Dunster Surgery

Updated 5 December 2018

Dunster and Porlock Surgeries (provider) is registered with CQC for the location Dunster Surgery. The provider provides primary medical services to approximately 6100 patients living in Dunster, Porlock and the surrounding rural area of Exmoor national park which encompasses Devon and Somerset, which brings its own challenges of divided healthcare services over two counties and 100 square miles. Since our previous inspection and following the closure of a local surgery, Dunster Surgery added 1700 people to their patient population. 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 in Dunster where they provide a dispensary service: West Street Dunster, Somerset TA24 6SN. We visited this address and the branch surgery: Porlock Medical Centre, Porlock, TA24 8PJ as part of our inspection. Further information about the practice can be found at www.dunsterandporlocksurgeries.co.uk

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 13% compared to 10% (local) and 7% (national). Patients aged 0 to 4 years was 3.3% (local 4.9% national 5.8%) and aged 5-14 years was 5.4% (local 11.1% national 11.8%).

The Partnership 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 partnership consists of three male GP partners and two salaried GPs (male and female). The practice team includes five practice nurses, one of which is an independent prescriber, a complex care nurse in a home support role, two practice managers, an associate practitioner and a health care assistant, administrative and dispensary staff.

The practice is a training practice for trainee GPs. At the time of the inspection, a GP registrar (a trainee GP) was working at the practice.

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 5 December 2018

This practice is rated as outstanding overall. (Previous rating May 2015 – Outstanding)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Good

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at Dunster Surgery and Porlock Medical Centre (the branch surgery) on 17 & 18 October 2018 as part of our inspection programme.

At this inspection we found:

• The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• 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, improved their processes and set review dates.
• The practice had an open culture in which all safety concerns raised by staff and people who use services were valued as integral to learning and improvement. They were innovative and implemented systems and processes to support them to identify and minimise risks to patients.
• There was a well-embedded culture of high quality sustainable care which included a strong focus on continuous learning and improvement, quality improvement such as clinical audit and reviews of the effectiveness and appropriateness of the care they provided across all levels of the organisation. This ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect. We saw that the practice cared for the population through provision of additional services such as those to enable end of life patients to remain at home. This included funding a night sitter nursing service for the local population and direct contact with a practice GP out of hours.
• There was compassionate, inclusive and effective leadership with an embedded system of progression and development which aimed to ensure that there was a whole team approach to service delivery. Practice leaders prioritised compassion and support towards their staff and other health professional’s wellbeing.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. They responded positively to their overall experience at the practice.

The areas where the provider should make improvements are:

• Dispose of medicine receptacles in line with safe management of healthcare waste guidance.
• Review and continue to monitor cervical smear screening to meet Public Health England screening rates.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 5 December 2018

Updated 5 December 2018

Updated 5 December 2018

Updated 5 December 2018

Updated 5 December 2018

Updated 5 December 2018