This practice is rated as Good overall. (Previous rating September 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive at Taunton Road Medical Centre on 9 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.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. 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.
• The practice had a good programme of ensuring that childhood immunisations were taken up.
• Feedback from other health professionals and services demonstrated that the practice worked well with them and provided support in the interest of the best outcomes for patients. Patients could access assessment and treatment locally instead to the need to travel to other locations.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system variable to use but reported that they were able to access care when they needed it.
• The practice provided a specialist allocation scheme, formally known as the violent patient scheme to provide medical care to patients who have been referred to the scheme by other local services who were unable to meet their needs.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Mutually support team of staff working well together with the aim of the best outcomes for patients.
• Staff given the opportunity for professional development.
• Medicines management system did not provide assurance that they were secure or that the oversight of high risk medicines was effective.

We saw areas of outstanding practice:

• The practice worked well with the secondary care cardiology team with shared clinics and pro-active treatment for patients. The cardiologist told us the practice’s post heart attack medication follow up and up-titration of medication as per the NICE guidelines had dramatically improved in the past 12 months. They now stood out compared to other practices in the area for their exemplary patient follow up with regards to the up-titration of their medication following a heart attack. This meant that by implementing the research patient’s long-term outcomes were improved. Information from the cardiologist also identified that 20 potential tests with 55 potential appointments at the local hospital were avoided.

• Shared clinics with the secondary care paediatrician had reduced the need for patients to be seen in a hospital environment by 80%.

The areas where the provider must make improvements are:

Reg 12 Ensure care and treatment is provided in a safe way to patients

• The provider MUST continue with developing aspects of safe with an oversight of staff’s immunisation status, processes for safe medicines management, and aspects of infection control audit.
• The provider MUST continue with monitoring the oversight of patients on high risk long term medications.

The areas where the provider should make improvements are:

• The practice should continue to monitor that the changes implemented for safeguarding adults, recruitment, and disclosure and barring check risk assessments are sustained.
• The provider should continue to monitor cervical smear screening to meet Public Health England screening rates.
• The practice should continue to proactively identify carers.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Taunton Road Medical Centre on 8 September 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for Older patients, Patients with long-term conditions, Families, children and young patients, Working age patients (including those recently retired and students), Patients whose circumstances may make them vulnerable, and patients experiencing poor mental health (including patients diagnosed with dementia). There were some outstanding elements of care and treatment for patients with learning disabilities, those with mental health problems and mothers and babies.

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, including those relating to recruitment checks.
• 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 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.

We saw areas of outstanding practice:

• There were examples of involvement and input into mental capacity decisions from a visiting learning disability nurse and how in partnership with GPs they ensured the best patient outcome in the circumstances for 99 registered patients.

• Staff worked with social services and the police to ensure patient safety. We heard how staff supported a patient to go from the consulting room directly to an out of area refuge to ensure their safety. In another case where a plea for help was made, a patient and their children were taken directly from the practice to the police station to prevent further harm from a violent partner.

• In specific circumstances the practice continued to support patients who moved away from the practice area. A young patient diagnosed with an eating disorder who had continued to lose weight. A multi-agency decision was reached to detain this patient for their own protection under the mental health act legislation but the patient left the area. The patient wanted to remain with her GP and the practice agreed. The GP met the patient monthly. Records showed the patient slowly improved with their current BMI being considerably improved.

• The practice was a GP training practice and had three registrar GPs located at the practice at the time of the inspection. We saw one of the GPs who supported the registrar GPs had been awarded “Best GP year 5 trainer” for 2015. The registrar we spoke with commented on the high quality of support and mentoring provided within the practice.

Additionally there were areas of practice where the provider needs to make improvements. Importantly the provider should;

• Provide a clearer chronology of when complaints are responded to and when they are completed.
• Review refrigeration provision for busy periods of immunisations.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice