Moretonhampstead Health Centre

Updated 24 May 2017

Moretonhampstead Health Centre is based in the rural town of Moretonhampstead on the edge of Dartmoor national park, Devon. The practice also provide simple consultations at two satellite clinics once a week at two parish halls in nearby villages which have minimal public transport access. The practice area is predominantly rural and covers 220 square miles.

The practice is commissioned by NHS Northern, Eastern and Western Devon CCG and is part of the Devon Local Medical Committee.

Moretonhampstead Health Centre provides a personal medical service to approximately 3100 patients. The 2011 census data showed that the majority of the local population identified themselves as being White British. The mix of patient’s gender (male/female) is almost equal female and male although there is a higher number of female over 85 years old. Public health data showed that 4.1% of the patients are aged over 85 years old which is higher than the local average (CCG) of 3.1% and higher than the national average of 2.3%. Levels of deprivation are recorded at 8 out of 10. One being more deprived and 10 being less deprived.

There are three GP partners (two female and one male) who together provided 17 sessions work at just under two whole time equivalent. There are two part time practice nurses and one healthcare assistant. The clinical team are supported by a practice manager, seven administration staff and a cleaner.

The practice is a training practice for medical students and for doctors who wish to become GPs.

The practice is open between 7.40am and 7pm on Mondays, and between 8.30am and 6pm Tuesday to Friday. Between 8am and 8.30am and 6pm and 6.30 calls are diverted to the out of hours provider who would contact the GP on call by mobile telephone if required. In addition to pre-bookable appointments that could be booked up to three months in advance, urgent appointments were also available for patients that needed them. Friday morning drop in appointments are also available and on average see 16 patients attending per week.

Out of hours patients are advised to contact the out of hours service provider via the NHS 111 service.

We inspected the main location at:

Moretonhampstead Health Centre, Embleford Crescent, Moretonhampstead, Devon, TQ13 8LW

The practice hold satellite surgeries at Lustleigh Parish Hall and Manaton Parish Hall. We did not inspect these sites however; we were provided with risk assessments for these locations which indicated a clean and safe environment for providing services at these locations.

Updated 24 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Moretonhampstead Health Centre on Tuesday 4 April 2017. Overall the practice is rated as Outstanding.

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.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• 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. Patients said the staff had a common caring ethos going over and beyond to ensure that patients are receivingoutstanding care.
• 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 GP but added they had to sometimes wait to see a named GP. Patients said there was continuity of care, with urgent appointments available the same day. Patients could access ‘drop in’ appointments on a Friday or access appointments on Tuesday afternoon at Lustleigh Parish Hall or Wednesday mornings at Manaton Parish Hall.
• Since the closure of the local hospital the practice had taken on a ‘walk in’ minor injury service during opening hours.
• The GPs worked with a RISE (Recovery and Integration Service) worker to care for and treat patients with a chronic drug addiction. This service had reduced the need for patients to travel 10 miles to the nearest service and had removed the stigma and made it more likely that patients will access the help they require to recover.
• 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.

We saw two areas of outstanding practice:

Involvement and empowerment of other organisations and the local community was integral to how services were planned and ensured that services met patient’s needs. There were innovative approaches to patient care and support in a rural close knit community which had reduced demand on GP and hospital services and improved patient wellbeing. For example, the practice had been supportive and instrumental in setting up domiciliary care agencies, community support groups, art groups, mother and baby support groups and prescription collection services for the benefit of local patients. These initiatives had resulted in more case histories of keeping patients at home, increased wellbeing and reduced social isolation. The art group promoted by practice staff met in the meeting room twice a week. Patients from the practice said this had improved their wellbeing and gave them something to look forward to each week. Data showed patients had reduced GP, nurse and home visit consultations compared to the periods prior to intervention. Their combined attendance dropped from 30 appointments in the eight months prior to the first set of classes to 10 appointments in the most recent eight month period.

There was strong culture of collaboration, empowerment and engagement from the leadership with a common focus on improving people’s experiences in the rural community. The leadership had an inspiring shared purpose to motivate staff, patients and the wider community to succeed and improve quality of care and people’s experience. The practice staff were outward looking and supportive in relation to the set up and governance of new community groups. For example, supporting and empowering the Morecare support group with recruitment and governance processes which then meant they could attend the monthly complex care multidisciplinary group meetings and offer support to patients. Additionally the practice had responded to the lack of domiciliary care services in the area and signed up as a partner to support an initial bid for a new community led local care agency ‘NedCare’. GPs had referred 27 patients who had received assistance from this service. We were given case histories where patients had been provided with support and reduced the need for admission to a care home or hospital.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 May 2017

The practice is rated as outstanding 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.
• Data showed that diabetes indicators were either comparable or higher than other practices in England and the CCG. For example, data from 2015/16 showed that 87% of patients with diabetes had had a normal blood sugar recording compared to the CCG average of 81% and 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 May 2017

The practice is rated as outstanding 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.
• 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 and patient participation group had been instrumental in setting up a ‘bumps and beyond’ group which had initially been held at the practice until attendance had grown in numbers. The group offered support to parents with young children and was supported by the practice based midwifery team. Any concerns identified were discussed at multidisciplinary team meetings.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 24 May 2017

The practice is rated as outstanding 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.
• 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.
• 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.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• Socially isolated older patients were encouraged to attend the art groups held at the practice to reduce their social isolation. Data also showed that patients had reduced GP, nurse and home visit consultations compared to the periods prior to intervention. Their combined attendance dropped from 30 appointments in the eight months prior to the first set of classes to 10 appointments in the most recent eight month period.
• The practice worked with Morecare, a local charity who provided befriending and transport services to patients. Practice staff had helped the charity with meeting space, with governance processes and also encouraged attendance at the multidisciplinary team meetings where patients with complex care needs were discussed.

Updated 24 May 2017

The practice is rated as outstanding 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 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.
• Repeat medicines could be requested via e mail, the local pharmacy or in person at The Health Centre. These could be collected from a designated collection point in Lustleigh village or sent by post.
• Appointments could be booked up to three months in advance. Early morning and evening appointments were available

Updated 24 May 2017

The practice is rated as outstanding 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.
• 92% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84% and CCG average of 87%.
• The practice specifically considered the physical and social health needs of patients with poor mental health and dementia. For example, patients and their carers were signposted to the art group which was held at the practice.
• 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 who have a comprehensive, agreed care plan documented was 100% which is better than the CCG average of 87% and 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.
• Patients at risk of dementia were identified and offered an assessment.
• 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 May 2017

The practice is rated as outstanding 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.
• 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 15 minute appointments to all patients and longer appointments for patients who needed them.
• The practice regularly worked with other health care professionals, support groups and charities 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. The practice offered their meeting room for these organisations and supported them with issues such as governance and fundraising.
• 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.
• The GPs worked with a RISE (Recovery and Integration Service) worker to care for and treat patients with a chronic drug addiction. This service had reduced the need for patients to travel 10 miles to the nearest service and had removed the stigma and made it more likely that patients will access the help they require to recover.