Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dawlish Medical Centre on 16 December 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. The practice was a sessional research practice which meant they not only identified patients for research programmes but collected data for trials.

• Feedback from patients about their care was consistently and strongly positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. Feedback about patients not being able to get through on the telephone prompted an increase of reception staff at peak times of the day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw several areas of outstanding practice including:

• A systematic approach was taken to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money. The daily work at the local community hospital not only provided continuity of care for patients, but also reduced hospital stay. For example, the target for average length of stay for the community hospital patients was 10 days and the actual average length of stay for patients was 6.7 days. Healthcare professionals from the community hospital told us that GPs often went above and beyond what was expected including the GPs mobile phone numbers for use during waking hours. Patient thank you cards also reflected this view point.

• The practice provided a GP service to patients who live at a local specialist medium secure mental health hospital. One of the GPs with a special interest in mental health worked with the community mental health team and hospital clinicians either on the hospital site or at the surgery.

• Results for cervical screening were above the national average. This was achieved using a system of offering telephone reminders for patients who did not attend for their cervical screening test. The practice also had a failsafe system for ensuring results were received for every sample sent as part of the cervical screening programme. 

However there were areas of practice where the provider should make improvements:

Ensure a system is in place to include doctors bags on the programme of checking and calibration of clinical equipment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Barton Surgery (Dawlish Medical Practice) provides primary medical services to patients living in Dawlish, Dawlish Warren and the surrounding areas. The practice in Dawlish has one small branch surgery in the holiday resort of Dawlish Warren where up to 3,500 patients and holiday-makers are seen per year. At the time of our inspection there were approximately 13,000 patients registered at the practice.

The practice has a team of nine GPs meeting patients’ needs. Six GPs are partners, meaning they hold managerial and financial responsibility for running the practice. There are three salaried GPs. In addition there are three registered nurses and three health care assistants. Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

Patients spoke very positively about the staff employed at the practice and the level of care they received.  Patients told us they felt that the practice was safe. They told us that care was given to them in accordance with their wishes and opportunities were given for informed decision making. Patients told us they felt the practice was responsive to their needs. For example, patients said that an urgent appointment could always be obtained on the day they contacted the practice and they could usually see their named GP for non-urgent visits. This reflected  the information provided on the practice website and within the practice welcome pack.

Patients told us about their experiences of the practice. Their responses were positive from patients we spoke to on the day, in 26 of the comment cards left for us and within the practice’s own patient survey 2012/13.

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

The practice was effective in the way it provided care to patients. In addition to the evidence obtained by our inspection team, the supporting data and documentation we reviewed about the practice demonstrated the practice performed very well when compared with all other practices within the clinical commissioning group (CCG) area. 

We saw the practice was well led, with a clear leadership structure in operation. The staff we spoke with spoke highly of the management within the practice and told us they felt supported in their roles. Supporting information reviewed during our inspection demonstrated the practice had appropriate systems in place that regularly monitored the safety and effectiveness of the care provided.