Background to this inspection
Updated
26 September 2018
Exmoor Medical centre is in Dulverton, Somerset within Exmoor National Park. It 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: Oldberry House, Fishers Mead, Dulverton, Somerset, TA22 9EN. We visited this address as part of our inspection. Further information about the practice can be found at www.exmoormedicalcentre.co.uk
The practice serves a population of approximately 4,000 patients over a rural area of 300 square miles which encompasses Devon and Somerset, which brings its own challenges of divided 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 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 two GPs and the practice manager. In addition, a salaried GP is employed which equates to the provision of 19 GP sessions per week in total. The practice team includes two registered nurses, a practice manager, a health care assistant, deputy practice manager, 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
26 September 2018
This practice is rated as Good overall. (Previous rating November 2014 – Good)
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Outstanding
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
We carried out an announced comprehensive inspection at Exmoor Medical Centre on 19 June 2018 as part of our inspection programme.
At this inspection we found:
- The practice had clear systems to manage risk so that safety incidents were less likely to happen. The systems such as the cancer significant event audit and the range of multi-disciplinary meetings led to improved, consistent high-quality care. When incidents did happen, the practice learned from them and improved their processes.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they could access care when they needed it.
- The practice undertook additional patient surveys such as individual GP feedback and bereaved family’s surveys following end of life care. They used colleague feedback surveys. These along with the national GP patient survey (2017) showed above average positive patient feedback.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
We saw one area of outstanding practice:
The practice had received accreditation for high quality end of life care and implementation of the Gold Standard Framework (GSF). The practice demonstrated innovative best practice and improvements in local care standards through implementation of the GSF for all patients with cancer and additional patient population groups. As a result, they could demonstrate improvements in quality of care provided.
The areas where the provider should make improvements are:
- Review the security of blank prescriptions within clinical rooms so that it is in line with national guidance.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.
People experiencing poor mental health (including people with dementia)
Updated
26 September 2018