Background to this inspection
Updated
29 October 2020
We carried out a desktop focused follow-up inspection of Holsworthy Doctors on 29 Sept 2020. We spoke with practice administration staff, clinical staff and patients via the telephone and electronic means. We did not carry out a site visit on this occasion. The practice is situated at Holsworthy Medical Centre, Dobles Lane, Holsworthy, Devon, EX22 6GH.
The practice is registered with CQC to deliver the following Regulated Activities: diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury.
The provider is a partnership of GPs and the strategic business partner registered as Ruby Country Medical Group, which is a multisite provider delivering services to nearly 30,000 patients in total from two registered locations: Stratton Medical Centre, Holsworthy Doctors and the branch surgery at Hatherleigh Medical Centre. The partnership works with Cornwall and Devon Clinical Commissioning groups to deliver services at these sites.
Holsworthy Doctors is situated within the Devon Clinical Commissioning Group (CCG) and provides services to 14,746 patients under the terms of a primary medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community. Patients are referred to secondary services within Cornwall and North Devon.
There are eleven partners (five male and six female). This included eight GPs, a clinical pharmacist, advanced nurse practitioner and the strategic business manager who are registered with the CQC as Ruby Country Medical Group. A team of salaried GPs are either based at one of the three sites or rotate across the group locations. There is a large multisite nursing team comprising of an Advanced Nurse Practitioner, eight Nurse Practitioners, 10 Practice Nurses, five Phlebotomists and six Health Care Assistants. There is a home visiting team comprising of Nurse Practitioners, a Paramedic and an Emergency Care Practitioner who review patients who are unable to attend the practice due to frailty or ill health. The practice networks with GP practices in Bude and across the North Devon border.
Holsworthy Doctors provides improved access appointments during early mornings, evenings and at weekends. Information about opening times is displayed at the practice and on its website.
The practice sees a significant number of temporary patients each year, peaking during the summer months. Holsworthy Doctors is located next to a local hospice and Holsworthy Community Hospital which provides outpatient services.
There are higher than average number of patients over 65 at 41.5% compared with the national average of 27.3%. The National General Practice Profile states that 99.2% of the practice population is from a white background with 0.8% of the population originating from Asian, black, mixed or other non-white ethnic groups. Information published by Public Health England, rates the level of deprivation within the practice population group as four, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 80 years compared to the national average of 79 years. Female life expectancy is 84 years compared to the national average of 83 years.
There are limited transport links due to the practice's remote rural location. The nearest acute hospitals are more than an hour’s drive away in Barnstaple, Exeter and Truro.
Ruby Country Medical Group is an approved training and teaching provider with close links to universities. It provides placements every year for medical students, GP registrars and F2 doctors. Students and registrars are able to work across all three sites run by the medical group, including Holsworthy Doctors.
Out of hours services are provided via 111 by Devon Doctors.
Updated
29 October 2020
This report follows a desktop inspection which was undertaken to follow up on previous concerns found at an inspection in November 2019. We carried out an announced inspection on 19 November 2019 of this service following our annual review of the information available to us including information provided by the practice. At that inspection we focused on the safe, effective and well led domains. We rated the practice as Good overall but requires improvement for providing effective services and requires improvement in all population groups. The practice was rated Outstanding for providing responsive services.
We rated the practice as requires improvement for providing effective services because:
- Some areas of performance for patient outcomes significantly declined during 2018/19 when patient numbers increased by 4,000, which the practice was aware of and targeting.
We carried out an announced focused desk-based inspection on 29 September 2020 to follow up on areas where we previously suggested the practice should look to improve their services.
We based our judgement of the quality of care at this service on a combination of:
• what we found when we reviewed evidence gathered from the provider remotely
• 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 good for providing effective services and good in the population groups older people, families, children and young people, working age people, vulnerable people and people experiencing mental health issues. We rated the population group of people with long term conditions as requires improvement. This is because:
- The patient outcomes areas of concern identified during our previous inspection had been monitored and improved. However, the practice achievement was below local Devon clinical commissioning group (CCG) and national averages.
- Data showed some improvement in the target areas of patients with long-term and mental health conditions in September 2020, however, there was also evidence of high exception reporting.
We found that:
- Staff teams and services continued to work collaboratively with the wider community and stakeholders.
- Patients with complex needs continued to receiveproactive co-ordinated care, which had been evaluated and improved upon since the last inspection. Innovative and efficient ways to deliver more joined up care in a safe way had been created for people using services in the wider community.
We also found:
- The practice had improved their systems to monitor and improve performance of reviewing patients with long-term and mental health conditions. However, further improvement and time was needed to see performance in line with CCG and national averages.
- Improvements had been made to slightly increase the uptake of cervical cancer screening. However, this was still below the national target of 80%.
- The practice had reviewed arrangements for storing blank prescription stationery across all sites and ensured that improved security was embedded in their systems and processes.
We identified areas where the practice should make improvements;
- The percentage of patients with cancer, diagnosed within the preceding 15 months, who have a patient review recorded as occurring within 6 months of the date of diagnosis was lower than the national average. The uptake of cervical cancer screening was also lower than the national target.
- Patients with dementia having an agreed comprehensive care plan’s exception reporting was 29% which was higher than the local CCG of 10% and nationally 8%.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant that we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what regulatory action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
Dr Rosie Benneyworth MB BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
Please refer to the detailed report and the evidence tables for further information.