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Archived: The Clock Tower Surgery Good


Inspection carried out on 3 December 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

The Clock Tower Surgery, which is run by Devon Health Limited was inspected on Wednesday 3 December 2014. This was a comprehensive inspection.

The Clock Tower Surgery is a unique primary medical service set up to provide access to health care for homeless and vulnerably housed people in Exeter. The practice provides support to help patients get back into main stream health and social care services as soon as their health and housing status is stable.

The practice provides primary medical services to a diverse population. At the time of our inspection there were approximately 563 patients registered at the service with a team of two salaried GPs. Devon Health Ltd runs the practice, which has a board and executive directors responsible for overall management and financial responsibility for the practice. Supporting the two GPs the team included a registered nurse, practice manager and administrative staff. We spoke with seven staff and two community mental health workers who worked closely with the practice team to support patients.

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 practice is rated as GOOD. Specifically, we found the practice to be good for providing, effective, caring, responsive services and for being well led. It was also good for providing services for all population groups: older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia)

Our key findings were as follows:

  • Patients reported high level of satisfaction with the care and treatment being offered to them. Several reported to us their health had improved as a result of this and felt the practice was unique and promoted equality and compassion.
  • Patients reported having good access to appointments at the practice and two GPs which improved their continuity of care. The practice was clean, well-organised, had good facilities and was well equipped to treat patients.
  • The practice was seeking patient feedback daily as part of the ‘Friends and Family Test’.
  • The practice was well-led and had a clear leadership structure in place. There was an atmosphere of mutual respect and team work. There were systems in place to monitor and improve quality, identify business risk and systems to manage emergencies.

  • The practice was responding to patient need. For example, funding had been secured to set up a Health, Wellbeing and Community Hub (HWCH) for patients within central Exeter presenting with complex needs. These include: drug and alcohol dependency, housing needs (homelessness), offending behaviours, access to primary health care services, access to employment and training, together with access to benefit and debt advice. This would provide services under one roof for patients and promote well co-ordinated care and support for them.

We saw several areas of outstanding practice including:

  • Eighty three patients commented in person or in writing that the team was exceptional and genuinely cared about their welfare. For example, the practice had a clothing and bedding bank, which provided clean, warm clothing to any patients needing it. In cold weather, the team visited known areas of the city where patients were rough sleeping and offered warm drinks, additional clothing and bedding.
  • The practice performance for carrying out cervical screening for female patients with complex mental health needs was well above the target set by the CCG.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice