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Review carried out on 15 January 2020

During an annual regulatory review

We reviewed the information available to us about Talbot Medical Centre on 15 January 2020. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 9 February 2018

During a routine inspection

This practice is rated as Good overall. (Previous inspection August 2016 – Good)

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

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

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

People whose circumstances may make them vulnerable – Good

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

We carried out an announced comprehensive inspection at Talbot Medical Centre on 9 February 2018 as part of our inspection programme.

At this inspection we found:

  • Talbot Medical Centre had merged with another practice in January 2017. The practice had increased the patient list size, taken on an additional branch practice known as Northbourne Surgery and employed additional staff.

  • 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.

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

  • The practice met with Bournemouth University’s student union four times a year to capture feedback and discuss improvement of provision of services for patients who attended university.

  • 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 practice used the Electronic Frailty Index (EFI) for patients over 65 years to help identify and predict risks for older patients in primary care. Patients identified as living with severe frailty were also reviewed every month at multi-disciplinary meetings in order to co-ordinate care to meet individual needs.

  • The practice used a text message system to remind patients of appointments.
  • The practice helped to establish the Dorset Acute Integrated Respiratory Service (DAIRS) which provides support and services for patients with chronic respiratory diseases across Dorset. These services included the ability for patients to self-refer to hospital, receive intravenous antibiotics at home, access specialist clinics, and access educational and exercise groups.

  • The practice has a ‘dementia friendly’ status which they achieved by ensuring all staff had undertaken dementia training and modifications had been made to the signage and toilets at the location to help patients with dementia find their way around the building more easily.

  • The practice offered an ‘open access’ emergencies surgery’ between 9am until 11.30am and 3pm until 5.30pm Monday to Friday, for patients to attend without a pre-booked appointment.

The areas where the provider should make improvements are:

  • Continue to review the processes for patients with long term conditions to improve uptake of reviews by patients for better health outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 10 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Talbot Medical Centre on 10 August 2016; Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • The practice had effective links with community matrons and district nurses to support the care management of patients with long term conditions. Patients were discussed at monthly Multi-Disciplinary Team (MDT) meetings where practitioners shared information to support improvements in health and wellbeing.
  • The practice held monthly clinics with a diabetes nurse specialist from Royal Bournemouth Hospital to review selected patients with diabetes.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The GPs had signed up to run an ‘Avoiding unplanned admission’ programme and had managed to reduce the emergency admissions in the over 85’s from 298 in 2014-2015 to 273 in 2015-2016.
  • Staff at the practice held an in house smoke stop service providing help and support patients and those of neighbouring practices. As a result, the practice had identified a number of patients with previously undiagnosed chronic obstructive disease (COPD) and were able to address this and their smoking.

  • The practice used the vaccination programmes to offer patients the opportunity for their pulse rate to be checked. Those with an irregular pulse had been invited for heart monitoring and had identified a number of patients with previously unrecognised heartbeat rhythms which was then appropriately managed.

  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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. The practice was clean, tidy and hygienic. We found that suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.
  • 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.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

The practice were proactive in the care of patient’s needs in the locality: For example:

  • One of the GPs had been instrumental in setting up a polypharmacy project to practices in the locality and had been instrumental in its success. The review project had seen more than 100 patients having their medicines reviewed with an aim to reduce hospital admission from complications of taking multiple medicines. Data showed non-elective admissions to hospital had been reduced by 8.7% with a reduction of 8.4% at the practice.

  • One of the GPs at the practice had been instrumental in setting up a community service for patients with chronic respiratory pulmonary disease, asthma, and bronchiectasis. This was in response to increased hospital admissions of these patients and following feedback from patients requesting them with an alternative to going to hospital when they became unwell. The Dorset Acute Integrated Respiratory Service (DAIRS) was started in 2014 and had resulted in a 13.3% reduction in hospital admissions, and an estimated cost saving £1,172,500 from bed days saved. This reduction was despite the national trend of admissions increasing by 8.5%. There had also been a reduction in hospital readmissions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 2 June 2014

During a routine inspection

Talbot Medical Centre is a GP practice with a branch practice located at Bournemouth university. Over 17,000 patients are registered with the practice. A range of services are provided for patients including clinics for the management of long term conditions, family planning and child health. The practice is registered to offer: Family Planning, Maternity and midwifery services, Surgical procedures, Treatment of disease, disorder or injury and Diagnostic and screening procedures.

The patients we spoke with were very positive about the services they received from the practice.

There were systems in place to identify, assess and manage risk and staff were well trained to report any incidents which they felt may compromise safe delivery of care and treatment.

Patients were referred efficiently to local hospitals when they required specialist advice and treatment and GPs received appropriate information to support patients who had attended hospital.

The GP partners and the practice management were supportive and the staff we spoke with told us they found them very approachable. An open management culture was in place and staff were aware of the decisions they could make appropriate to their roles and responsibilities.

Clinical data showed us the practice performed well in delivering care and treatment for patients with long term conditions. The needs of the working age population were recognised because a range of appointment times, including evening appointments, were offered. Mothers babies and young children received services including childhood immunisation clinics and mother and baby checks. Patients at a number of nursing and care homes were registered with GPs at the practice. GPs visited patients at the care homes. GPs were prepared to carry out more home visits to patients recognised as in low income groups to ensure they received appropriate care and support. Sexual health and counselling services were provided for the registered student population.

The inspection took place at The Talbot Medical Centre. We did not visit the branch surgery.