Letter from the Chief Inspector of General Practice

Axminster Medical Practice was inspected on Wednesday 1 October 2014. This was a comprehensive inspection.

The practice provides primary medical services to people living in the town of Axminster, Devon and the surrounding areas. At the time of our inspection there were approximately 11,120 patients.  Approximately 5,500 patients live in Axminster town itself with the other 5,600 living in the surrounding villages. The practice area covers approximately 100 square miles.

The practice provides services to a diverse population age group and is situated in a town centre location. 

The practice comprises of a team of nine GP partners, who hold managerial and financial responsibility for running the business. In addition there are three salaried GPs, four registered nurses, two nurse practitioners, three health care assistants, a practice manager, and administrative and reception staff.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

The practice had a dispensary attached.

Our key findings were as follows:

Patients reported having good access to appointments at the practice and liked having a named GP which improved their continuity of care. The practice was clean, organised, with facilities and equipment to consult with, examine and treat patients. There were effective infection control procedures in place. 

The practice valued feedback from patients and acted upon this. Feedback from patients about their current care and treatment was consistently positive. Staff portrayed a non-discriminatory, person centred culture. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Views of external stakeholders were very positive and aligned with our findings.

The practice was well-led and had a clear leadership structure in place whilst retaining a sense mutual respect and team work. There were systems in place to monitor and improve quality and identify risk and systems to manage emergencies. 

Patient’s needs were assessed and care planned and delivered in line with current legislation. This included assessment of patients’ mental capacity to make decisions about their care and treatment, and the promotion of good health. 

Recruitment, pre-employment checks, induction and appraisal processes were in place.  Staff had received training appropriate to their roles and further training needs had been identified and planned. 

Statistical data analysis demonstrated the practice performed comparatively with all other practices within the clinical commissioning group (CCG) area.

Patients felt safe in the hands of the staff and felt confident in clinical decisions made. There were effective safeguarding procedures in place. 

Significant events, complaints and incidents were investigated and discussed. Learning from these events was performed and communicated amongst all staff.

We saw one area of outstanding practice:

The practice provided carers with health and wellbeing checks, these detailed health checks were followed by a discussion session on a one to one basis with the carer about their needs and what other services may be available to them. The practice had a representative from an established local carers group who visited the practice once a month to augment this service. Carers were encouraged to contact the surgery at any time and were routinely followed up every six months.

However, there were also areas of practice where the provider needs to make improvements.  

Importantly, the provider should:

Ensure that there is a record of the distribution of blank loose leaf prescriptions. 

Ensure that a standard operating procedure is in place for the safe storage and use of liquid Nitrogen.

Professor Steve Field

CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We visited the surgery and dispensary over two days and we met and spoke with 6 patients during the day. This included a member of the patient representative group. This is mainly a virtual group with some people who meet up regularly. We obtained information and support and spoke with the practice manager, GPs, receptionists, administrators, the dispensary supervisor and dispensary staff and practice nurses who were on duty. We observed how the surgery was run and looked at the facilities and the information available to patients.

Patients told us about their experiences of the service, comments included: "There is no problem getting an appointment and the GPs really listen to you” and “The nurses are able to prescribe some medications which is great if that’s all you need, a great service”.

People told us their privacy and dignity were respected. People also told us they thought they were listened to and their opinion mattered, for example, "In general it’s a great place, everyone is very accessible and you can talk to anyone.” One person said “The receptionists are generally good, they ask if we mind sharing information but don’t probe. We are always respected here. It is a bit public if you are picking up medication for a sensitive issue but the staff are all lovely”.

There was evidence that learning from incidents, significant events and investigations took place and appropriate changes were implemented to improve the service and patient experiences.