Exmoor Medical Centre

Updated 1 July 2022

Exmoor Medical Centre is located in Dulverton, Somerset, within Exmoor National Park

Oldberry House

Fishers Mead

Dulverton

Somerset

TA22 9EN

The practice offers a dispensing service for patients who live more than one mile (1.6 kilometres) from their nearest pharmacy. The practice has a General Medical Services (GMS) contract to deliver primary health care to the local population.

The service operates from a purpose-built building which is co-located with a dental surgery.

We visited this address as part of our inspection. Further information about the practice can be found at www.exmoormedicalcentre.co.uk

The practice is situated within the Somerset Clinical Commissioning Group (CCG) and delivers general medical services (GMS) to a patient population of approximately 4,000. This is part of a contract held with NHS England. The practice serves a rural community over an area of 300 square miles which encompasses Devon and Somerset. This brings challenges relating to the delivery of healthcare services over two counties.

The Index of Multiple Deprivation 2015 is the official measure of relative deprivation for small areas in England. The deprivation decile for this area is five with one being the least deprived and 10 the most. The practice had a higher than average number of patients aged over 65 which equates to 32% of the practice population compared with the local average of 24% and national of 17%. The percentage of patients aged over 75 was 14% compared to 10% (local) and 7% (national).

The provider is registered with the CQC in respect of the regulated activities: Diagnostic and screening procedures; Family planning; Maternity and midwifery services; Surgical procedures and Treatment of disease, disorder or injury.

The practice consists of a Clinical Lead GP, three salaried GPs and a practice manager. In addition to three registered nurses, an Advanced Nurse Practitioner, a health care assistant, administrative and dispensary staff. The practice is a training practice for trainee GPs.

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury and surgical procedures.

The practice is part of a wider network of GP practices in the West Somerset Primary Care Network.

Due to the enhanced infection prevention and control measures put in place since the pandemic and in line with the national guidance, most GP appointments were telephone consultations. If the GP needs to see a patient face-to-face then the patient is offered an appointment.

The practice has opted out of providing out-of-hours services to their own patients. Patients can access a local out-of-hours GP service via NHS 111.

Updated 1 July 2022

We carried out an announced inspection at Exmoor Medical Centre on 28 April 2022. Overall, the practice is rated as outstanding.

At our previous CQC inspection in June 2018, the practice was rated good overall. It was rated good in the safe, caring, responsive and well-led questions and outstanding in the effective domain. We also rated the care of people with long term conditions and those whose circumstances may make them vulnerable as outstanding.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Exmoor Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection to review the standard of care since being taken over by a new provider.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A short site visit

Our findings

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 have rated this practice as Outstanding overall

We found that:

The practice was able to demonstrate that they had continued to learn and innovate since the last inspection and through the COVID-19 pandemic. There was a commitment to engage with other providers to highlight and share best practice.

The practice had built on the areas identified through audits and innovative data collection to respond to the needs of their registered population. There was flexibility to redesign services to meet new challenges. The practice championed quality initiatives and all opportunities for learning.

Audit processes were embedded within the practice and we saw how this drove service improvements and patient safety. There was strong leadership with the clinical lead and staff engaging in external networks and using this as a basis to foster an environment of continuous learning and innovation.

A well-developed holistic approach to planning a patient’s, discharge or transfer to other services or into their own home, which included the use of a rapid response multi-disciplinary team helps meet an individual’s circumstances or preferences.

A truly holistic approach to assessing, planning and delivering care and treatment to the people who use the service with the creation of the rural hub for the farming community and those who are socially isolated.

The change process associated with the integration of Symphony Healthcare Services had been handled sensitively with the support and commitment of the practice team, and without any interruption to continuity at the practice.

The practice provided care in a way that kept patients safe and protected them from avoidable harm. Patients received effective care and treatment that met their needs with staff responding to patients with kindness and respect and involved them in decisions about their care.

The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.

The way the practice was led and managed promoted the delivery of high-quality, person-centered care.

We found no breaches of regulation.

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