Background to this inspection
Updated
6 April 2018
Beech House, Shebbear Surgery is run by two partners, the principle GP and a lead nurse practitioner prescriber, who also manages the practice. They took over neighbouring Hatherleigh Medical practice as the registered providers in October 2015. Both practices provide a service to approximately 3880 patients with patients being able to go to either location. The providers have one NHS contract to deliver primary care services to the two registered locations. The partners work as a GP and nurse at the practice, and also work at and manage this second GP practice.
The Beech House practice is situated in the rural village of Shebbear in North Devon. At the time of our inspection there were approximately 1,300 patients registered at the Shebbear Surgery. The practices population is in the sixth decile for deprivation, which is on a scale of one to ten. The lower the decile the more deprived an area is compared to the national average. The practice population ethnic profile is predominantly White British. The practice has a slightly higher elderly population than the national averages with 28% of the practice list aged over 65 years. The average male life expectancy for the practice area is 83 years which is higher than the national average of 79 years; female life expectancy is 84 years which is higher than the national average of 83 years.
There is a principle male GP supported by locum GPs. The team are supported by the practice manager who is also the lead nurse practitioner and prescriber, a practice nurse, a healthcare assistant/phlebotomist (phlebotomists are people trained to take blood samples) and additional administration and reception staff.
The practice also has a dispensary overseen by the lead GP and the pharmacist.
The practice opens Monday, Wednesday, Thursday and Friday from 8am until 6.30pm with a 1pm to 2pm session for lunch when calls are transferred to an answer machine with information about how to contact the out of hours provider. On a Tuesday the practice is open from 8am to 1pm with calls being transferred to the Hatherleigh Medical practice during the afternoon. Patients are able to access appointments at both of the provider's locations. Appointments are available at Beech House, Shebbear between 9am and 1pm or 2pm and 5pm Monday, Wednesday, Thursday and Friday. On Tuesday appointments are available between 8am and 1pm.
Outside of these times patients are directed to contact the out of hour’s service by using the NHS 111 number.
The practice have a Primary Medical Services (PMS) contract with NHS England.
This report relates to regulated activities from the site at Beech House, Shebbear, Beaworthy,
Devon. EX21 5RU.
Updated
6 April 2018
The LMC, CCG and NHS(E) have supported the practice following previous inspections and the practice had shown signs of improvement. Recently there have been whistleblowers, plus other concerns raised by healthcare professionals resulting in our planned focussed inspection being changed to a comprehensive inspection. Since the current inspection ended the practice has been working with NHS(E) to manage their contract.
This practice is rated as Inadequate overall. (Previous inspection February 2017 – Good overall).
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Inadequate
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Inadequate
People with long-term conditions – Inadequate
Families, children and young people – Inadequate
Working age people (including those retired and students – Inadequate
People whose circumstances may make them vulnerable – Inadequate
People experiencing poor mental health (including people with dementia) - Inadequate
We carried out an announced comprehensive inspection at Beech House, Shebbear Surgery on Tuesday 30 January 2018. The purpose was to follow up concerns about the leadership at the practice received in January 2018.
At this inspection we found:
- Care and treatment was delivered according to evidence- based guidelines.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical staff had been trained to provide patients with effective care and treatment.
- Patients we spoke with said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- Patients said they found it easy to make an appointment with a named GP and there was continuity of care now that the locum GPs were more regularly employed.
- The Hatherleigh practice ran an open surgery daily between 9am and 10.30am and between 4pm and 5pm whereby patients were able to walk in and wait to see a nurse or GP without a pre booked appointment and the patients of Beech House could also benefit from this service.
- The practice held a three monthly diabetic outreach clinic where patients with complex diabetes could be reviewed by the visiting diabetic team from the Royal Devon and Exeter Hospital.
- The service offered a ‘Market clinic’ in Hatherleigh where staff from the practice held an open surgery in the market once a year where anybody, including patients not on the practice registered list, could come and have blood pressure, blood glucose and any health queries checked. The practice staff then gave a report to take to the patient’s own practice.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients; for example, ensure systems are established and maintained for the proper and safe management of medicines, including ensuring; safe systems were in place for issuing private prescriptions for controlled drugs. Repeat prescriptions were not always signed before being dispensed to patients and there was not a reliable process to ensure this occurred.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care; for example, by ensuring; failsafe processes are in place for managing medicine alerts to ensure patient safety; systems are established and maintained to assess monitor and mitigate the risks associated with patient safety, staff employment, staff training, policies and procedures and management of significant events and feedback from staff; staff receive appropriate support, training and appraisal to carry out their duties and levels of leadership and and governance adequately facilitate safe, effective and well-led services for patinets and staff, considering the geography of the locations coupled with the clinical commitments of the partners and recent change in GP cover.
The areas where the provider should make improvements include:
- Policies are reviewed to provide current best practice guidance for staff
- Employment records show suitable medical defence cover and current registration with professional bodies before staff are employed
- Records for significant events clearly show staff involvement, learning points and actions taken.
- Communication with healthcare professionals is maintained during periods of staff shortages
- Systems are in place to ensure any medicines within doctors bags are within expiry date
- Staff have opportunities to attend meetings and are supported to give feedback
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice