Archived: South Molton Health Centre

Updated 5 March 2015

South Molton Health Centre is a town centre practice, based at 9 –10 East Street,

South Molton, Devon EX36 3BZ. Around 5,500 patients are registered with the practice.

There are five GP partners, three men and two women and a retained GP(female). Three qualified nurses are employed, plus two health care assistants.

A large proportion of registered patients are older people, so there is a high level of need with respect to long term conditions and complex needs. The population is quite stable and includes young families and working people.

This is a training practice, with medical students, a registrar and a trainee doctor in the second year of their foundation programme.

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

This practice was last inspected in January 2014 when it was found to be compliant with the outcome groups that were inspected.

The CQC intelligent monitoring placed the practice in band six. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

Out of practice hours, patients are directed to NHS 111.

Updated 5 March 2015

Letter from the Chief Inspector of General Practice

South Molton Health Centre was inspected on Tuesday 4 November 2014. This was a comprehensive inspection.

This practice provides primary medical services to people living in the North Devon town of South Molton and the surrounding areas. It provides services to a diverse population age group and is situated in the heart of the town.

Five GP partners and a retained GP make up full time equivalent of 3.65 GPs which provides cover for approximately 5,500 registered patients. A mix of services is provided in addition to core services, including carers’ health checks. 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.

We found this practice promoted safe working practices energetically and systematically and was very responsive to patients’ needs. We found the practice was effective, caring and well led.

Our key findings were as follows:

Patients told us they had found staff to be helpful, kind, caring and patient. Four patients said their care had been excellent. Patients told us that their GP listened to their problems, explained treatment options so they could understand and treated them with dignity and respect.

Patients said that this service had not made assumptions about people, or ‘pigeon-holed’ them. They said the GPs and staff would expand a service in order to fit a person in, if necessary. There were systems in place, but variations could be made for individual’s welfare. Patients said the positive relationships observed within the team gave them confidence and made them feel comfortable.

A duty system had been introduced. There was a GP each day to deal with urgent appointments during normal opening hours. There were also some same day non-urgent slots available. Patients told us it was a good system and that staff were prepared to flex it to accommodate a patient.

Nurses ran clinics for patients with coronary heart disease, asthma, chronic obstructive pulmonary disease (COPD), hypertension and diabetes. This recognised the needs of the locality. They followed up blood test results and any patients who did not attend to ensure they received essential treatment.

Infection prevention and control (IPC) was actively monitored throughout the practice. Progress was checked at monthly intervals at the Quality Group meeting. Achievement was recorded every month, with a different aspect of IPC promoted across the practice.

Good communication was maintained to provide good outcomes for patients. Practice nurses told us they were in regular communication with district nurses about the patients that they both treated.

The management team had developed a set of core competencies to outline expected standards of behaviour across the whole practice, for partners and staff. There was a clear leadership structure with named members of staff in lead roles and all the staff who spoke with us were clear about their own roles and responsibilities.

We saw outstanding practice including:

There was a reliable and proactive method for maintaining safe working practice. The Quality Group met bi-monthly to monitor progress and included a GP partner, a staff representative, the practice manager, deputy practice manager and lead nurse. All matters to do with any aspect of patient safety identified by any staff member were entered on the risk register, which was seen to be a working document. At each meeting, new concerns and progress with old ones were discussed, focussing on items that team leaders were actively promoting. The spreadsheet was updated each month and the current version made available for staff input over the next month. This provided a reliable and proactive way of assessing risk and taking action effectively across the whole practice to provide a safe service.

The practice joined in an annual outreach event in town hall with local voluntary groups providing health promotion, lifestyle advice and health checks. This year the event was entitled ‘Ageing Well’. The practice took care to offer flexibility with appointments to enable people who could not drive, to access services, where public transport was limited to one bus per week. Staff arranged for prescriptions to be signed on the day to avoid the need for a repeat journey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 March 2015

This practice is rated as good for the care of people with long term conditions.

The full range of chronic disease clinics were provided - coronary heart disease (CHD), diabetes, asthma, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD) and hypertension. There was a recall service to ensure patients received the checks they needed. Patients were offered regular testing if they were prescribed anticoagulant medicines and they had the option to attend in the practice or a separate phlebotomy service for their blood tests.

They gathered feedback from patients with long term conditions who served on the patient participation group known as P3.

The practice offered active carers support, led by a member of the administrative team who developed a link with the carer who was then offered health and well-being checks with follow up. A specific notice board was provided in the waiting room to display information about carers’ issues.

A same day consultation was always available if needed. A ‘named usual doctor’ service had been in place for a long time to give good continuity and personalised service. Patients with complex needs had their care proactively managed on ‘virtual ward’ in collaboration with other health care professionals to make sure their changing needs were identified and met.

Updated 5 March 2015

This practice is rated as good for the care of families, children and young people.

A full child health programme was offered with vaccinations in accordance with national guidelines. The practice aimed to achieve a baby’s eight week check on the same day as the post natal check and the first immunisations, for the convenience of the new parent. Nappy changing facilities had been provided and a side room was provided so that mothers could breast feed in private. Staff were prepared to childmind whilst a parent was in with a health care professional.

The practice had made efforts to maintain good communication with midwives and health visitors who no longer shared the same site.

They had built up good relationships with the local community college and established a link with the school council. Some young mothers had been recruited on to the patient participation group known as P3 who were therefore able to give regular feedback to the practice.

Updated 5 March 2015

This practice is rated as outstanding for the care of older people.

The practice took care to offer flexibility with appointments to enable people who could not drive to access services, where public transport was limited to one bus per week. Staff arranged for prescriptions to be signed on the day to avoid the need for a repeat journey.

The building had been made accessible with a power assisted door and wheelchair access to most areas. Raised chairs had been provided in the waiting room for the use of patient with reduced mobility and three of the treatment rooms had been furnished with adjustable height couches. Staff were prepared to help frailer patients by ringing a taxi for them and helping them to and from the consulting rooms.

The practice joined in an annual outreach event in town hall with local voluntary groups providing health promotion, lifestyle advice and health checks. This year the event was entitled ‘Ageing Well’.

GPs had built good relationships with local care homes. They had been proactive about raising any concerns over care and trying to work with the homes to improve their procedures and ability to provide good patient care.

Updated 5 March 2015

This practice is rated as good for the care of working age people (including those recently retired and students).

The practice had made arrangements flexible so that patient could book appointments at their own convenience. Patients could book appointments and reorder repeat prescriptions via the practice’s website. Evening and lunch time surgeries were available so patients could avoid using their working hours, and telephone consultations were available daily.

NHS health checks were offered for patients over the age of 40. The practice manager was currently working on a project with CCG and the local hospital trust to improve access to physiotherapy services.

A full travel health service was offered, including yellow fever.

Updated 5 March 2015

This practice is rated as good for the care of people experiencing poor mental health.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The CPN for the elderly attended the practice’s multidisciplinary team meeting to contribute to care planning. GPs carried out advance care planning for patients with dementia.

Longer appointment times were regularly given for a mental health consultation. Patients’ blood pressure and body mass index (BMI) were checked before their annual reviews. Nurses were alert to the possibility of low mood, particularly with new mothers, to help with identification of developing problems.

Patients were signposted to depression and anxiety services. They were encouraged to self-refer.

A private counsellor visited the practice, providing a choice for patients. An Alzheimers Disease society support worker was linked to the practice.

The practice manager had regular meetings with community psychiatric nurses (CPN) to ensure good collaboration. The CPN saw patients in the practice when that was more helpful than seeing them in their home.

Updated 5 March 2015

This practice is rated as good for the care of people whose circumstances may make them vulnerable.

Medical assessment and treatment was provided immediately when needed for people who were homeless, travellers, or itinerant workers. Patients who had been victims of physical abuse including domestic abuse were supported and signposted to other services. Patient alerts were entered on the computer to help staff identify people in these situations in order to make an appropriate response to support them.

Vulnerable adults and children known to the practice were discussed at the regular multidisciplinary team meeting, in order to co-ordinate care and keep colleagues up to date with any changes in patients’ well-being. There were effective arrangements in place to support anyone needing to raise an alert.

A GP took the lead on learning disability for the practice. They had developed their working relationship with a local residential care home for people with learning disabilities, visiting regularly so that patients would be familiar when they needed examination or treatment, and to provide support to the staff.

Staff were aware of patients for whom English was not their first language. They said they had access to a translation service if required but that most patients came with their own translator.