Archived: Boutport Medical Centre

Updated 19 March 2015

This practice is situated in a Georgian house in the centre of Barnstaple. The building is owned by a charitable trust, the Barnstaple Bridge Trust. Staff had been reassuring to patients who had been disturbed by the retirement and departure of GPs who had provided their care for many years. Five new GP partners now ran the practice, three women and two men, all part timers. Three practice nurses, a full time health care assistant and a team of administrative staff were employed. The partners said they would like to take trainee GPs but did not have a consultation room suitable for a registrar.

The practice population had increased by 3% in the past year, now over 5,000 people were registered as patients of the practice. It includes higher than average numbers of people living in sheltered accommodation. There is a higher than average number of people involved in drugs and alcohol. In the neighbourhood is a centre for homeless people and a support service for families in difficulties. Patients from these groups come to this practice because it is seen to be friendly and approachable.

The reception staff team had all worked at the practice for many years and knew the patients well. 98% of patients completing the practice’s survey had been happy with the reception staff saying they were welcoming and tried to help. Staff told us that the ethos throughout has been to help people. The partners stated mission was to aspire to be patient centred, responsive, to provide quality care and promote wellbeing.

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

Updated 19 March 2015

Letter from the Chief Inspector of General Practice

Boutport Medical Centre was inspected on Thursday 23 October 2014. This was a comprehensive inspection.

Boutport Medical Centre provides primary medical services to people living in the North Devon town of Barnstaple, and the surrounding areas. The practice provides services to a diverse population age group and is situated in the historic heart of the town.

Information from Public Health England shows this practice had more patients with long standing health conditions and more disability allowance claimants and carers than average for England and the population was found to have average levels of deprivation overall.

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. The midwives were based in the practice.

Overall this service was rated as good, with some work that was outstanding and some elements that needed improvement.

Our key findings were as follows:

• Patients could book in advance and see their own named GP, which they liked. Half of all appointments were ‘book on the day’.
• Patients with complex problems said they had been shown understanding and kindness and the care, manner and treatment from GPs had been second to none and very reassuring. Patients specifically mentioned the compassion and humour of reception staff.
• The practice used the Quality and Outcomes Framework (QOF) to measure its performance. The QOF data for this practice showed it was performing in line with national standards and above average with respect to support provided to some vulnerable groups.
• The premises needed considerable maintenance, as the practice was housed in a grade two listed Georgian building. A manager was identified as responsible for risk assessment and had carried out a health and safety audit of the service. Not all safety issues had been fully dealt with.

We saw several areas of outstanding practice including:

• A GP from this practice had arranged and produced a successful bid on behalf of the 23 member practices in the North Devon GP provider group, for funding for a single computer system to be used across these practices to help them work together. The bid was under the Prime Minister’s Challenge Fund for innovative models of care.

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

The provider should:

• Gather references as evidence of conduct in previous employment of GPs seeking to join the practice.

• The flooring in all clinical areas should be seamless and smooth, so it can be easily cleaned.

• There should be documented protocols in place for chronic disease management clinics that would ensure best practice was consistently followed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 March 2015

The practice is rated as good for the population group of people with long term conditions.

Speciality clinics and services were provided for patients requiring chronic disease management such as with asthma, Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Ischaemic Heart Disease, Stroke, Dementia, rheumatoid arthritis, mental health, epilepsy, the monitoring of warfarin (a blood thinning medicine), thyroid disease, cancer care. Patients were given appointments with respective trained nursing staff, combined with a health care assistant for testing as required.

Self-management plans were encouraged, with information about and links into expert patient programs, such as a ‘Breathe Easy’ group for patients with COPD.

A register was maintained of all patients at risk of unplanned admission to hospital including those who had been recently discharged. Proactive care planning and reviews were carried out in a timely manner.

A ‘virtual ward’ service was provided for patients with complicated health needs, whose care extended across multidisciplinary teams. Their care needs were discussed at regular meetings. The practice liaised on behalf of patients, with secondary care services such as specialist nurses in respiratory, heart failure, rheumatology and multiple sclerosis.

Updated 19 March 2015

The practice is rated as good for the population group of families, children and young people.

Pre-pregnancy counselling was offered. Antenatal care and maternity services were provided in partnership with midwives who were based in the practice. New-born baby checks were provided as well as postnatal checks for mother and baby.

Childhood immunisations were provided in accordance with the NHS programme with a high proportion of children immunised. Information from NHS England showed that 100% of children aged 24 months received their meningitis vaccination.

The receptionists ensured that families with young children were given appointment times that were convenient to them and appointments were provided the same day to children under five years presenting with a health problem. Regular links were maintained with a health visitor who ran a clinic from the premises.

The patients participation group had provided a baby change facility in a ground floor toilet. In the waiting room there were little chairs and tables for children, with a puzzle.

GPs provided information on sexual health, including promoting chlamydia screening. Contraception, including contraceptive implants was provided. GPs told us of using their professional judgement in accordance with the Gillick guidelines when assessing the competence of young patients to make decisions about contraception in their own best interest. A GP said young patients often came with a parent.

Safeguarding policies were in place and staff had received training in child protection. Health care professionals said they would phone the multi-agency hub and make a referral about any child they had concerns about and knew of the number they could phone to discuss queries.

Updated 19 March 2015

The practice is rated as good for the care of older people.

The practice followed good practice guidance in providing a named GP for all patients over the age 75, providing flu vaccines for all over 65 and shingles vaccinations for patients in the specified age range.

GPs aimed to provide a holistic and patient centred approach and provided home visits to frail patients.

Annual medication reviews were carried out as appropriate. Carers were supported to identify themselves and offered health needs assessments and reviews by staff trained for this purpose.

Consultations and treatment were always available on the ground floor for patients who found the stairs difficult and appointments were arranged to suit different needs, including extended hours.

Updated 19 March 2015

The practice is rated as good for the population group of the working-age people (including those recently retired and students).

Online access was provided for booking appointments and receiving test results to provide convenience and speed for working people. The practice opened at 7:30am every day for booked appointments. Telephone appointments were available.

Adult health checks were offered for patients over the age of 40. Work related medicals were offered such as those needed for taxi and heavy goods vehicle driving licences. In-house health care checks included phlebotomy, ECG, ambulatory BP, spirometry so that patients did not have to travel for these services. Machines were available for patients to borrow to test their blood pressure at home over a period of time.

If referral to secondary care was needed, patients were provided with a choice of care providers through the use of a full choose and book access to Devon services.

Updated 19 March 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia).

Patients with mental health problems were offered annual checks of their physical health. They were assured same day access to medical care if their health deteriorated.

Links were being promoted with the Depression and Anxiety Service which was based In a neighbouring property. Workers from that service used practice rooms to provide counselling services for patients at the practice.

Mental health services were actively promoted in the information screens provided in both waiting rooms, and leaflets about services and support groups were available.

Updated 19 March 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable.

Staff considered care of vulnerable patients to be a core part of their service because of their town centre location. Staff said they had made appointments for people who did not have a home address but needed medical attention. Support was provided to patients who had suffered domestic violence.

The practice supported the work of the Devon-wide adult substance misuse service. There was a high incidence of addiction in the area. Some GPs were accredited for shared care prescribing.

A register was maintained of patients who had a learning disability and they were offered annual health care checks.

The local population was predominantly white British. Use of a language line was available in case of need. Staff told us that local pharmacies directed holiday makers and other people away from home to this practice. When homeless people arrived, needing medical attention, they were registered and offered an appointment.