Kingskerswell and Ipplepen Medical Practice Also known as Dr D'Arcy & Partners

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We rated the service as outstanding for providing a responsive service. The practice had developed systems which enabled patients to book and request appointments via an electronic system. The duty GP triaged the requests each day and the appointments were prioritised to reflect clinical need. Staff were observed contacting people following the review of their health condition by the duty GP to offer an appointment or further guidance and support. Staff reviewed the clinical notes prior to contacting individuals to ensure they were allocated to the appropriate clinician. For patients who could not complete this form assistance was provided by staff over the telephone or in person at the practice in a private area.

This service scored 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback provided by people using the service, both to the provider and to CQC, was positive. Staff treated people equally and without discrimination. People were able to seek support from a clinician of their choice although, this meant the appointment might incur a short wait. On the day of inspection non urgent appointments were being booked a week ahead.

Leaders proactively sought ways to address any barriers to improving people’s experience and worked with local organisations. Staff understood the importance of providing an inclusive approach to care and to support equity in people’s experience and outcomes.

The staff recognised the diverse needs of people registered with the practice. Reception staff had an awareness of people who required additional assistance or who needed longer appointments to be made. Clinicians had allocated roles with specialist interests. For example, carrying out annual reviews for people living with a learning disability or diabetes. This meant they were able to provide joined up care and continuity.

Feedback from the staff of 2 care homes within the practice catchment area was positive. The practice provided regular visits to the homes enabling continuity of care and easy access to care and treatment for the people living in the care home. The staff of the care homes felt supported and able to discuss any concerns with the clinicians.

The practice discussed individual patients at the multi disciplinary meeting to ensure they received the care and treatment they required. The practice worked collaboratively with health visitors, midwives and school nurses to provide care, treatment and support to children and their families.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The practice website provided information on how to share compliments and concerns. People who raised concerns were listened to and provided with feedback.

The management of complaints had been an additional and recent role for one member of staff. They were supported in this by the practice manager and other management staff.

There was a system to record and investigate complaints, and when things went wrong, staff apologised and gave people support. There was evidence that complaints were used to drive continuous improvement. The practice had a policy and procedure in place to support and guide staff when dealing with complaints. A patient participation group (PPG) was in operation within the practice. The aims of the group were set out in terms of reference adopted from an external organisation. The PPG had recently restarted since the pandemic and had held 2 meetings at the time of the inspection. The PPG was made up of people registered with the practice and acted as representatives of peoples’ views. The PPG was looking to recruit more members. Arrangements had been made for the practice manager to represent the practice at future meetings.

Arrangements had been made for patients who could not access the electronic system from home. We observed one person completing the electronic form at the practice and also heard a member of staff supporting a person on the telephone to complete the form. This meant there was no delay for people in accessing the appointment system. During the inspection we observed that there were rarely more than 2 people waiting for a response by telephone with an average of 60 calls received per hour. Data collected from the practice demonstrated that the average wait time was 9 minutes for the telephone to be answered.

The practice had reviewed and developed systems for carrying out home visits. A member of staff had been appointed, who focussed on providing care and treatment to people living in their own homes, including residential care homes. We observed a member of staff discussing the need for a home visit with the duty GP. A visit to local care homes was made each week to review patients registered with the practice. Following the implementation of the electronic patient access system the practice had reviewed and developed they system based on initial findings of its use. A member of staff with qualifications in the field of digital health had helped to evolve the system to meet the needs of the patients and staff. Staff commented favourable about the system and provided examples of where wait times for appointments and a response by telephone had been reduced for patients.

Information was displayed on an interactive white board to show the numbers of telephone calls throughout the day, calls waiting and the length of time the person had been waiting. The board was monitored by reception and management staff. In busy times staff from other teams supported the reception team to answer calls to avoid people waiting on the line. The practice had reviewed the online system for patients to complete when requiring care, treatment or support from the practice. Each form completed through this system was reviewed by a duty GP who triaged the priority of their call and either telephoned the person, responded to queries or requested reception staff liaised with the person to book an appointment. Each morning the practice reviewed the workflow in line with staffing levels. On a Monday morning the staffing resource was reviewed for the week to ensure the rota would fulfil the workflow. A poster displayed in reception set out a plan for the duty GP. This had been developed followed a review of the system and identifying what had worked well and where changes had been made. One clinician had been concerned that moving to on the day triage could potentially impact continuity with people. Explanations were provided how patients were able to access follow up appointments with a preferred clinician. The practice opened outside of working hours on a Thursday to enable people of working or school age to access services. People registered at the practice were able to access services at weekends in area local area?. This service was provided as part of the primary care network.

Vulnerable people were supported with their contact with the practice and appropriate clinicians. For example, people who needed support with their mental health were able to access the social prescriber promptly. A duty GP reviewed all requests for access to services each day to ensure people saw an appropriate clinician within a satisfactory timescale to meet their needs.

Staff made positive comments regarding how the new electronic access system had provided people with equality to access the service. They explained this meant people received appointments according to need rather than in order of request.

The social prescribers supported vulnerable people and were able to link them to relevant support services and community services. Appropriate systems were used to share information with, and receive feedback from people using the service, including those who did not speak English or have access to the internet. The practice had access to a British Sign Language interpreter to support people living with a hearing impairment and to translation in Braille for people living with sight impairment. Enhanced signal on phone system and hearing loop for people living with hearing loss. The practice had processes to ensure people could register at the practice when needed, including those from vulnerable backgrounds, such as homeless people and Travellers.

Our clinical searches identified that people’s wishes and choices regarding their care and treatment and future planning were recorded within their records.

The practice shared information at team meetings and multidisciplinary meetings, attended by external clinicians, to ensure people who used the service received the right care at the right time in the right place. People with complex needs were supported by this team approach to their care and treatment. The GPs participated in shared care (a service where the care and treatment of people’s conditions is shared by clinicians) with external clinicians to provide end of life care for people.

Clinical staff used the Devon and Cornwall Shared Care Record treatment escalation plan (TEP) to assess and support people in reaching decisions about end-of-life care. This identified that peoples’ views had been sought and respected. We saw information had been shared appropriately with relevant agencies.