This practice is rated as Good overall. (Previous inspection October 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Fremington Medical Centre on 28 June 2018. The inspection was a routine inspection part of our inspection schedule.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved processes.
• Patients gave strongly positive feedback at the inspection about staff treating them with compassion, kindness, dignity and respect.
• People’s individual needs and preferences were central to the planning and delivery of flexible tailored services. All patient feedback highlighted ease of access to the appointment system, on the day assessment and short waiting time for routine appointments. Extended hours were available enabling working patients and school children to access a range of services from the multi-disciplinary team.
• IT was used effectively to engage patients in conversations about developments at the practice including social network sites. Access to advice and support was accessible for patients on the practice website.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Proactive succession planning based on staff development and training of future GPs, doctors and practice nurses was reinstated.
• Staff were committed to working collaboratively using innovative and efficient ways to deliver more joined-up care to vulnerable patients who used services.
• There were two areas where the provider could increase the frequency of audit to build on the quality improvement systems and review how patients who could be at risk of stroke or heart attack are assessed.

We saw areas of outstanding practice:

The practice established and ran a quarterly health and well-being club. Vulnerable patients who were not yet engaged with services were able to attend for companionship, healthy living advice and access support. Early identification of long term conditions, such as, hypertension (high blood pressure) had been picked up when blood pressure checks were done. At the June 2018 club, 13 patients had their blood pressure checked resulting in four booked in for review at the practice.

A dedicated internet application was developed at the practice for staff. This provided real time information easy access about current national guidelines, policies and procedures, shared learning, news, links and contact names and services available to signpost patients to.

An area where the provider should make improvements is:

Review the frequency of clinical audit to build on the quality improvement systems focussed on patient safety and effective care.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Fremington Medical Centre was inspected on Tuesday 14 October 2014. This was a comprehensive inspection.

Fremington Medical Centre provides primary medical services to people living in the very large quayside and inland village of Fremington and the area between the Bideford and Barnstaple bridges, North Devon.

At the time of this inspection approximately 6,400 patients were registered with the practice.

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

We rated this practice as good overall with elements of outstanding practice and some aspects of the service that required improvement.

Our key findings were as follows:

• Patients told us they had found GPs and nurses to be very kind and compassionate, and reception staff were on the whole friendly. Patients thought the practice was well organised, and often found their own GP was good at communicating with them about their care needs and treatment options. Patients said they felt they had been listened to.

• The practice had done extensive work on their appointment system. They had introduced a full telephone triage system for GP urgent appointments. This had improved both continuity and access, because all patients with urgent needs were seen on the day by the duty GP, so other GPs were able to see their regular patients at booked appointments.

• Requests for home visits were triaged by GPs. One patient with a long term condition described how the system helped them. Their GP listened to their account of their varying condition, reviewed medication regularly, and the triage system meant they only needed to see the GP occasionally as telephone calls back meant they did not need to attend. They said they felt the GP cared about their well-being.

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

• A trained nurse was the practice lead for infection prevention and control (IPC). She carried out an IPC audit, identified shortfalls and introduced improvements as a result.

We saw several areas of outstanding practice including:

• The practice had well above average clinical staff numbers for their population with 22 hours nursing provided per 1,000 population, with two nurse practitioners, four practice nurses and four health care assistants. This meant that nurses could offer patients appointments of 40 minutes to an hour to consider care and management of patients’ chronic conditions. The nurse team leader made home visits where appropriate to discuss results of tests and review the care of frail and ill patients. Training for the health care assistants meant that one now was able to support the GP in minor operations, a second was trained for wound dressing and a third was a phlebotomist.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice