Queen's Medical Centre

Updated 4 February 2016

The GP partnership runs the Queens Medical Centre, which has this one location.

Queen’s Medical Centre is contracted with NHS Devon and the Northern, Eastern and Western Devon CCG (Clinical Commissioning Group) to provide general medical services to people living in Barnstaple, where social deprivation is high with some surrounding areas of affluence. There were 7441 patients registered at the practice when we inspected. The practice population of working age people is slightly higher with more patients over the age of 45 years.

The practice provides some enhanced services which are above what is normally required covering extended hours access, facilitating timely diagnosis and support for people with dementia, influenza and pneumococcal immunisations as well as monitoring the health needs of people with learning disabilities. The practice also provides direct enhanced services including remote care monitoring for vulnerable patients and shingles and rotavirus vaccination.

There are five GP partners and a salaried GP at Queen’s Medical Centre: three male and three female. The GPs are supported by three female registered nurses and two female health care assistants. The practice has a practice manager, additional administrative and reception staff. Patients have access to community staff based at the practice including district nurses, health visitors, and midwives.

Queen’s Medical Centre is a teaching practice, with one GP partner approved as a trainer and two GP partners approved as teachers with Health Education South West. The practice normally provides placements for trainee GPs and senior trainee doctors (ST2 and ST3 medical doctors. Teaching placements are provided for year 3, 4 & 5 and medical students. However, there were no medical students on placement at the time of the inspection.

Queen’s Medical Centre is open from 8. 30 am – 6 pm each weekday. Throughout each day the practice has a same day team with appointments available on the day for emergencies. Extended hours appointments and telephone consultations are available for working patients. These are on Monday 6.30 – 7.30 pm and Friday 7.15am – 8am. Routine appointments are available to be booked up to 6 weeks in advance. Appointments are usually for 10 minutes but longer appointments are available on request.

When the practice is closed, patients are directed to an Out of Hours service delivered by another provider. This is in line with other GP practices in the Northern, Eastern and Western Devon CCG.

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queens Medical Centre on 18 August 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• Feedback from patients about their care was consistently and strongly positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand.
• The practice had a clear vision which had quality and safety as its top priority in delivering person centred care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 February 2016

The practice is rated as good for the care of people with long-term conditions.

• Longer appointments and home visits were available when needed.
• Nursing staff had lead roles in chronic disease management with support from the GPs.
• Staff had extended their skills and were able to offer services such as minor surgery for removal of dermatological lesions.
• Patients with long term conditions had a named GP and a structured annual review to check that their health and medicine needs were being met.
• The practice maintained registers and provided regular clinics for patients with long term conditions. QOF results indicated that chronic disease management was good.

Updated 4 February 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Midwives, health visitors and school nurses confirmed the practice worked well with them.
• A full range of contraception services and sexual health screening, including cervical screening and chlamydia screening was available at the practice.
• Young person friendly resources about sexual health was accessible on the practice website.
• The practice was starting to use social media and working in partnership with the local college to increase young patients’ involvement in the patient participation group.

Updated 4 February 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Older patients receiving regular medicines were seen for bi-annual and more frequent where required face-to-face reviews with the GP. 
• The practice participated in the Unplanned Admissions Direct Enhanced Service with systems in place to identify the top 2% of the practice population who were judged to be most at risk. These patients were made known to staff, had a care plan and were discussed with the multidisciplinary team to help maintain patient independence and enable patients to remain at home, rather than be admitted to hospital.

Updated 4 February 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Pre booked appointments were available 6 weeks in advance in addition to same day appointments. There were early morning and late evening appointments twice a week for the working population and other patients.  
• The practice offered NHS health checks to patients aged 40-70, smoking cessation clinics and provided dietary advice to patients.

Updated 4 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 89.71% of patients on the mental health register had received an annual physical health for 2014/15.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. 
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 4 February 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It had told vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The practice provided support for people with drug and alcohol issues in conjunction with RISE (Recovery and Integration Service) a service for adults in Devon.
• Translation phone services were used to accommodate language needs if requested. The practice had an induction hearing loop and was accessible for people in a wheelchair. 
• The practice has a learning disability register and offered annual health checks for this patient group.