West Somerset Healthcare

Updated 8 May 2017

West Somerset Healthcare is located in West Somerset in the county of Somerset and provides primary medical services for approximately 10,000 patients within the villages of Williton and Watchet and surrounding rural area of 140 square miles.

The main practice is known as Williton Surgery, Robert Street, Williton TA4 4QE. A purpose built building (built in the 1970s) with an accessible car park and an independent pharmacy on the site. Approximately 65% of patients are seen at this location. Two miles north is Watchet, a harbour village where the branch surgery is located. This is known locally as Watchet surgery, 55 Swain Street, Watchet TA23 0AG. The branch surgery is located in a converted factory. Both villages are roughly equidistant between Minehead, Bridgwater and Taunton, lying between the Quantock Hills and the Brendon Hills, close to Exmoor.

West Somerset has a higher than average ageing population, with the longest living population in Europe with over 40% of pensionable age (Office National statistics 2010). This is reflected in the practice demographics with a much higher than average population over 65 years of age.

The practice has a much lower than average population under 39 years of age. The practice has a high level of deprivation with a score of 26.8 which is higher than the England average of 21.8 and the Somerset average of 18.

The practice has a Primary Medical Services contract (PMS) with NHS England to deliver primary medical services. The practice provides enhanced services which include facilitating timely diagnosis and support for patients with dementia; childhood immunisations; learning disabilities; minor surgery and enhanced hours patient access.

The practice team includes five GP partners (male and female) one management partner and one salaried GP. In addition the practice team comprises of two female advanced nurse practitioners, six practice nurses, two health care assistants, a practice manager, a reception manager, and data admin team leader and part time administrative staff which include receptionists and secretaries and a practice administrator. Most of the staff work across this practice and the branch surgery.

The practice is open between 8am to 6.30pm Monday to Friday with extended hours on various evenings, dependant on patient need, until 7pm and on one Saturday per month. Appointments are bookable six weeks in advance. The national GP patient survey (January 2016) reported that patients were satisfied with making appointments. Patients reported they were slightly less than satisfied with the practice opening hours.

The practice is a training practice for trainee GPs.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access NHS 111 out of hours and an Out Of Hours GP service provided care and treatment. Information is displayed in the surgery reception area and on the providers website.

Updated 8 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West Somerset Healthcare on 14 April 2016. The overall rating for the practice was good, with the area of safe being rated as requiring improvement. The full comprehensive report on the 14 April 2016 inspection can be found by selecting the ‘all reports’ link for West Somerset Healthcare on our website at www.cqc.org.uk.

This inspection was an announced focused follow-up inspection of West Somerset Healthcare on 18 April 2017, to confirm that the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good, with the area of safe now rated as good.

At the inspection 14 April 2016 the areas where the provider must make improvement were:

• The practice must follow the guidance on the Control of Substances Hazardous to Health Regulations (2002) and ensure safety data sheets were available in the practice.

• The practice must follow the Electricity at Work Regulations (1989) with regards to electrical system maintenance.

• The practice must review fire safety in line with Health Technical Memorandum 05-01.

• The practice must review emergency system checks including emergency lighting and fire alarms.

• Systems must be in place for the effective prevention and management of infection for equipment used for diagnosis and treatment.

• All staff must receive safeguarding adults training in a timely manner and in line with Safeguarding Adults: Roles and competences for health care staff – Intercollegiate Document (2016).

• Patient records must be stored securely in line with national policy.

• The practice must review and risk assess the stock of emergency medicines with regard to the use of atropine for the treatment of bradycardia, as a possible complication of intrauterine device insertion.

The areas where the provider should make improvement were:

• Effective systems should be in place to record and review fridge temperature readings in a manner that will identify if vaccines had been stored safely.

• A system to record minutes from vulnerable adult meetings to allow for a single document which explained any actions which had been taken to improve quality of care and safety for this group of patients.

• Consent forms for patients who undergo insertion of intrauterine (contraceptive) devices should inform patients fully of the risks associated with the procedure including the potential risk to them if the practice does not stock the recommended emergency medicine.

• Effective systems should be in place to safely store and monitor the security of blank prescriptions as per practice policy.

This inspection was an announced focused inspection carried out on 18 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• The provider had ensured there were safety data sheets available in the practice for the storage and handling of chemicals that were required to be kept in accordance to Control of Substances Hazardous to Health Regulations (2002).

• The practice had followed the Electricity at Work Regulations (1989) with regard to electrical system maintenance; an electrical hard wiring safety check had been carried out.

• The practice had reviewed fire safety in line with Health Technical Memorandum 05-01. Fire safety drills, fire safety training, emergency lighting, and external fire safety assessment had been carried out.

• Systems were in place for the effective prevention and management of infection for equipment used for diagnosis and treatment.

• All staff had received safeguarding adults training.

• Patient records were stored securely in line with national policy.

• The practice had reviewed their protocols in regard to the stocking of emergency medicine atropine (for the treatment of bradycardia, as a possible complication of intrauterine device insertion). The practice now ensured it was readily available when these procedures were carried out.

• Effective systems were in place to record and review refrigerator temperature readings to ensure vaccines had been stored safely.

• The provider had implemented a system to record minutes of vulnerable adults safeguarding meetings including any actions which had been taken.

• Effective systems were in place to safely store and monitor the security of blank prescription paper as per practice policy.

The provider should:

• The provider should continue to ensure that all staff remain aware of where the emergency medicine atropine was kept, so that they could respond appropriately if required for coil insertion procedures.

• The provider should continue to ensure that the emergency medicine atropine that is not held centrally with the other emergency medicines is checked in accordance with their emergency medicines policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 August 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance data for diabetes related indicators was similar to national averages.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 11 August 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 accident and emergency attendances. Immunisation rates were relatively high compared to the local clinical commissioning group averages for all standard childhood immunisations.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• Patients aged 16 received a letter from the practice offering support and the practice was engaged with the ‘Its ok 2BU’ agenda. The practice had an open access agreement with other local practices which enabled younger patients to visit any GP practice for advice and support. These services led to the practice being awarded a teenage friendly surgery accreditation.

• The practice had a families and a young person’s information board.

Updated 11 August 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 11 August 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 offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a health promotion and screening that reflects the needs for this age group.

Updated 11 August 2016

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

• Performance for mental health and dementia outcomes were similar to national averages.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example, the practice had trained and provided equipment to the community healthcare team to enable them to undertake health screening and reduce patient needs to attend the practice.

• The practice carried out advance care planning for patients with living with dementia. We saw patient centred personalised intervention plans which respected patient wishes.

• The practice had appointed a dementia lead who undertook twice weekly ward rounds at care and nursing homes where the majority of patients living with dementia resided to meet patient’s healthcare needs.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 11 August 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 those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed 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. However we saw staff were not up to date with safeguarding adults training.

• The practice held regular vulnerable adult and child protection meetings.  Vulnerable adult meetings minutes did not follow the same procedures for minutes as occurred during child protection meetings. This meant staff could not make reference to any single documentation which explained any actions which had been taken to improve quality of care and safety for this group of patients.