Archived: Taw Hill Medical Practice

Updated 3 September 2015

Taw Hill medical centre is a large modern purpose built medical centre located approximately two miles from Swindon town centre. The practice has 13 consulting/treatment rooms on the ground floor and first floors. Some of these were used by other service providers or were not in use. There are large management, meeting and training areas on the first floor. The practice is registered as a training practice.

There are two partner GPs, one partner is male and the other is female. Additionally there are seven salaried and locum GPs in the practice. The majority of locum GPs were regularly employed to cover GP absences such as maternity leave and clinical commissioning group commitments. The GPs provide an average of 33 patient sessions each week and collectively are the equivalent to 4.5 whole time employees. A team of four nurses, a health care assistant nurse and a phlebotomist provide a range of nursing services and clinics over the five days of the week which the practice is open. In addition there are administrative and reception staff including a practice manager who support the day to day running of the practice.

The practice has approximately 12,500 patients registered from an area immediately surrounding the practice and nearby villages. The practice age distribution is very different to the national average with most patients being under the age of 60 years. There are relatively few patients with long term conditions, with health conditions which affect their daily lives or who have a caring role when compared to national averages. Information from our data sources shows the population falls within the least deprived in the country. Life expectancy for male patients is equal to the national figure of 79 years with female life expectancy being 89 years which is above the national average of 83 years. The Quality and Outcomes Framework (QOF) value for the practice is in the middle range and is indicated as being average.

The practice has opted out of providing Out of Hours services to its own patients, this service is provided by SEQOL. Information about Out of Hour’s services is available on the practices website and on their telephone answering service.

Updated 3 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection at Taw Hill Medical Centre on 5 August 2015 to follow up on actions identified during out previous inspection in October 2014. Aspects of the practice we asked the provider to improve which were covered during our inspection included; staff recruitment, the safety and availability of equipment, medicines management and quality assurance processes. We saw the provider had made improvements to their service; overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with improvements to those relating to recruitment checks, medicines management and emergency equipment.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on and quality assurance processes had improved.

We saw one area of outstanding practice:

• The phlebotomist’s role had been extended to improve outcomes for patients. Alongside blood tests they took the patient’s blood pressure, measured their weight, recorded their body mass index and recorded their smoking status. Where concerns were noted the GP was informed and a further appointment was made. This helped the practice to proactively work towards preventing patients acquiring longer term conditions.

However there were areas of practice where the provider could make improvements. Importantly the provider should;

• Ensure all newly appointed staff have their induction training prioritised so that key subjects such as safeguarding and mental capacity are covered earlier in their induction.
• Ensure more frequent supervision of nurse prescribers is arranged and implemented.
• Ensure monthly infection control checks are recorded to evidence the work carried out.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 19 March 2015

The practice is rated as requires Improvement for the population group of people with long term conditions. The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as inadequate for safety and requires improvement for effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed, longer appointments and home visits were available. All these patients had access to a named GP if requested and annual reviews were being planned to check their health and medicines needs were being met. For those people with the most complex needs the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 19 March 2015

The practice is rated as requires Improvement for the population group of families, children and young people. The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as inadequate for safety and requires improvement for effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. Systems were in place for identifying and following-up children living in disadvantaged circumstances and who were at risk. For example, children and young people who had a high number of A&E attendances.

Immunisation rates were relatively high for all standard childhood immunisations. Patients told us and we saw evidence that children and young people were treated in an age appropriate way and recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies. We were provided with positive examples of joint working with midwives, health visitors and school nurses. Emergency processes were in place and referrals made for children and pregnant women who had a sudden deterioration in health.

Updated 19 March 2015

The practice is rated as requires Improvement for the care of older people. The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as inadequate for safety and requires improvement for effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. Nationally reported data showed the practice had average outcomes for conditions commonly found amongst older people. The practice offered personalised care to meet the needs of the older people in its population and had a range of services, for example in dementia and health and wellbeing. The practice was responsive to the needs of older people, including offering home visits and rapid access appointments for those with enhanced needs.

Updated 19 March 2015

The practice is rated as requires Improvement for the population group of the working-age people (including those recently retired and students). The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as inadequate for safety and requires improvement for effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering some online services such as prescription requests as well as a health promotion and screening which reflected the needs of this age group. However some comments made by patients using the NHS Choices website indicated they were dissatisfied with access to appointments.

Updated 19 March 2015

The practice is rated as requires Improvement for the population group of people experiencing poor mental health (including people with dementia). The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as inadequate for safety and requires improvement for effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The majority of patients experiencing poor mental health had received an annual physical health check. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice had in place care planning for patients with dementia.

The practice had sign-posted patients experiencing poor mental health to various support groups and local organisations including MIND and similar local services. The practice had a clear system in place to follow up on patients who had attended accident and emergency where there may have been mental health needs.

Updated 19 March 2015

The practice is rated as requires Improvement for the population group of people whose circumstances may make them vulnerable. The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as inadequate for safety and requires improvement for effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice held a register of patients living in vulnerable circumstances including those with learning disabilities. The practice had carried out annual health checks for people with learning disabilities and the majority of these patients had received a follow-up appointment. The practice offered longer appointments for people with learning disabilities if required.

The practice worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. Most staff knew how to recognise signs of abuse in vulnerable adults and children. Most staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns but were less clear about how to contact relevant agencies in normal working hours and out of hours.