Norton Brook Medical Centre

Updated 24 July 2017

Norton Brook Medical Centre is situated in the rural town of Kingsbridge in South Devon.

The deprivation decile rating for this area is seven (with one being the most deprived and 10 being the least deprived). The practice provides a primary medical service to approximately 10,100 patients of a diverse age group. The 2011 census data showed that majority of the local population identified themselves as being White British. Public health data showed that 13% of the patients are aged over 75 years old which is higher than the local clinical commissioning group average (CCG) of 10% and the national average of 8%.

There is a team of seven GPs partners, three female and four male; the partners are supported by two salaried GPs and two GP registrars. Some GPs worked part time making the whole time equivalent seven. Partners hold managerial and financial responsibility for running the business. The GP team are supported by a practice manager, deputy practice manager, a reception manager, three practice nurses, four health care assistants, a phlebotomist and additional administration staff.

Patients using the practice have access to community matrons, nurses and midwives, mental health teams, district nurses, school nurse and health visitors. South Hams hospital is also located nearby and the practice provided GP support for this 12 bed hospital. Other health care professionals visit the practice on a regular basis including a hospice nurse and palliative care nurses.

The practice is open from 8am to 6.30pm and from Monday to Friday. Appointments are offered between 8am and 6pm. Extended hours are worked every Monday and Thursday from 7.30am until 8am and on Monday to Thursday evenings from 6.30pm to 7.30pm. Outside of these times patients are directed to contact the out of hour’s service and the NHS 111 number.

The practice offers a range of appointment types including face to face same day appointments, telephone consultations and advance appointments (four weeks in advance) as well as online services such as repeat prescriptions.

The practice has a General Medical Services (GMS) contract with NHS England.

This report relates to the regulatory activities being carried out at:

Norton Brook Medical Centre

Cookworthy Road

Kingsbridge

Devon TQ7 1AE

We visited this location during our inspection.

Updated 24 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Norton Brook Medical Centre on 4 July 2017. 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 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.
• Results from the national GP 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 available. 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.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice understood its population profile and had used this understanding to meet the needs of its population. For example, the practice had introduced dementia and learning disability friendly signage throughout.
• The practice had adapted its practice nurse and health care assistant team in line with patient need, to meet a growing patient demand for more leg ulcer treatment and hypertension checks.
• The practice had introduced an “Emergency Team” which comprised one GP, one practice nurse and a GP registrar to provide urgent health care appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 July 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.

• Performance for diabetes related indicators was higher than the CCG and national averages. The percentage of patients with diabetes on the register for whom the most recent blood sugar readings were in the average range was 83% compared the CCG average of 81% and the national average of 78%.

• 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.

• 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 24 July 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, by close liaison with midwives and health visitors in the locality who came to the practice for monthly multi-disciplinary meetings.

• 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.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 24 July 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. 27% of the practice population were aged 65 years or older, which was higher than the national average of 17.2%.

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care. Of the total 97 deaths in the last 12 months, 47% of patients had died at their usual place of residence, in line with their requests. This was higher than the national average of 44%.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services. For example, the practice provided GP support to nearby South Hams Hospital which involved close liaison and appropriate information sharing of patient records in order to deliver safe and effective treatment.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, the practice was able to refer patients to support services for occupational health home assessments and individual care plans.

Updated 24 July 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.

• 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 provided telephone consultations, early opening extended hours, online appointment booking and an informative website for working age people who found it difficult to attend the practice during office hours.

Updated 24 July 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. Patients at risk of dementia were identified and offered an assessment.

• 84% of patients diagnosed with dementia had their care plan reviewed in the last 12 months. This was comparable with the national average of 84%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. The practice had introduced dementia friendly colour coded signage throughout the building.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 98%. This was higher than the national average of 89%.

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

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

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

Updated 24 July 2017

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 homeless people, travellers and those with a learning disability. The practice had introduced learning disability friendly signage throughout the building. This was colour coded.

• 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 with a learning disability.

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

• The practice had information available for vulnerable patients 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.