Background to this inspection
Updated
23 April 2018
Axminster Medical Practice is a GP practice which provides its services under a Personal Medical Service (PMS) contract for approximately 11,900 patients. The practice is situated in the rural town of Axminster.
The practice population area is in the seventh decile for deprivation. In a score of one to ten, the lower the decile the more deprived an area is. The practice distribution and life expectancy of male and female patients is equivalent to national average figures. However, the practice had a significantly higher than average number of patients aged over 75 and 85 years, (15% of the practice list were over the age of 75 years compared to the national average of 7% and 5% of the patient list were over the age of 85 compared with the national average of 2%). Average life expectancy for the area is similar to national figures with males living to an average age of 81 years and females living to an average of 84 years.
The practice offers dispensing services to approximately 6,000 patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy.
There is a team of twelve GPs. Of the 12 GPs eight are partners and four are salaried GPs. The whole time equivalent of GPs was just under 8 WTE.
The team also includes a practice manager, assistant practice manager, a nurse practitioner, a prescribing practice nurse, three practice nurses, four health care assistants, a phlebotomist, nine administration staff, seven reception staff and eleven dispensary staff.
Patients using the practice have access to community staff including community nurses, health visitors, counsellors, alcohol and drug recovery workers and other health care professionals.
The practice is a teaching practice for GP Registrars (doctors training to become a GP) and foundation doctors (doctors who have qualified in the last two years).
The GPs provide medical support to residential care homes and nursing homes in the area who are registered at the practice.
The practice is registered to provide regulated activities which include:
Treatment of disease, disorder or injury, surgical procedures, family planning, maternity and midwifery services and diagnostic and screening procedures and operate from the location of:
St Thomas Court
Church Street
Axminster
Devon
EX13 5AG
We visited this location during our inspection.
Updated
23 April 2018
Letter from the Chief Inspector of General Practice
Axminster Medical Practice is rated as good overall and outstanding in the responsive domain. (the 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? – Outstanding
Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection of the Axminster Medical Practice on Tuesday 6 March 2018 as part of our inspection programme.
At this inspection we found:
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The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen there was a genuinely open culture in which all safety concerns raised by staff and people who use services were used as opportunities for learning and improvement.
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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.
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Staff involved and treated patients with compassion, kindness, dignity and respect.
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Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
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There was a strong focus on continuous learning and improvement at all levels of the organisation.
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The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care.
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The practice had recently purchased a piece of equipment to prepare blood samples to extend how long the practice could store samples until collection which meant patients could access blood test procedures throughout the day.
We saw one area of outstanding practice
The involvement of other organisations and voluntary services and the local community were integral to how services were planned and ensured that services met patient’s needs. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers and the voluntary sector, particularly for people with multiple and complex needs. For example:
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The practice provided a minor injuries service at the practice which in 2017 had treated 764 patients with low onward referrals for further treatment.
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Full contraception services and joint injection service reduced the need for patients to travel over 25 miles to the nearest service.
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Effective working relationships with younger persons mental health support services
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Proactive health promotion and provision of 141 NHS health checks of patients and non patients with a local employer.
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Setting up, promoting, hosting and supporting a voluntary counselling and psychotherapy service (Axminster Recovery with Counselling) for patients experiencing trauma, bereavement and grief which since 2009 had seen 2030 patients referred.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
5 March 2015
Axminster Medical Practice is rated as good for the care of people with long-term conditions. There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
Families, children and young people
Updated
5 March 2015
Axminster Medical Practice is rated good for families, children and young people. The practice worked with local health visitors to offer a full health surveillance programme for children under the age of five. Checks were also made to help ensure the maximum uptake of childhood immunisations.
Ante-natal care was provided by a team of midwives who worked with the practice. Midwives held clinics twice a week. The midwives had access to the practice computer system and could speak with a GP if needed. Health visitors also held baby clinics at the community hospital and the practice had contact with the school nursing team. Systems were in place to alert health visitors when children had not attended routine appointments and screening.
Appropriate systems were in place to help safeguard children or young people who may be vulnerable or at risk of abuse.
Updated
5 March 2015
The practice is rated as outstanding for the care of older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.
Care was tailored to individual patient needs and circumstances. Patients were reviewed regularly by the GPs and nurses to promote their health and independence and to help avoid the admission to hospital. There were regular patient care reviews involving patients, and their carers where appropriate.
Working age people (including those recently retired and students)
Updated
5 March 2015
Axminster Medical Practice is rated good for working age people. Patients who were of working age or who had recently retired were pleased with the care and treatment they received.
The practice offered extended opening times two days a week to provide easier access for patients who were at work during the day. Patients were offered a choice when referred to other services.
People experiencing poor mental health (including people with dementia)
Updated
5 March 2015
Axminster Medical Practice was rated good for people experiencing poor mental health. The practice was tailored to patient individual needs and circumstances, including their physical health needs. Annual health checks were offered to people with serious mental illnesses.
GPs had the necessary skills and information to treat patients with poor mental health. They were also responsive in referring patients with mental health concerns to specialist services. Liaison was undertaken with external agencies, for example the mental health crisis team, local support groups and counsellors when required.
People whose circumstances may make them vulnerable
Updated
5 March 2015
Axminster Medical Practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability and offered longer appointments for them if required.
There were care homes for people with learning disabilities in the area. Annual health checks were offered to these patients in their own homes and for those living in care homes. Vaccinations were offered when required and managed safely. Appropriate arrangements were in place to facilitate access to care for patients with mobility limitations.
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.