Minehead Medical Centre Also known as Harley House

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 practice as inadequate for providing responsive services because: The practice could not demonstrate they had the necessary appointments available to ensure patients could access care and treatment when required. The practice could not demonstrate that they had monitored and developed services in response to the needs of the local population. The practice directed patients to use other local services with the knowledge that they did not have the necessary staff to facilitate all required medical interventions. The practice was unable to provide assurance that patients with the most urgent needs had their care and treatment prioritised. Patient feedback included negative themes regarding access to appointments

This service scored 4 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient feedback demonstrated a lack of continuity of care. One patient told us that the last time they tried to access an appointment at the practice, the practice passed them between services. For example, the practice initially directed them to contact NHS 111 however as it was during practice opening hours, they were referred back to their GP practice. When they advised the practice of this, they were then directed to use the local minor injuries unit (MIU). The practice had directed a patient to the local MIU service for a severe leg ulcer which was not healing and had started to bleed, as they did not have any available appointments. This was outside the scope of practice for the MIU so the patient was directed back to the practice. Our review of patient records identified that there had been an unexplained 2-day delay in care for a patient presenting with symptoms which indicated deep vein thrombosis (DVT is a medical condition that occurs when a blood clot forms in a vein usually in the leg or pelvis).

Due to the backlog in document workflow and summarising, the practice could not provide assurance that patients received person-centred care.

The practice did not have a process to monitor patient access to ensure they had the necessary workforce to meet the needs of the patient population. They had also not monitored the number of patients who were directed to other services to ensure signposting was appropriately and was conducted with clinical oversight.

Due to the backlog in documents and summarising, the practice could not demonstrate that they always provided accurate and up-to-date information. Our review of patient records identified risks in patients not attending appointments at other health care setting as they had not been provided information on referrals done on their behalf. For example, one patient had not been told that a referral had been made querying the potential for a cancer diagnosis.

We saw evidence that complaints were discussed at management meetings.

At our inspection in 2022 we found that the practice was unable to give assurance that patients would receive continuity of care for wound management as they did not have the staffing capacity to hold their own wound clinics. At this inspection, we found that necessary improvements had not been made to ensure patients could access necessary care and treatment, in particular for wound management. The practice had not reviewed patient access to identify if they offered the right type of appointments to meet patient needs. They had also not conducted any analysis to identify if they employed enough suitably qualified staff to meet the demands of the local population. The practice had not identified a minimum number of appointments required to provide a basic service level to patients. At the time of inspection, an action plan to improve patient access had not been identified. The practice could not demonstrate that econsult forms completed by patients were responded to consistently by suitably qualified staff and that patient outcomes were appropriate. There was no policy to support this process and give necessary guidance to staff. Econsults were triaged by a clinician seconded to the practice from secondary care. No limitations were placed on the types of symptoms or conditions this clinician could review which was not line with their contracted scope of practice. This meant the practice could not be assured that patients were triaged appropriately and that they received the care and treatment required. No monitoring had been conducted to ensure patients received treatment that met their needs. The practice did not offer bookable extended access appointments. The practice’s appointment system showed econsult appointments outside of the core hours. However, discussions with staff identified that these were not patient access appointments but rather time slots for practice staff to triage econsult forms received during normal clinic hours.

The practice had not conducted any patient surveys or conducted any monitoring on patient access. As a result, they could not demonstrate care and treatment was tailored to meet the needs of those most likely to experience inequality in experience or outcomes.

DNAR (do not attempt resuscitation) decisions and treatment escalation plans were not consistently reviewed to avoid harm and distress at the end of life. We identified that DNAR and treatment escalation plans had not been reviewed by practice clinicians. It was also not always documented if these decisions had been made in collaboration with patients and their relatives, to ensure the patient was at the centre of these decisions. Feedback from the practice included that they did not have a process to systematically review DNAR and treatment escalation plans and that any changes would be made as required. This meant that some patients could have these decisions on their record which no longer reflected their wishes. The practice could not give assurance that changes would be made prior to them being implemented into the patient’s care.