Letter from the Chief Inspector of General Practice
Waterside Practice was inspected on Tuesday 25 November 2014. This was a comprehensive inspection. Overrall the practice is rated as good.
Waterside Practice provides primary medical services to people living in the town of Ilfracombe. Waterside Practice is a medium sized practice caring for approximately 10,100 patients. The practice area covers approximately 60 square miles, with the majority of patients living in and around Ilfracombe, Combe Martin and a few larger villages. The area receives a considerable influx of tourists over the holiday season and this generates additional work for the practice.
The practice operates from two sites. The main site is Ilfracombe Medical Centre. This is purpose-built and is open five full days per week including some extended hours. The other site is a branch in Combe Martin and this is open five mornings and four afternoons each week. There are currently seven GP Partners, some part time, giving approximately 6 whole time equivalents. There is also a GP retainer for four sessions per week. The GP retainer scheme allows part time GPs to keep up to date with their clinical skills. A proportion of GP retainer salaries are paid for by the local clinical commissioning group.
Some areas which the practice supports have above average levels of deprivation. Ilfracombe Central is ranked the most deprived ward in Devon County. Life expectancy in Ilfracombe is below average at 77 years for the district, and is the lowest in Devon as a whole. There are high levels of substance and alcohol abuse, and significant levels of people with mental health problems.
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.
Our key findings were as follows:
Patient feedback about care and treatment was positive. The practice had a patient centred culture. Practice staff were well trained and experienced. Staff provided compassionate care to their patients. External stakeholders were positive about the practice.
The practice was well organised, clean and tidy. The practice had well maintained facilities and was well equipped to treat patients. There were effective infection control procedures in place. Patients had easy access to appointments at the practice. Patients had a named GP which improved their continuity of care.
The practice had a clear leadership structure in place and was well led. Systems were in place to monitor quality of care and to identify risk and manage emergencies.
Patient’s needs were assessed and care was planned and delivered in line with current legislation. This included assessment of the patient’s capacity to make informed choices about care and treatment, and the promotion of good health.
Recruitment, pre-employment checks, induction and appraisal processes were in place. Staff had received appropriate training for their roles and additional training needs had been identified and planned.
Information about the practice provided evidence that the practice performed comparatively with all other practices within the clinical commissioning group (CCG) area.
Patients told us that they felt safe with the practice staff and confident in clinical decisions made. There were safeguarding procedures in place. Significant events, complaints and incidents were investigated. Improvements made following these events had been discussed and communicated with staff.
We saw several areas of outstanding practice including:
A urology specialist GP working at this practice had put forward guidance which had been adopted as best practice by the CCG.
In the event of receiving news of extreme adverse weather conditions in this area which abutted the hills of Exmoor, the practice had plans in place for a duty GP to stay overnight at the practice. This would enable a reduced service to carry on from the practice the following day despite deep snow.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice