This service is rated as Good overall.

We undertook a comprehensive inspection of Ward Practice in August 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as Requires Improvement for providing well led services.

We undertook a follow up inspection on Wednesday 16 May 2018 to check that action had been taken to comply with legal requirements. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for Ward Practice on our website at www.cqc.org.uk.

At this inspection the key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

At this inspection we found:

• An overall improvement in the systems and processes used to ensure good governance in accordance with the fundamental standards of care, particularly in regard of record keeping, recruitment, staff training, risk management and staff development.
• Continued reporting and management of significant events with a more detailed recording system to further evidence learning and actions taken.
• A more comprehensive system for the identification of patients who were also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ward Practice, also known as Honiton Surgery, on Wednesday 16 August 2017. Overall the practice is rated as good. The well led domain requires improvement.

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 learning from significant events, although records kept did not clearly demonstrate this.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective clinical care and treatment.
• The GPs and nursing team used clinical audit to monitor and improve services and clinical care.
• The GPs provided medical input and were able to admit patients to the local community hospital medical ward. This enabled older or patients at the end of life to be looked after closer to home, with the continuity of care from the community rehabilitation team.
• The practice worked jointly with healthcare professionals from the local acute trust and benefitted from educational sessions provided by this team. This enabled patients to be treated within their local community.
• The practice had a system for identifying patient at risk of falling. These patients were then referred to the local falls team nurse who visited and assessed the patient at their home. The GPs then worked with a local rehabilitation team to address the risk factors.
• Patients told us they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Patients were complimentary about the staff group and said the care they received was efficient and thorough.
• Prescription management and medicines at the practice were well managed.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Feedback from patients reported that access to a named GP and continuity of care was not always available in a timely way, although urgent appointments were available the same day. The provider was aware of this feedback and had taken steps to communicate the reasons for this and implemented actions to mitigate risk whilst further staff were being recruited.
• Extended appointments were available in the morning on Mondays, Wednesdays and Thursdays and late evening appointments were offered on Tuesdays and Wednesdays.
• The practice had recently extended the building to provide additional clinical and office space. The facilities were clean, tidy and well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by the GP partners.
• The practice proactively sought feedback from staff and patients, which it acted on. Examples of changes included additional appointment times, changes to patient car parking, introduction of water dispenser and staff badges.
• Despite many changes over the last year, staff said it was a good place to work and morale was high.
• There was a formal structure of meetings to aid communication with external health care providers and staff at the practice.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are to ensure:

• Effective systems and processes are established to ensure good governance in accordance with the fundamental standards of care, particularly in regard of; record keeping, risk management and staff development.

The areas where the provider should make improvement are:

• Improve the systems to identify carers to ensure they receive all the information and support required.
• Review records relating to significant event processes to ensure they reflect the actions taken and lessons learnt.
• Review appraisal records to ensure they show that the findings are agreed by the staff being appraised and the appraiser.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Honiton Surgery Group – Ward Medical Practice, was inspected on Wednesday 16 December 2014. This was a comprehensive inspection. The Ward Medical Practice is part of the Honiton Surgery Group. The practice is shared with Seamark Practice and they operate in the same building. Staff are employed by the Honiton Surgery Group and work for both practices. There is a computer system that has a shared administrative facility which enables all teams to view patients as one data base (GPs, nurses, community nurses and administrative staff). Both practices work as if the Honiton Surgery is one practice, however financially they are separate, and they are registered with CQC as separate locations.

The practice provides primary medical services to people living in the town of Honiton.

The practice provides services to a diverse population age group and is situated in a town centre location.

The practice comprises of a team of ten GP partners, who hold managerial and financial responsibility for running the business. In addition there are nine registered nurses, five health care assistants, a practice manager, and administrative and reception staff.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

Our key findings were as follows:

Patients reported having good access to appointments at the practice and liked having a named GP which improved their continuity of care. The practice was clean and organised. The facilities and equipment were suitable for patient consultations and to examine and treat patients. There were effective infection control procedures in place.

The practice valued feedback from patients and acted upon this. Feedback from patients about their current care and treatment was consistently positive. Staff portrayed a non-discriminatory, person centred culture. Staff were 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 clear leadership structure in place whilst retaining a sense of mutual respect and team work. There were systems in place to monitor and improve quality, and to identify risk and systems to manage emergencies.

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

Recruitment, pre-employment checks, induction and appraisal processes were in place. Staff had received training appropriate to their roles and further training needs had been identified and planned.

Statistical data analysis 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 performed and communicated amongst all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice