St Thomas Medical Group

Updated 17 May 2019

St Thomas Medical Group is a group of four GP practices which provide services under a Personal Medical Service (PMS) contract for approximately 38,400 patients The group is situated in the Devon city of Exeter.

St Thomas Medical Group is made up of four separate practices with one patient list. This means patients can be seen at any one of the four sites. Patients tended to visit the same practice for their own convenience. Administration staff rotated across all sites but clinical staff tended to be based at one group to provide better continuity for patients.

St Thomas Health Centre is open Monday to Friday between 8.30am and 6pm. The practice is closed between 12.30 pm and 1.30 pm on Friday lunchtimes for staff training. Extended appointments are offered from 7am to 8am on a Tuesday and Thursday and 6.30 pm to 8pm on Tuesdays and Wednesdays.

Exwick Health Centre is open Monday to Friday between 8.30am and 6pm. The practice is closed between 12.30pm and 1.30pm on Fridays for staff training. Extended hours are offered each day between 7am and 8am.

The student health centre at Exeter University is open during term time Monday to Friday between 8.45am and 6pm. Extended hours are offered from 7am to 8am on Tuesdays and 6.30 pm to 8pm on Thursdays during term time. During University vacations appointments are variable but include a minimum of three days a week between 9am and 5pm. These days are usually a Monday, Wednesday and Friday.

All calls are managed through the call centre based at St Thomas Health Centre. Calls outside of Exeter University Student Health Centre opening times are automatically diverted to St Thomas Health Centre.

Pathfinder Surgery is open on Mondays and Thursdays between 8.30am and 4.30pm but is closed at lunchtime on both days between 1pm and 2pm.

Calls outside of the St Thomas opening hours are answered by the Out of hours message handling service by patients dialling the NHS 111 service.

The group were a member of Exeter Primary Care (EPC), a federation of 16 Exeter GP groups. The EPC group organise increased GP access outside of the core hours of 8.30 and 6pm. All registered patients are therefore able to be seen, by appointment, by an ExeterGP, at an Exeter GP group between Monday and Thursday 6.30 to 8pm and Saturday and Sunday 9am and 5pm. St Thomas Medical group provides this service every Saturday between 9am and 5pm and on Tuesday and Wednesday evenings between 6.30pm and 8pm.

The group population area is in the seventh decile for deprivation. In a score of one to ten, the lower the decile the more deprived an area is. There is a group age distribution of male and female patients equivalent to national average figures. Average life expectancy for the area is similar to national figures with males living to an average age of 79 years and females living to an average of 80 years.

The organisation employs over 110 staff. There is a team of 28 GPs (19 female, nine male). Of the 28 GPs, ten are GP partners, there are two GP registrars (Doctors training to become a GP). The whole time equivalent of GPs is just over 14. The team of GPs are supported by a group manager, assistant group manager, nurse manager (an advanced nurse practitioner), paramedic, four lead group nurses, eight group nurses and eight health care assistants. The group employ an emergency care practitioner who has experience of working at the local emergency department. They work within the minor illness clinic at the group. The clinical team are supported by a clinical team lead, 12 clinical administration staff, six prescribing team members, 10 secretarial support staff, bookkeeper, volunteer coordinator and care taker.

Patients using the practices had access to community staff including community nurses, health visitors, midwives and counsellors. There is an independent pharmacy on the same site as St Thomas Health Centre.

The group were a teaching group for GP Registrars, (doctors who are training to become GPs). The group had also been identified as a placement for student nurses and has scheduled a student nurse to start in April 2018.

The GPs provide medical support to ten residential care and nursing homes.

St Thomas Medical Group is registered to provide regulated activities which include:

Treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services and Diagnostic and screening procedures and operate from the main locations of:

St Thomas Health Centre, Cowick Street, St Thomas, Exeter, Devon, EX4 1HJ

And three branch surgeries at:

Exwick Health Centre, New Valley Road, Exeter, EX4 2AD

Student Health Centre, Reed Mews, Streatham Drive, University Campus, Exeter, EX4 4QP

and

The Surgery, Brookside, Pathfinder Village, Exeter, EX6 6BT

We visited all these locations as part of our inspection.

Updated 17 May 2019

Letter from the Chief Inspector of General Practice

St Thomas Medical Group is rated as Outstanding overall. (the previous inspection October 2014 – Outstanding)

For purposes of the report the practice will be referred to as ‘the group’.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection of the St Thomas Medical Group on Tuesday 16 January 2018 and Thursday 18 January 2018 as part of our inspection programme.

At this inspection we found:

• The group had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen there was a genuinely open culture in which all safety concerns raised by staff and people who use services were highly valued as opportunities for learning and improvement.

• The group routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Patients with diabetes received effective care and were cared for by an experienced team of six nurses specialising in diabetic care.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

• The group were organised, efficient and had effective governance processes.

• The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care and were clear, supportive and encouraged creativity.

• There had been many organisational changes and annual changes in university patient population. In response to this, the leadership had maintained positive patient outcomes, effective communication, positive feedback from patients and provided a popular place for staff to work.

We saw two areas of outstanding group:

People’s emotional and social needs were seen as important as their physical needs and the group had recognised that there were a high number of socially isolated patients within the community. As a result the group had responded by employing a volunteer coordinator who ran a proactive team of over 40 volunteers within the league of friends group. Together the volunteers offered; a telephone service to ring lonely older adults every one to two weeks to offer support, a full programme of social events during the week, a medicines delivery service, a sitting service for carers and shopping services. The services offered by the volunteers, in conjunction with the group, had been welcomed by patients and was successful in attracting new members after they themselves had been supported.

The staff were proactively responsive to the needs of the local population and services were delivered in a way to ensure flexibility, choice, convenience and continuity of care for patients. For example, the group offered additional services for their own patients and others in the community including vasectomy service (268 patients had received this service in 2017), rheumatology clinic (599 appointments in the last year), headache clinic (304 patients had been seen and treated in the last year) and leg ulcer service (85 patients had been seen at the leg clinic in the last two years and 53 ulcers had healed through the effective treatment provided). Students at the University Health Centre had access to additional proactive services including close co-ordination with the University Well Being Centre, prescription services and reviews during non-term time.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 May 2019

Updated 17 May 2019

Updated 17 May 2019

Updated 17 May 2019

Updated 17 May 2019

Updated 17 May 2019