We carried out an announced comprehensive inspection at Okehampton Medical Centre on 13 November 2018. The overall rating for the practice was good with safe rated as requires improvement. The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for Okehampton Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 April 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection on 13 November 2018. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

The overall rating for the practice is unchanged and rated as good. Safe is now rated as good.

Our key findings were as follows:

• Improvements implemented now ensured there were reliable systems for appropriate and safe handling of medicines.

• The leadership team were proactive in addressing risks so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Governance arrangements were strengthened with strong leadership and management of medicines evidenced.
• Policies and procedures for medicines management and dispensary services had been reviewed and a rolling review programme put in place to ensure current best practice guidance was followed to reduce risks.
• Exception reporting was reviewed through a programme of linked audit to increase uptake of reviews for any patients with long term conditions. Data over three years showed a trajectory of improvement with increased percentages of patients being reviewed.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Good overall. (Previous rating December 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

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 Okehampton Medical Centre on 13 November 2018. This was a routine inspection as part of the inspection schedule.

At this inspection we found:

• Okehampton Medical Centre had experienced a significant increase of 15% in the number of patients registered with the practice. The leadership team were proactive in addressing risks, responding to the community needs and had been successful in taking over the minor injury service keeping it in the town of OKEHAMPTON.
• 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 their processes.
• The practice did not always have reliable systems for appropriate and safe handling of medicines, although evidence received since the inspection confirmed these matters had been addressed.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patient feedback was actively encouraged. Feedback about the telephone and appointment system was acted upon and improvements made increasing access and availability of staff.
• Engagement with patients and community was driving development of services at the practice.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice is a member of the National Institute for Healthcare Research Clinical Research Network South West Peninsula and is actively involved in clinical research to improve patient care.
• Leaders had an inspiring shared purpose and strive to deliver high quality services and motivate staff to succeed. There was long-term investment in staff, increasing their skills, qualifications and well-being. Staff had access to health and well-being sessions at lunchtime to increase resilience. They were loyal, proud to work at the practice and there was a low staff turnover. Leaders were successful in recruiting newly qualified GPs, some of whom had trained at the practice. In 2018, this support and motivation was recognised when the employer had won an apprentice training provider award.

The practice focussed on the early identification of risks and illness for the farming community being aware of the high risk of suicide linked to occupational conditions in farming. Thirty-nine patients were identified as farmers, of which 19 were eligible for NHS health checks and had been recalled for a health check. The practice was continuing to carry out regular searches to identify patients in the farming community. Displays in waiting rooms and the patient participation group were helping to increase engagement with this at-risk group.

The area where the provider must make improvements as they are in breach of a regulation is:

Ensure there is proper and safe management of medicines. Governance arrangements for the management of medicines must be kept under review to ensure implemented changes are maintained and safety improved.

The areas where the provider should make improvements are:

Keep policies and procedures for medicines management and dispensary services under review to ensure current best practice guidance is followed to reduce risks.

Keep exception reporting under review to increase uptake of reviews for any patients with long term conditions.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Okehampton Medical practice on 21 July 2015.

Overall the practice is rated as good.

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

• The team was committed to providing co-ordinated, responsive and compassionate care for patients.
• Urgent appointments were available the same day but not necessarily with a GP of the patient’s choice.
• The practice had good facilities including disabled access and recognised there were areas of the building which could be improved in consultation with disabled patients.
• Information about services and how to complain was available. The practice actively sought patient views about improvements that could be made to the service and worked with the patient participation group (PPG) to do this.
• The practice proactively sought to educate their patients to manage their medical conditions and improve their lifestyles. Additional in house services were available and delivered by staff with advanced qualifications, skills and experience.
• There were systems in place to reduce risks to patient safety for example, infection control procedures.
• Patients’ needs were assessed and care was planned and delivered following current practice guidance. Staff had received training appropriate to their roles.
• The practice used audits and had shared information from one of their audits with other practices to promote better patient outcomes.

The Provider should:

• Reinstate a schedule of review dates for all policies and procedures to ensure that these meet current legislation and guidelines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We received feedback from six people who were patients at the Okehampton Medical Health Centre. This included people telling us about their spouse/partner’s experience, and about/or their experience of the practice as a carer accompanying people registered here. We also met with a representative of the Patient Participation Group (PPG). This group acted as voice for patients at the practice.

People told us everything was explained and the doctors and nurses discussed treatment options. Everyone said they were involved in their treatment plan and given the time to consider the options.

We found people's treatment needs were assessed and treatment was provided by experienced and qualified staff. There were systems in place in the event of a medical emergency. Medicines and vaccinations were managed appropriately to keep people safe.

We found that staff were qualified and had the relevant skills and experience to carry out their jobs. They were registered with relevant professional bodies which meant they were able to carry out their respective jobs.

We found the service was well-led and the quality of the service provided was audited and monitored by the staff, the provider and externally by other regulatory bodies to ensure it was safe and effective.