The Quantock Medical Centre

Updated 8 October 2015

The practice is located in a rural village of Nether Stowey in Somerset and provides services to patients living in the Nether Stowey and the surrounding villages. The patient population of 3200 is predominantly white British. The practice is at the heart of the community and offers a patient centred service. The patients see their own GP who is also often the family GP and this gives a continuity of care. The practice also supports patients in residential and nursing care homes.

The Quantock Medical Centre is a dispensing practice with services provided at one location:

Banneson Road,Nether Stowey,Bridgwater,Somerset,TA5 1NW

The practice is routinely open from 8am - 6.30pm Monday to Friday and on Saturdays 8.30am - 10am. There are daily urgent care appointments for patients with an illness requiring same day medical care either at the surgery or as a home visit. The practice is part of the Bridgwater Bay Health Federation.

The practice operates as a partnership between two GPs and one salaried GP who work a total of 17 sessions across the week. The practice also employs a nurse practitioner and two practice nurses. The practice has a General Medical Services (GMS) contract and provides specific enhanced services.

The practice does not offer Out-of-Hours care, but provides telephone information to patients about Out-of-Hours and emergency appointments. The practice referred their patients to Somerset Doctors Urgent Care, operated by Vocare. This information is also available in the practice leaflet and on their website.

The patient age demographic for the practice is:

0 to 4 years 4.6% - lower than the national average

5 to 14 years 8.4% - lower than the national average

under 18 years 11.5% - lower than the national average

65+ years 28.9% - higher than the national average

75+ years 12.7% - higher than the national average

85+ years 4.1% - higher than the national average

The practice also has a higher than national average number of patients with long term conditions. NHS England- GP Patient Survey published on 4 July 2015 showed the practice consistently scored higher than the Clinical Commissioning Group average for patient satisfaction.

Updated 8 October 2015

Letter from the Chief Inspector of General Practice

We undertook a comprehensive announced inspection on 18 November 2014. Overall the practice is rated as good for providing an effective, caring, responsive and well led service; however, at the November inspection the practice was rated as requiring improvement for the safe domain. This was because clinical governance systems were not systematic and did not fully demonstrate that the service was robust in monitoring the safety of patient care. We carried out a focussed inspection on 12 August 2015 to review the action the provider had taken to address these issues.

Our key findings were as follows:

• The provider had established processes in place to assess and monitor the quality of service which included effective clinical governance processes such as clinical audit and significant events, which assured the safety of patient care.
• The provider had reviewed the needs of the practice population and had appointed experienced and skilled staff to meet these needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 March 2015

The practice is rated as good for the care of patients with long-term conditions. The practice provided specialist nurse support for conditions such as asthma, diabetes and heart disease. They worked well as a team with the lead nurse ensuring they undertook all necessary training to keep their knowledge up-to-date. These combined skills and knowledge in different areas which complemented one another. Patients’ conditions were monitored and reviewed with planned appointments sent directly to them.

We found patients were assessed and signposted to the most appropriate healthcare provision. The practice promoted self-care and offered patients with long term conditions an assessment and education to use telehealth systems for monitoring their condition. All vulnerable patients had a care plan which could include emergency medicines such as antibiotics or steroid therapy. The care plan was made available to the Out of Hours service.

Updated 26 March 2015

The practice is rated as good for the population group of families, children and young people. Systems were in place for identifying and following-up children living in disadvantaged circumstances and who were at risk. For example, children and young patients who had a high number of A&E attendances. Immunisation rates were high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We were provided with good examples of joint working with midwives, health visitors and school nurses. The practice had a number of services based within the building which were accessible by patients though self-referral, such as the counselling service and healthy living sessions. The practice liaised with a range of other agencies regarding patients for example, the sexual health clinic. Young adults were able to access confidential appointments with a GP who ensured using the Gillick competence guidance that the person was competent to make decisions for them self.

Updated 26 March 2015

The practice is rated as good for the care of older patients. The statement of purpose for the practice sets out the key philosophies for the care and treatment of all patients, which ever population group they belong to. The practice worked hard to achieve quality patient care for older patients and maximised patient choice through being able to see and /or speak with their usual GP or any other GP in the practice. The nursing staff had a wide range of expertise such as and routinely updated their specialist skills. The practice provides a named accountable GP for all patients aged 75 and over. We found the practice was committed to keeping older patients as well as possible and worked collaboratively with other agencies to implement a range of monitoring and preventative measures. The practice had sourced chiropody services for patients who were unable to travel to the local town. Monthly multidisciplinary meetings were held with community teams to discuss the most vulnerable patients to enable their optimum care. For patients requiring end of life care and support, a palliative care meeting was held every month with the lead GP. The practice maintained a palliative care register of patients which was updated as appropriate and the care needs of patients were regularly reviewed. The practice also supported older patients living in local care homes.

Updated 26 March 2015

The practice is rated as good for the population group of the working-age patients (including those recently retired and students). GP and nurse appointments were arranged to accommodate work commitments when required by patients. The practice had emergency appointments each day during extended hours, and a Saturday morning for planned appointments. The practice also provided telephone consultations. The practice provided a fitness and nutrition advisor who held weekly sessions at the practice. NHS health checks were offered to all patients aged 40-74. We found the practice participated in health screening programmes such as the national cervical cancer screening programme and held health promotion events at the weekend which were available to patients who worked.

Updated 26 March 2015

The practice is rated as good for the population group of patients experiencing poor mental health (including patients with dementia). The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health including those with dementia. The practice had in place advance care planning for patients with dementia.The practice had recognised they were sited in a rural location with some social isolation and had employed their own counsellor who provided on site psychological therapies. The practice also sign-posted patients experiencing poor mental health to various support groups and third sector organisations such as local self-help groups run by Somerset Talking Therapies. The practice had a system in place to follow up on patients who had attended accident and emergency where there may have been mental health needs. Staff had received training on how to care for patients with mental health needs and dementia and offered longer appointments to patients with mental health needs.

Updated 26 March 2015

The practice is rated as good for the population group of patients whose circumstances may make them vulnerable. The practice had a system of identifying those patients in vulnerable circumstances who may have had difficulty accessing services such as those with learning disabilities or those patients whose first language was not English. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. The practice also included patients who were not necessarily medically vulnerable, but through other circumstance, were on their vulnerable patient register. The practice had sign-posted vulnerable patients to various support groups and third sector organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out of hours.