Dartmouth Health & Wellbeing Centre

Updated 14 April 2016

Dartmouth Medical Practice was inspected on Tuesday 1 March 2016. This was a comprehensive inspection.

The main practice is situated in the coastal town of Dartmouth, Devon. The practice provides a primary medical service to 8,000 patients of a predominantly older population, 33% of which were aged over 65 years. The clinical commissioning group average is 24% and the national average is 16%. The practice is a teaching practice for medical students and is a training practice for GP registrars. The practice currently has one GP registrar.

There is a team of six GPs partners, one female and five male. There are also two salaried GPs, one female and one male. The practice also has a female GP retainer returning to practice starting in May 2016. The whole time equivalent was four and a half GPs. Partners hold managerial and financial responsibility for running the business. The team is supported by a practice manager, three practice nurses, four health care assistants, and additional administration staff.

Patients using the practice also have access to community nurses, palliative care nurses, mental health teams and health visitors. Other health care professionals such as drug and alcohol counsellors and midwives visit the practice on a regular basis.

The practice is open between the NHS contracted opening hours 8am - 6:30pm Monday to Friday. Appointments are offered anytime within these hours. Extended hours surgeries were until recently offered on a Saturday morning 8:30am to 12 noon. This is currently under review with the patient participation group (PPG) to make adjustments in line with patient demand.

Outside of these times patients are directed to contact the Devon doctors out of hour’s service by using the NHS 111 number.

The practice offers a telephone triage system with a duty GP each day. The practice is able to offer same day appointments, telephone consultations and advance appointments.

The practice has a Personal Medical Services (PMS) contract with NHS England.

The practice provides regulated activities from a single location at 35 Victoria Road, Dartmouth TQ6 9RT. We visited this location during our inspection.

Updated 14 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dartmouth Medical Practice on 1 March 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

The practice provided a room free of charge together with electricity, telephone lines and photocopier use to Dartmouth Caring, a charity that provided a support service to the town and rural community including the practice’s patients. This charity, which was based on practice premises and worked closely with the practice, offered luncheon clubs, home visits, befriending, a memory café, counselling, financial advice and help with hospital transport.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 April 2016

The practice is rated as good for the care of patients 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.

• The percentage of patients with diabetes on the practice register, who had received a flu vaccination in the last 12 months was 97%. This was higher than the national average of 93%.

• 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 14 April 2016

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

• 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 patients 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 patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice worked closely with a child health centre providing health promotional activities. A practice GP worked alongside a health visitor at a weekly clinic run from the Dartmouth children’s health centre to provide child health surveillance.

• The practice combined six week maternal and child postnatal checks in the same appointment at the children’s health centre to allow both to be done in a single visit. Patients had provided positive feedback about this. If mothers preferred a separate appointment with a different GP they were able to request this.

• The practice had provided cervical screening to 80.45% of its eligible patients which was in line with the national average of 81%.

• 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.

• Information displayed encouraged cervical screening, chlamydia and other sexually transmitted infection screening. Chlamydia screening bags were obtainable in the patient toilets.

• The practice offered an extensive range of contraceptive services.

Updated 14 April 2016

The practice is rated as outstanding for the care of older patients.

• Dartmouth Medical Practice had a higher than average elderly population. 33% of patients were aged over 65 compared with a clinical commissioning group (CCG) average of 24.1% and a national average of 16%, and the practice had tailored its services accordingly.

• The practice offered proactive personalised care to meet the needs of older people in its population with a named GP for all our patients, with as much continuity of care as possible.

• The practice offered home visits and urgent appointments to those with enhanced needs. In 2015, practice GPs had made 482 home visits, 90% of which were to patients over 65. The practice kept appointments available to fit in with the bus timetables for older people coming in from the rural villages. GPs carried out a regular weekly ward round at a local nursing home and virtual weekly ward rounds were held with two residential care two homes.

• Practice staff went the extra mile to provide a caring service. We found examples when practice staff had arranged transport for unwell elderly patients to get home and unable to make their own way, staff dropped emergency medicines off to isolated patients, GPs visited End of Life patients out of hours and gave them their home telephone numbers to ensure continuity of care and prompt response in case of emergency.

• The practice performed above average when compared with the local CCG and national averages in respect of management of clinical conditions commonly affecting older people such as, dementia, heart failure, osteoporosis, atrial fibrillation, cancer and palliative care.

• The practice had daily interaction with the local district nurses and community matron who worked with the most vulnerable patients. The practice maintained strong working relationships with community teams in order to support patients living independently in their own homes.

• Staff met regularly with the community rehabilitation team and a local well-established falls clinic with referrals from Torbay Hospital, GPs, Dartmouth Caring (a voluntary group based at the practice) and the local community team. Older patients were encouraged to attend strength and balance classes run by physiotherapists at nearby Dartmouth Hospital.

• The practice worked very closely with the local 18 bed Dartmouth community hospital where the occupancy was predominantly elderly. Practice GPs managed the day to day medical care with a daily ward round and on call in hour’s service. This enabled a good working relationship between the hospital staff and GPs. Practice GPs also regularly visited elderly patients attending the Day Care Centre at the hospital.

• Practice GPs provided cover for the local community hospital and enabled priority emergency admission beds to be available to practice patients at the hospital and in local care homes, so that older patients do not have to be admitted to distant hospitals where it is difficult for relatives and friends to visit.
• The practice provided a room free of charge together with electricity, telephone lines and photocopier use to a local charity (Dartmouth Caring), a charity that provided a support service to the town and rural community. This charity, which was based on practice premises and worked closely with the practice, offered luncheon clubs, home visits, befriending, a memory café, counselling, financial advice and help with hospital transport.

Updated 14 April 2016

The practice is rated as good for the care of working-age patients (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.

• The practice had referred 15 patients for smoking cessation support in 2015. Of these, 80% had successfully stopped smoking.

• The practice had systems in place to identify military veterans and ensured their priority access to secondary care in line with the national Armed Forces Covenant. The practice policy on military veterans was created in September 2015. The practice had identified 22 military veterans.

Updated 14 April 2016

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

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  90% of patients diagnosed with mental health issues had had their care plan reviewed within the last 12 months.

• Access to mental health care formed part of the practice and patient participation group action plan for 2014/15 and resulted in one of the GPs working with a retired psychiatrist and member of the PPG to create a simple leaflet detailing contacts to a variety of mental health support providers. This leaflet was displayed in the waiting areas and reception. The practice invited the local community psychiatrist and the crisis team psychiatrist to practice meetings where issues of access, communication and quality of care have been discussed.

• GPs had training in this area and were also able to refer patients to a secondary care mental health counsellor who provided a clinic at the practice on a weekly basis.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice 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.

• The practice 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 patients with mental health needs and dementia.

• Child mental health services were in the process of review locally and the practice was contributing to these developments in partnership with the PPG and Dartmouth Caring.

Updated 14 April 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.

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

• The practice regularly worked with multi-disciplinary teams 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.

• The practice worked closely with Dartmouth Caring, a charity that provided a support service to the town and rural community.The practice provided a room and resources to this charity which was based on practice premises, offering luncheon clubs, home visits, befriending, a memory café, counselling, financial advice and help with hospital transport.

• The practice had strong links with the bridge workers from Dartmouth Hospital and Dartmouth Caring who visited patients at home providing support for patients newly discharged from hospital.

• Several GP partners were trained to support and prescribe for recovering addicts under the shared care scheme. Patients were seen by the recovery and integration service (RISE) drug and alcohol team at the practice, often with the partner involved in their care.