointments on Tuesday afternoon at Lustleigh Parish Hall or Wednesday mornings at Manaton Parish Hall.
• Since the closure of the local hospital the practice had taken on a ‘walk in’ minor injury service during opening hours.
• The GPs worked with a RISE (Recovery and Integration Service) worker to care for and treat patients with a chronic drug addiction. This service had reduced the need for patients to travel 10 miles to the nearest service and had removed the stigma and made it more likely that patients will access the help they require to recover.
• 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw two areas of outstanding practice:

Involvement and empowerment of other organisations and the local community was integral to how services were planned and ensured that services met patient’s needs. There were innovative approaches to patient care and support in a rural close knit community which had reduced demand on GP and hospital services and improved patient wellbeing. For example, the practice had been supportive and instrumental in setting up domiciliary care agencies, community support groups, art groups, mother and baby support groups and prescription collection services for the benefit of local patients. These initiatives had resulted in more case histories of keeping patients at home, increased wellbeing and reduced social isolation. The art group promoted by practice staff met in the meeting room twice a week. Patients from the practice said this had improved their wellbeing and gave them something to look forward to each week. Data showed patients had reduced GP, nurse and home visit consultations compared to the periods prior to intervention. Their combined attendance dropped from 30 appointments in the eight months prior to the first set of classes to 10 appointments in the most recent eight month period.

There was strong culture of collaboration, empowerment and engagement from the leadership with a common focus on improving people’s experiences in the rural community. The leadership had an inspiring shared purpose to motivate staff, patients and the wider community to succeed and improve quality of care and people’s experience. The practice staff were outward looking and supportive in relation to the set up and governance of new community groups. For example, supporting and empowering the Morecare support group with recruitment and governance processes which then meant they could attend the monthly complex care multidisciplinary group meetings and offer support to patients. Additionally the practice had responded to the lack of domiciliary care services in the area and signed up as a partner to support an initial bid for a new community led local care agency ‘NedCare’. GPs had referred 27 patients who had received assistance from this service. We were given case histories where patients had been provided with support and reduced the need for admission to a care home or hospital.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Moretonhampstead health centre was inspected on Thursday 6 November 2014. This was a comprehensive inspection.

Moretonhampstead health centre provide a primary medical service to approximately 3,000 patients of a diverse population age group in the rural town of Moretonhampstead close to Dartmoor national park.

The practice also holds branches at three remote villages in the surrounding rural area. These branch surgeries are located in the villages of Lustleigh, Manaton and Bridford but were not inspected on this occasion.

There was a team of three GP partners. GP partners hold managerial and financial responsibility for running the business. In addition there were two registered nurses, one health care assistant, a practice manager, and additional administrative and reception staff.

Patients using the practice also have access to community staff including district nurses, community psychiatric nurses, health visitors, school nurses, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

We rated this practice as good.

Our key findings were as follows:

The practice was well led and responded to patient need and feedback. Innovative and proactive methods were used to improve patient outcomes even where no financial incentives or contractual agreements were expected.

The practice had an active patient participation group which had identified the need for coordinated services locally in partnership with the GPs and health care professionals.

Patients reported having good access to appointments at the practice and liked having a named GP which, they told us, improved their continuity of care. The practice was clean, well-organised, had good facilities and was well equipped to treat patients. There were effective infection control procedures in place.

Feedback from patients about their care and treatment was consistently positive. We observed a non-discriminatory, person centred culture. Staff told us they felt motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Views of external stakeholders were very positive and aligned with our findings.

The practice was well-led and had a leadership structure in place, staff displayed a sense of mutual respect and team work. There were systems in place to monitor and improve quality and identify risk and systems to manage emergencies.

Patient’s needs were assessed and care was planned and delivered in line with current legislation. This included assessment of mental capacity to make decisions about care and treatment, and the promotion of good health.

Suitable recruitment, pre-employment checks, induction and appraisal processes were in place and had been carried out thoroughly. There is a culture of further education to benefit patient care and increase the scope of practice for staff.

Documentation received about the practice prior to and during the inspection demonstrated the practice performed comparatively with all other practices within the clinical commissioning group (CCG) area.

Patients felt safe in the hands of the staff and felt confident in clinical decisions made. There were effective safeguarding procedures in place.

Significant events, complaints and incidents were investigated and discussed. Learning from these events was implemented and communicated to show what learning, actions and improvements had taken place.

We saw an area of outstanding practice relating to patient access:

The practice were responsive to the needs of patients and provided services even when the service provided is not included in the GP contract. For example the GPs had recognised that some patients travelled a long distance in the rural setting, often with no links to public transport.

• The GPs has worked with the supplying pharmacist to ensure medicines and prescriptions could be collected and delivered to the branch surgery villages. For example, the GP who attended Lustleigh would take the medicines to the local post office for collection.

However, there were also areas of practice where the provider should make improvements.

The provider should ensure that:

• The emergency equipment should be checked for expiry date.

• The practice should check the suitability of locum staff working at the practice. For example, there should not be an assumption that locum staff have provided evidence of indemnity insurance and General Medical Council (GMC) check.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice