Beacon Medical Centre

Updated 15 May 2017

Beacon Medical Centre, also known as Sid Valley Practice is located on the outskirts of Sidmouth. There is a branch surgery; Blackmore Health Centre which is also located in the town centre of Sidmouth. The practice supports approximately 15, 000 patients.

The practice population is in the tenth less deprived decile for deprivation. In a score of one to ten the lower the decile the more deprived an area is. There is a practice age distribution of male and female patients equivalent to national average figures. Average life expectancy for the area is higher than national figures with males living to an average age of 83 years for males and females to 86 years.

There are 11 GP partners, five of which are female and six are male. There are three salaried GPs (one male and two female). Together they provide 78 patients sessions per week (just under 10 whole time equivalent staff). The GPs are supported by a practice manger, an assistant practice manager, an office manager, a human resources manager, eight nurses, seven healthcare assistants, and 35 additional administrative and reception staff.

Patients using the practice also have access to community staff including district nurses and health visitors.

The practice is a teaching and training practice. GPs work with the university of Exeter Medical School and provide support for 4th and 5th year medical students. One of the GPs provides support and training for FY2 doctors (A Foundation doctor (FY1 or FY2 also known as a house officer) is a grade of medical practitioner in the United Kingdom undertaking the Foundation Programme – a two-year, general postgraduate medical training programme which forms the bridge between medical school and specialist/general practice training.) who are working at the local community hospital.

The main practice, Beacon Medical centre, is open from Monday to Friday, between the hours of 8am and 6pm in line with local arrangements with the out of hours provider between 6 and 6.30pm. The branch practice, Blackmore Health Centre, is open every Monday, Wednesday, Thursday and Friday, between the hours of 8.30am until 1pm and then 2pm until 5pm and every Tuesday and between 8.30am and 1pm. Patients can book routine appointments up to eight weeks in advance. If a patient cannot get a routine appointment with their own GP within 3 weeks then they are offered an alternative GP if they wish.

During evenings and weekends, when the practice is closed, patients are directed to attend Exeter NHS Walk in centre or to dial NHS 111 to talk to an Out of Hours service delivered by Devon Doctors.

The following regulated activities are carried out at the practice; Treatment of disease, disorder or injury; Surgical procedures; Family planning; Diagnostic and screening procedures.

We visited the main practice located at: Sedemuda Road, Woolbrook, Sidmouth, EX10 9YA. We did not visit the branch located at Blackmore Drive, Sidmouth EX10 8ET which was being used as a branch surgery.

Updated 15 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Beacon Medical Centre on 11 April 2017. Overall the practice is rated as good with requires improvement in the well led domain..

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. Staff were encouraged and actively supported to develop their roles.
• There were GPs with a special interest (GPwSI) in dermatology and orthopaedics which meant patients could receive specialist treatment at the practice.
• The practice employed a pharmacist one day a week who performed roles to assist the GPs at the practice. These roles included patient medicine reviews and audit.
• Results from the in house patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was not readily available in written format and difficult to access online. However, improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Patients said they appreciated the minor injury service provided by the practice.
• The main practice had good facilities and was well equipped to treat patients and meet their needs. This included a designated operating theatre where carpel tunnel surgery and skin cancer surgery was performed. The GPs were in discussions with NHS estates regarding the development and upgrade of the branch site as they recognised improvements were required.
• There were age appropriate toys and books in the waiting room and an interactive flooring area that was popular with children.
• Recruitment was well managed and detailed systems were efficiently used to monitor staff recruitment and employment issues.
• The prescriptions team at the practice worked closely with the local pharmacies to ensure blister packs were provided for older people with memory problems.
• One of the GPs was a dementia champion and used their knowledge and experience to make early diagnosis and referrals as necessary.
• One of the GPs sits as a trustee on a voluntary basis at the local Memory Café and personally led the work to secure an Admiral Nurse for the town, now in place. (Admiral Nurses are specialist dementia nurses who give expert practical, clinical and emotional support to families living with dementia). Staff at the practice supported fundraising for this service.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice were proactive in the care of patients with dementia. One of the GPs was a dementia champion and had used their knowledge and experience to make early diagnosis and referrals as necessary. 79.1% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average (30-75%). Another GP had acted as a trustee on a voluntary basis at the local Memory Café and supported fundraising to secure an Admiral Nurse for the town, now in place.

The areas where the provider should make improvement are:

• Review systems and records so they reflect the discussions and actions taken to ensure staff who do not attend the significant event meetings are fully aware of learning and outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 May 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• Sid Valley Practice had signed up for the local shared care record project in 2016. This enabled health and care professionals such as Devon Doctors, the ambulance service and Royal Devon & Exeter hospital to view relevant information about the patients.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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 15 May 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice provided support for premature babies and their families following discharge from hospital.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• There were age appropriate toys and books in the waiting room and an interactive flooring area that was popular with children.

Updated 15 May 2017

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

• There was a higher than average elderly population at the practice (40% of patients are over 65 and 21% were over 75 years of age.)
• The GP practice had developed a proactive and personalised programme of care and support, which was tailored to the needs and views of older people registered with the practice. Each patient had a named GP but were also able to see other GPs at the practice.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The practice employed a duty personal assistant who supported the duty GP by contacting patients to update and help patients where appropriate.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Care plans were in place for patients at high risk of unplanned admission and these were shared with local out-of-hours providers, the ambulance services and emergency department. Regular hospital avoidance of admission meetings were held.
• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• Older patients and carers were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible
• The GPs undertook a daily ward round at the hospital (situated next to the branch surgery in Sidmouth) during the week and were responsive to urgent requests from the hospital for patient care such as medicine changes and X-ray requests.
• The practice had responsive systems in place for the care of their patients in care homes. The practice manager and one of the GPs visited six care homes in the area to discuss and review the care provided to their patients with a view to find ways to continually improve the service. As a result of these meetings the care homes were given a direct line telephone number so that they could contact the practice without delay when needed.

Updated 15 May 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.
• The staff were proactive in calling patients into the practice for health checks. These included offering referrals for smoking cessation, providing health information, routine health checks, carers assessments and reminders to have medicine reviews. This gave the Practice the opportunity to assess the risk of serious conditions on patients which attend. The Practice also offered age appropriate screening tests including cholesterol testing.

Updated 15 May 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 79.1% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average (30-75%).
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. A pharmacist had been employed by the practice to assist with this role.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• The prescriptions team at the practice worked closely with the local pharmacies to ensure blister packs were provided for older people with memory problems.
• One of the GPs was a dementia champion and used their knowledge and experience to make early diagnosis and referrals as necessary.
• One of the GPs sits as a trustee on a voluntary basis at the local Memory Café and personally led the work to secure an Admiral Nurse for the town, now in place. Staff at the practice supported fundraising for this service.

Updated 15 May 2017

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

• The practice provided care and treatment to patients living in vulnerable circumstances including homeless people, refugee families and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients who needed them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients and their carers about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.