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

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We have rated the practice as good for providing a well led service. As part of this inspection, we reviewed the governance, management and sustainability. The partners and practice manager, supported by the deputy practice manager, had oversight of systems and practices to promote the effective running of the service.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were encouraged to attend monthly staff meetings during which updates, and new information was shared. Minutes of the meeting were recorded and accessible to all staff on the practice electronic system. Staff were aware of their own responsibility for completing required training and actions that would be taken by the practice if their training was not completed. Reminders were provided by the practice to all staff via the practice electronic system when training was due. There were regular staff meetings in which learning, for example following significant event investigations, and updates were shared. Staff made positive comments on working within the practice. One person said they did not realise they could enjoy going to work prior to their employment at the practice. Staff referenced cohesive teams who worked well together. This included the implementation of a duty GP. Staff found this system worked well for them and that the GP was available and willing to answer queries and provide help during clinics as well as triaging patient requests. Comments were made regarding an improved staff morale.

Practice staff were observed and evidence was seen which identified an understanding of how the practice delivered care, treatment and support for people. The strategy, vision and values of the practice were reviewed and discussed at each business meeting. The visions and values had been developed with participation from the staff and assurances provided to ensure the staff worked within the values. Where concerns had been identified that a staff member had not worked within the values, the practice had taken action to reduce the risk of this reoccurring. The practice manager had oversight of the training process and records provided following the inspection, demonstrated staff were up to date with their mandatory training. The practice had oversight and assurances obtained of the work carried out by non-medical prescribers. The provider listened to staff and took action in response to feedback . For example, staff had requested better communication staff and management. As a result the management team had been restructured. Staff identified the need for an additional dispenser which had been agreed and actioned. The provider had amended processes to ensure that all triage was carried out by a GP following feedback. Staff were able to share thoughts and concerns on a flip chart and were able to do so anonymously if they wished.

Staff recognised there had been changes within the management team and structures. We received many positive comments regarding the support provided by team leaders. The staff working at the branch surgery in Ipplepen, had access to a manager on site each day which was recognised positively by the staff. Views from staff regarding the accessibility of the senior managers was mainly positive. We were told staff felt listened to by their team leaders, GP partners and management staff. Some staff commented that since the management team worked in a separate area on the first floor of the building they were not as accessible. One newly recruited member of staff commented they had been welcomed to the practice and found the practice manager and their team had an open door policy and made themselves available to staff during each day. Previously, not all staff had found communication and/or support from the managers inclusive or available when needed. Systems for providing communication had been developed and included additional methods for staff and people who use the service. For example, notice boards, newsletters, practice website and social media.

Changes to management team were still embedding at the time of the inspection. Managers we spoke with demonstrated an awareness of this and were receptive to receiving feedback from staff regarding their experiences. The Managers demonstrated they had the skills, knowledge, and experience to lead effectively.

Staff demonstrated an awareness of how to access the freedom to speak up (FTSU) guardian. Staff said they were also able to raise issues with their team leads, GP partners or the managers of the practice as they chose. One member of staff commented they had not felt listened to and their concern had not been addressed.

Staff had access to a FTSU guardian. Anonymised information from the guardian was shared with the providers. The practice manager provided information that the process for staff to raise concerns had been developed. Staff were provided with the opportunity to attend an exit interview when leaving the practice. We saw clear evidence of how information, which had been shared during an exit interview, had been considered by the management team and acted upon.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We heard positive feedback regarding the new electronic systems, implemented by the practice to monitor staff workload and ensured the correct staffing levels were available to meet the demands of the service. These systems had provided the practice with data and insight, which had enabled the practice to identify new specified roles to be implemented to meet the demand to operate the electronic access system. Staff demonstrated knowledge and spoke of the safe practices they followed regarding IT security. Policies and procedures were available to staff, who were knowledgeable regarding the processes for lone working and key holding.

A business continuity plan provided guidance and information for staff to follow in the event of systematic failures. This included action to take in emergency situations such as electrical power failure, environmental issues, inclement weather, and sickness. Digital services were used securely and effectively within the service. Staff were provided with guidance on how to maintain IT security when working from home. The provider risk assessed the security of home working for individuals prior to agreeing this. The practice business meetings provided assurances and oversight of governance. The minutes from the meetings included actions for individual staff members to follow. The provider had oversight of contracts with external providers and liaised with them regarding any issues or changes required. Following staff feedback the practice had identified there had been delays in investigating and responding to significant events and scanning and processing documents received in the practice. Evidence was provided to support the systems and processes which had been implemented to address these issues. The provider completed audits to ensure they were effective. The outcomes from the audits demonstrated there had been a substantial reduction in missed actions linked to processing documents. Oversight of the environment was not consistent as we observed not all areas were locked as per the practice policy, such as clinical rooms and cupboards. These issues were addressed and fixed during the site visit. The process for opening and closing the building had been risk assessed. The buildings were protected by alarms and CCTV. The safety of patients and staff during the event of a fire had been considered with all staff having completed fire training. Fire risk assessments were up to date and available to staff. Evacuation chairs were readily accessible in the stairwell and two members of staff had received additional training in their use.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff reported that following a period of staff changes they were now experiencing a settled team and learning and developing was taking place. Annual appraisals were provided to all staff with their team leader. However, one person commented they had not had an appraisal for 14 months and would welcome this. Other staff said they regularly met with their team leader to discuss learning needs and also discuss any concerns or issues. The nursing team had access to a lead nurse who supported them with their learning needs. However, we were told that the nurses did not have a regular team meeting which would provide them with opportunities to discuss complex patients, safety briefings and other updates.

There was a planned programme of quality improvement projects ongoing. For example, there was a full review of the safeguarding systems being undertaken. This had included reviewing the patients with identified safeguarding risks, linking family members including those not living in same household. Records had been updated following communications and liaison with external partners. The practice was part of a primary care network and participated in joint projects. For example, identifying people at risk of being admitted to hospital by reviewing bloods, clinical contacts, telephone calls to the practice and to the NHS 111 and out of hours services. Searches had been carried out for patients who had recently become housebound. The social prescriber worked with a virtual occupational therapist to identify and review unmet needs for these people. The practice had taken part in research projects with a number of universities. For example, dietary approach and management of type 2 diabetes, a study examining impulse control in Parkinson’s disease and improving sleep disturbance of people living with dementia and mild cognitive impairment. This research helped shape and develop patient care within the practice. The practice had developed a model to proactively manage the care and treatment of people living in care homes. The model had been continually evolving since pre COVID and positive impacts had been identified for patients, care home staff and the practice. The model had been shared with the commissioners of services and other practices. The introduction of the total triage model and use of electronic access forms for patients had been reviewed using feedback from patients and staff, data and clinical safety information. The model had been adapted in relation to feedback but the review findings found improvements in efficiency, patient satisfaction and staff morale. Phone wait times, appointment delays had been reduced and continuity of care improved.