Dr Campbell & Partners Tarporley Health Centre

Updated 20 January 2017

Dr Campbell & Partners Tarporley Health Centre is responsible for providing primary care services to approximately 7792 patients. The practice is situated in Park Road, Tarporley in West Cheshire. There are two branch practices based in the nearby villages of Waverton and Tarvin. There are dispensaries at all three locations. The practice is based in an area with lower levels of economic deprivation when compared to other practices nationally. The practice has a predominantly rural community. The practice has a slightly higher than average number of patients with a long standing health condition and of older patients when compared to other practices locally and nationally.

The staff team includes four GP partners, one salaried GP, a nurse clinician, three practice nurses, a health care assistant, two phlebotomists, a practice manager, dispensary, administration and reception staff. Three GPs are female and two are male. The nursing staff, health care assistant and phlebotomists are female.

The main practice is open 8am to 6.30pm Monday to Friday. The branch practice at Tarvin is open on Monday to Thursday from 8.30am to 11.30am and from 3pm to 6pm Monday and Friday. The branch practice at Waverton is open on Monday to Thursday from 3pm to 6pm and 8.30am to 11.30am on Friday. An extended hour’s service for routine appointments and an out of hour’s service are commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. Patient facilities are on the ground floor. The practice has limited on-site parking.

Dr Campbell & Partners Tarporley Health Centre has a General Medical Services (GMS) contract. The practice offers a range of enhanced services including, minor surgery, timely diagnosis of dementia, learning disability health checks and influenza and shingles immunisations.

We identified that the practice is carrying out minor surgery at a location for which it is not registered. This meant we were unable to inspect the premises where this regulated activity is taking place. We advised the registered manager to address this without delay to ensure that the registration is legally correct.

Updated 20 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Campbell & Partners Tarporley Health Centre on 15 and 22 November 2016.

Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There were systems in place to reduce risks to patient safety, for example, the practice ensured equipment was checked to ensure it was safe to use and there were sufficient numbers of staff to meet the needs of patients.

• Staff understood their responsibilities to raise concerns and report incidents and near misses. Staff spoken with knew how to identify and report safeguarding concerns.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff told us they felt well supported. They received an annual appraisal and had access to the training they needed for their roles.

• Patients were overall positive about the care and treatment they received from the practice. The National Patient Survey July 2016 showed that patients’ responses about whether they were treated with respect, compassion and involved in decisions about their care and treatment were comparable to local and national averages.

• Services were planned and delivered to take into account the needs of different patient groups.

• The National GP Patient Survey results showed that patient’s satisfaction with access to care and treatment was generally in line with local and national averages.

• Information about how to complain was available. There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

The areas where the provider should make improvements are:

• Involve the wider staff team in discussions about the actions to be taken following significant events and record annual reviews of significant events to demonstrate that actions taken were effective and any trends have been appropriately identified and addressed.
• Review the management of vaccine fridges to ensure staff are adhering to the protocol for the safe management of vaccines.

• The security of prescriptions should be reviewed as some were left in printers in rooms which were not locked.

• Checks of controlled drugs should be performed by two staff members to reduce the risks of mishandling or significant events remaining unnoticed.

• A clear process to follow for identifying a person collecting a prescription on behalf of a patient should be introduced.

• Medication at the Waverton branch should be passed to patients through the reception window to improve medication security.

• The system for ensuring staff receive regular training updates should be improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 January 2017

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), ischaemic heart disease and hypertension. This information was reflected in the services provided such as screening programmes and vaccination programmes. Blood tests were also routinely carried out for patients’ with anticoagulation, gastroenterological and dermatological conditions. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. The clinical staff took the lead for different long term conditions and kept up to date in their specialist areas. The practice had monthly multi-disciplinary meetings and clinical meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice provided information to patients to encourage them to manage their long term conditions. Patients were also referred to educational courses to support them to manage their long term conditions. The practice referred patients who were over 18 and with long term health conditions to a well-being co-ordinator for support with social issues that were having a detrimental impact upon their lives.

Updated 20 January 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Immunisation rates were comparable to or higher than local and national averages. Appointments for young children were prioritised. Appointments were available outside of school hours. Family planning and sexual health services were provided. The practice liaised with the school health team, midwives and health visiting service to discuss any concerns about children and their families and how they could be best supported. A monthly meeting was held with the health visiting service which provided a forum to discuss the needs of younger patients, including safeguarding concerns. Child health promotion information was available on the practice website and in leaflets displayed in the waiting area.

Updated 20 January 2017

The practice is rated as good for the care of older people. T he practice kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice worked with other agencies and health providers to provide support and access specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients. The practice prioritised patients who may be at risk of poor health due to frailty. Following a medical event such as an unplanned hospital attendance the medical needs of these patients were reviewed to identify what could be put in place by multi-disciplinary services to prevent future ill-health or hospital admission. The practice was working with neighbourhood practices and the Clinical Commissioning Group (CCG) to provide services to meet the needs of older people. The practice shared a daily ward round at Tarporley War Memorial Hospital with its neighbourhood practices. This provision meant that patients had access to care and treatment in a timely manner and avoided duplication of visits. The GPs provided a weekly ward round and responded to urgent calls at a local care home for people with dementia. The nurse clinician made weekly visits to older patients at a local residential home. An Acute Visiting service was provided with the aim of improving patient access to GP services and reducing emergency admissions to hospital and use of emergency services. The dispensary provided home delivery of medication to patients who were unable to collect them. Medication was also blister packed to assist and monitor medication where there were concerns about usage. Polypharmacy (the concurrent use of multiple medications) reviews were undertaken to ensure patients were prescribed with medication that best met their needs.

Updated 20 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments, book on the day appointments and telephone consultations. Appointments could be booked up to four weeks in advance. Patients were encouraged to sign up for Patient Access so they could order repeat prescriptions, book appointments and view their medical records on-line which provided flexibility to working patients and those in full time education. The main practice was open from 8am to 6.30pm Monday to Friday. The branch practice at Tarvin was open on Monday to Thursday from 8.30am to 11.30am and from 3pm to 6pm Monday and Friday. The branch practice at Waverton was open on Monday to Thursday from 3pm to 6pm and from 8.30am to 11.30am on Friday. An extended hour’s service for routine appointments and an out of hour’s service were commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. The practice website provided information around self-care and local services available for patients. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, sexual health, smoking cessation advice and family planning services. The practice also promoted Exercise on Prescription (this helps people with medical conditions (who are not normally active) to access a supported exercise programme with the help of a specialist adviser) and weight management programmes. Reception staff sign-posted patients who do not necessarily need to see a GP. For example to services such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP) and the Physio First service (this provided physiotherapy appointments for patients without the need to see a GP for a referral).

Updated 20 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services. There were counsellors located at the practice that the clinicians could refer patients to, such as an alcohol and substance misuse counsellor. The practice monitored patients using lithium and carried out checks to ensure their wellbeing. There was a system to follow up patients who attended accident and emergency departments of hospitals due to poor mental health. Patients were screened for dementia and referred to memory clinics if required. GPs provided a weekly ward round at a local care home for people with dementia. The staff team had received training in dementia awareness to assist them in identifying patients who may need extra support.

Updated 20 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient had a learning disability or a serious diagnosis to enable appropriate support to be provided. The practice worked with health and social care services to support the needs of vulnerable patients. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff was the carer’s link. The practice referred patients to local health and social care services for support, such as drug and alcohol services. Staff had received safeguarding training relevant to their role and they understood their responsibilities in this area. Monthly multi-disciplinary meetings were held which were an effective way of identifying vulnerable patients and any support they required.