You are here

Bideford Medical Centre Good

Reports


Inspection carried out on 11 February 2020

During an inspection looking at part of the service

We carried out an announced focused inspection at Bideford Medical Centre on 11 February 2020 as part of our inspection programme.

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice.

This inspection focused on the following key questions:

Is the service effective?

Is the service responsive?

Is the service well led?

Because of the assurance received from our review of information we carried forward the ratings for the following key questions:

Is the service safe?

Is the service caring?

The practice was previously inspected in June 2017 and the report published in July 2017 with an overall rating of Good and all domains rated as Good. On our inspection in February 2020 we found that significant improvements had been made which had changed the rating awarded.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We rated all population groups as good.

We saw areas of outstanding practice:

  • A national first had been achieved by the practice in setting up the community pharmacist scheme. As part of Improved Access appointments on weekends or evenings, patients could book a pharmacist appointment to discuss minor ailments or illnesses. Home visits were available. This service was open to all 180,415 pts across the 18 practices.

  • A new website had been designed to promote self-care and self-manage conditions such as drug and alcohol problems, better eating, anxiety, sleep and welfare. Patients in younger age groups had been particularly positive about the new service. The practice had shared the new website with the 18 other practices in North Devon.

  • A citizen’s advice bureau with a trained employee was available for bookable appointments at the practice. This service was funded by the practice. Patients could access consultations on a wide range of holistic solutions for health and well-being. For example, social prescribing, social security and housing, relationships and mental health.

  • Hospital waiting lists were actively reduced by the practice. A practice GP provided in-house vasectomy and carpal tunnels procedures. The practice had secured an agreement with the local hospital to enable them to reduce hospital waiting lists.

  • As the lead practice both in the North Devon Collaborative Board (NDCB) and Torridge Health Primary Care Network (PCN) the practice had initiated and implemented the improved access system across the 18 practices in North Devon.

Whilst we did not find any breaches of regulation, we found an area where the provider should make improvement;

  • Continue to improve cervical cancer screening uptake in line with national guidance

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 20 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bideford Medical Centre on 20 June 2017. 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 a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they found it easy to make an appointment with a named GP and there were urgent appointments available the same day. The practice deployed a dedicated “Same Day” team of GPs and a receptionist to make this happen for patients.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice offered carpal tunnel and vasectomy surgery.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff, patients, and external stakeholders, which it acted upon.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
  • The practice had acted upon the findings of its previous CQC inspection in November 2014. This included the provision of Mental Capacity Act 2005 training for all staff.
  • A wide range of external stakeholders including district nurses, community matrons, health visitors, school nurses and community nursery nurses visited the practice during our inspection and all provided us with positive feedback about the practice.

We saw areas of outstanding practice:

Patient’s individual needs and preferences were central to the planning and delivery of tailored services. For example, the provision of a dedicated “Same Day” team of GPs and a receptionist in addition to the practice GP team, the provision of a nurse practitioner run clinic minor illness clinic, for patients of all ages including babies. Patients were able to book an appointment and be seen the same day. This was provided five days a week.

The practice employed two clinical pharmacists, one partially funded by a clinical commissioning group (CCG) pilot scheme which ends November 2017 and the other is part of the national phase one clinical pharmacist pilot for three years. When the local initiative and national pilot end their posts will be funded entirely by the practice, in order to improve the service for patients. Their role was to check patient’s prescriptions were safe, effective and appropriate. They discussed patient’s different options such as blister packs and dosette boxes with separate compartments for days of the week to help patients maintain their medicine dosage accurately and safely. They checked hospital discharge summaries to identify required changes. They also liaised with external professionals such as care home staff, community matron and community nurses to review safe delivery and usage of medicines.

The practice recognised the challenge of communicating with teenagers. There was a dedicated teenager’s section on the practice website which offered advice and signposting to relevant services such as contraception and sexual health services. The practice worked locally with other practices to raise awareness of teenage pregnancies and accommodated poor timekeeping by some teenagers. Practice policy was to always book in young patients when they asked, recognising their courage in coming to the practice.

The areas where the provider should make improvement are:

The practice should ensure that audit systems are maintained to monitor the risks of infection.


Professor Steve Field

CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 25 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced inspection at Bideford Medical Centre on 25 November 2014. Overall the practice is rated as good. Specifically, we found the practice to be outstanding for providing responsive services. It was good for providing safe, effective, caring and well led services. It was good for providing services for all the population groups, noting that it was outstanding for providing responsive services for older people, children and young people, and people in vulnerable circumstances.

Our key findings were as follows:

  • Outcomes for patients were positive, consistent and met expectations. Patients told us it was easy to get an appointment and a named GP or a GP of choice, which provided continuity of care. They confirmed they were seen or spoken with on the same day if they had an urgent need. All had an allocated GP.
  • GPs kept individual lists so all patients had a named GP.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
  • Reliable systems were in place to maintain safety throughout the practice.
  • There was good IT support to enable staff to manage patient records well.
  • Treatment rooms and public areas were clean and there were systems in place to ensure hygienic conditions and equipment.
  • Continuity of care and good communication between parts of the practice and community staff was the key mark of this practice.

We saw several areas of outstanding practice including:

  • The nurse practitioner ran a clinic for minor illness, for patients of all ages. Patients were able to book an appointment and be seen on the same day. This was provided all day on Mondays and Fridays, and on Wednesday mornings. She found that anxious parents often brought their babies on Fridays, to get advice before the weekend.
  • A pharmacy advisor was employed, funded for four hours by the CCG and eight hours per week by the practice in order to improve the service for patients. She said that if she found a patient’s prescription was not appropriate for the patient she discussed it with their GP. She herself did not prescribe. She showed the patient different options such as blister packs and dosette boxes. These are boxes that patients can fill by themselves, or with assistance from family and carers. These have separate compartments for days of the week and / or times of day such as morning, afternoon and evening to help patients take their medicines accurately. The community matron and deputy contacted the pharmacy advisor when they encountered patients who needed support, for review of their medications or the method of delivery. They said she was a good resource and they consulted her for advice on queries also about patients who were registered at other practices. The pharmacy advisor told us that a new part of her job was to review discharge summaries from hospitals, especially of older frail patients, to identify potential mistakes or misunderstandings. She also checked that domiciliary care staff had been given clear instructions for example, whether eye drops were for the right or left eye.
  • The practice recognised the challenge of communicating with teenagers. They had introduced a teen noticeboard, making changes to their web site and using twitter. They had been collaborating with other practices with the aim of reducing teenage pregnancies. They accommodated young patients who may have poor time keeping, with open type surgeries allowing them to be seen by a GP if they presented at reception, without much waiting or bureaucracy. They always booked in young patients when they asked, recognising their courage in coming to the practice. Patients came to the practice at 3.30pm after college, even if they were not registered there.

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

The provider should:

  • Provide training for staff in the Mental Capacity Act 2005 (MCA) and its relevance for their work in respect of patients who may lack capacity to give informed consent to care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice