Buckfastleigh Medical Centre

Updated 1 August 2017

The practice is situated in the small rural town of Buckfastleigh which is situated on the edge of Dartmoor National Park and provides a primary medical service to approximately 4,900 patients of a diverse age group.

There is a team of four GPs partners, two male and two female. Partners hold managerial and financial responsibility for running the business. The team are supported by a part time business manager, a nurse practitioner, two practice nurses,  a healthcare assistant and additional clerical and reception staff who are managed by a reception manager and administration manager.

The practice is a training practice for doctors who are training to become GPs and for medical students. The practice also supports the apprentice scheme.

Patients using the practice also have access to community nurses, midwives, mental health teams, counsellors, research nurses, aortic screening and retinal screening on site. Health visitors and school nurses were based at the practice.

The practice is open from 8am to 6pm Monday to Friday. Early morning clinics are offered from 7:10am on Monday and Fridays. Outside of these times patients are directed to contact the Devon Doctors out of hour’s service by using the NHS 111 number.

The Buckfastleigh Medical Centre provides regulated activities from Bossell Road, Buckfastleigh Devon TQ11 0DE.

Updated 1 August 2017

Letter from the Chief Inspector of General Practice

This announced focused inspection was carried out on 5 July 2017 to confirm that the practice had made improvements to meet the actions falling below a regulatory breach in our previous comprehensive inspection on 24 February 2016. In February 2016 the overall rating for the practice was Good. The full comprehensive report for the February 2016 inspection can be found by selecting the ‘all reports’ link for The Buckfastleigh Medical Centre on our website at www.cqc.org.uk .

This report covers our findings in relation to improvements made since our last inspection.

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

• The practice had clearly defined systems to minimise risks to patient safety. A new pharmacist had been employed to oversee medicines management.

• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The practice had introduced a new on line tool to assist with the provision of staff training

• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was clean, tidy and hygienic. We found that suitable arrangements were in place which ensured the cleanliness of the practice was maintained to a high standard.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 April 2016

The practice is rated as good for the care of people 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.
• 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.
• Feedback from health and social care professionals was positive. They said communication was effective and that patients at risk of hospital admission were identified as a priority.
• The practice maintained robust registers and provided appointments for patients with long term conditions. QOF results indicated an efficient management of chronic disease management with maximum points achieved in the last few years.
• Flu vaccine uptake rates were slightly lower than national average due to the alternative lifestyles of significant numbers of parents in this locality. The practice had attempted to improve uptake by advertising in the local paper, a leaflet drop to houses in the town, offering vaccines in extended hours and encouragement during routine appointments.
• Flu clinics were used as an opportunity to screen and test patients for long term conditions using a questionnaire and basic physiological measurements.

Updated 7 April 2016

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

• 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 people who had a high number of A&E attendances.
• There was a safeguarding children lead who also acted as the families and young people specialist GP for the practice. This GP held weekly clinics with the health visitors for mothers and babies to ensure any concerns are addressed. Monthly meetings were held with the health visitors to discuss concerns of vulnerable families.
• Immunisation rates were slightly lower than national average for all standard childhood immunisations due to the alternative lifestyles of significant numbers of parents in this locality. The practice were aware of this and had in place many initiatives provided to attract more parents. For example, flexible appointments, opportunistic immunisations and repeated contact by practice staff.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Patients were able to access a full range of contraception services and sexual health advice.
• We saw positive examples of joint working with midwives. Health visitors and school nurses were located on site and feedback about the practice from these health care professionals was positive.

Updated 7 April 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people 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.
• Older patients receiving regular medicines were seen for bi-annual face-to-face reviews with the GP.
• The practice participated in the unplanned admissions Direct Enhanced Service with systems in place to identify the top 2% of the practice population who were judged to be most at risk. These patients were made known to staff, had a care plan and were discussed with the multidisciplinary team to help maintain patient independence and enable patients to remain at home, rather than be admitted to hospital. A member of the local voluntary service also attended to assist with transport needs.
• The GPs used flu clinics to gather information and perform initial screening for health issues including dementia and irregular heart patterns.
• Practice staff worked with two local care homes and carried out ward rounds at the local hospital.

Updated 7 April 2016

The practice is rated as good for the care of working-age people (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.
• Patients had access to NHS Health Checks and smoking cessation at the practice.
• Extended hours were offered on Monday and Fridays from 7:10am following feedback from patients.

Updated 7 April 2016

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

• 78.12% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84.01%.
• 26 of the 45 patients on the mental health register had received an annual health check so far this year.
• 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. Any relevant information for at risk patients in this group were shared with out of providers to provide continuity of care.
• 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.

Updated 7 April 2016

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 patients, 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 offered longer appointments for patients with a learning disability and patients with learning difficulties were all offered an annual health check, by the health care assistant. The practice had performed 45 of the 54 of the annual health checks on patients on the practice learning disabilities register so far this year.
• The practice staff support care homes for patients with learning disabilities in the town and home visits were offered where patients were unable to visit the practice.
• The practice promote the ‘Green prescription’ service in conjunction with Dartmoor National Park. This allows patients to access outdoor group activities including walking, cycling and arts to promote wellbeing and reduce the need for repeated appointments. The practice also encourage a group of patients with mental health issues to use the practice garden to grow vegetables and plants to improve their mood.