Archived: Wincanton Health Centre

Updated 30 April 2015

Wincanton health centre provides a service to approximately 8,500 patients in the Somerset town of Wincanton.

Wincanton health centre provides primary medical services to a diverse population age group and is situated in a purpose built practice in the outskirts of the town centre.

The team at Wincanton health centre composed of four GP partners and a practice manager who was also a partner. There are three female GPs and one male. The partners at the practice hold managerial and financial responsibility for running the business. The practice also employs three acute care practitioners (ACPs). The ACPs are able to assess, diagnose, treat and prescribe medicines for acute common conditions such as minor accidents, chest and urine infections. In addition the team were supported by three practice nurses, two health care assistants, and additional administrative and reception staff.

The practice is open between the hours of 8.30 and 6pm. Pre bookable evening appointments were available until 7.30pm with a GP every Monday to help those patients who worked during routine office hours. Pre booked appointments were also available on Saturday mornings from 08.30am until 11.30am.

Patients using the practice also had access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, midwives and counsellors.

The practice had opted out of providing out-of-hours services to their own patients and refer them to another out of hours service.

Updated 30 April 2015

Letter from the Chief Inspector of General Practice

Wincanton health centre was inspected on Tuesday 9 December 2014. This was a comprehensive inspection.

Wincanton health centre provides primary medical services to approximately 8,500 patients of a diverse age group. The practice was situated in a purpose built building on the outskirts of Wincanton.

The team at Wincanton health centre was composed of four GP partners and a practice manager who was also a partner. The partners at the practice hold managerial and financial responsibility for running the business. The practice employs three acute care practitioners (ACPs). The ACPs are able to assess, diagnose, treat and prescribe medicines for acute common conditions such as minor accidents, chest and urine infections. In addition the team were supported by three practice nurses, two health care assistants, and additional administrative and reception staff.

Patients using the practice also had access to community staff including district nurses, an independent living team, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

We rated this practice as good.

Our key findings were as follows:

There were systems in place to address incidents, deal with complaints and protect adults, children and other vulnerable people who use the service. Significant events were recorded and shared with multi professional agencies and there was evidence that lessons were learned and systems changed so that patient care was improved.

There were systems in place to support the GPs and other staff to improve clinical outcomes for patients. Patient care and treatment is considered in line with best practice national guidelines and staff are proactive in promoting good health.

The practice were pro-active in obtaining as much information as possible about their patients which do or can affect their health and wellbeing. Staff knew the practice patients well, were able to identify patients in crisis and were professional and respectful when providing care and treatment.

The practice planned its services to meet the diversity of its patients. There were appropriate facilities available, adjustments were made to meet the needs of the patients and the appointment system enabled good access to the service.

There was a clear leadership structure in place. The team structure had changed in recent months with the introduction of a new advanced nursing team. Any issues we identified had already been recognised and were being addressed to make sure quality and performance was monitored and risks were identified and managed.

There were areas of practice where the provider should make improvements.

The provider should ensure that:

• All nursing and medical staff should receive training in the Mental Capacity Act (2005).

• The practice should ensure quality standards are monitored whilst the new systems are introduced, to ensure all patients with severe mental illness were being seen each year for a review.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 30 April 2015

The practice identified patients who might be vulnerable, have multiple or specific complex or long term needs. The practice ensured patients with long term conditions were offered consultations or reviews where needed. The staff at the practice worked together with and maintained links with external health care professionals for advice and guidance.

Patients with long term conditions had detailed tailor-made care plans in place. All patients with a long term condition were invited in for an annual review around the time of their birthday. The “birthday review” was a review of all chronic conditions the patient may have and was offered at a time that suited the patient.

Each nurse has a recognised clinical area in which they specialised and were supported by a named GP. All practice nurses offered reviews for all conditions and provided clinical support to one another in their areas of clinical specialty and interest.

The GPs and nurses attended educational updates to make sure their lead role knowledge and skills were up to date. Practice staff also involved healthcare specialists for advice where appropriate.

The practice promoted independence and encouraged self-care for this population group by using patient held personalised care plans.

There was a blood pressure machine in the waiting area so patients could monitor their own blood pressure. The practice nurses provided weight management support for patients and a dietician held a clinic once a month.

The practice was in the process of introducing group education sessions for patients who were newly diagnosed with a chronic condition. The patient participation group had also facilitated talks of common conditions for patients which were free of charge. Health education was provided on healthy diet and life style as part of the birthday review and in general consultation.

Patients receiving certain medicines were able to access screening services at the practice to make sure the medication they received was effective.

Updated 30 April 2015

There were baby and child immunisation programmes available.

Ante-natal care was provided by a team of visiting midwives who held clinics at the practice. The midwives had access to the practice computer system and could speak with a GP if the need arose. The practice also had strong relationships with health visitors who were based at the local children’s centre. Systems were in place to alert GPs when children did not attend for immunisation.

The practice held monthly multi-disciplinary meetings to discuss vulnerable children and all at risk families. This meeting was attended by the health visitors, the GPs, and nurse practitioners.

Women, men and young people had access to a full range of contraception services and sexual health screening including chlamydia testing and cervical screening. There was a quiet private area in the practice for women to use when breastfeeding.

Appropriate systems were in place to help safeguard children or young people who may be vulnerable or at risk of abuse.

Updated 30 April 2015

Patients aged 75 and over had their own allocated GP but had the choice of seeing whichever GP they preferred. Flu, Pneumococcal and Shingles vaccinations were provided at the practice for those in the appropriate age groups. Vaccines for older people who had problems getting to the practice or those in local care homes were administered in the community by the practice nurses. Nurses and GPs did home visits for older people and for patients who required a visit following discharge from hospital.

Treatment was organised around the individual patient and any specific condition they had.

The practice had a system to identify older patients and held a multi-disciplinary team (MDT) meeting for the planning and delivery of palliative care for people approaching the end of life. The MDT was attended by practice clinical staff, district nurses, the hospice nurses, the Independent Living Team and community psychiatric nurses (CPNs).

The practice website included a number of links containing extensive information about the promotion of health for conditions which affect older people.

The practice worked to avoid unnecessary admissions to hospital and worked with other health care professionals to provide joint working.

The clinical areas in the practice were all on one level and were easily accessible. There were some chairs in the waiting room with arm rests to assist patients to stand.

Updated 30 April 2015

Advance appointments, (usually up to around six weeks in advance) evening and Saturday morning appointments were available to assist patients not able to access appointments due to their work or study times.

There was a virtual patient participation group (PPG) at the practice which had a high number of working age members. These PPG members used electronic communication to provide feedback to the practice.

Foreign travel advice was available from the nursing staff within the practice and supporting information leaflets were available within the waiting areas.

Patients who received repeat medicines were able to collect their prescription at a pharmacy of their choice.

Updated 30 April 2015

The practice had an at risk register for patients about whom any of team had expressed a concern. These patients were reviewed monthly at the multidisciplinary team meetings.

The practice had a small minority of patients whose first language was not English and offered a telephone translation service where appropriate. Family members were used to translate at times at the patient’s request. Information posters were on display in different languages.

Patients with learning disabilities were offered a health check every year during which their long term care plans were discussed with the patient and their carer if appropriate.

Practice staff were able to refer patients with drug and alcohol addictions to a drug and alcohol service for support and treatment. The support service visited the practice if the patient chose this.

Updated 30 April 2015

The practice had an at risk register for patients about whom any of team had expressed a concern. These patients were reviewed monthly at the multidisciplinary team meetings.

The practice had a small minority of patients whose first language was not English and offered a telephone translation service where appropriate. Family members were used to translate at times at the patient’s request. Information posters were on display in different languages.

Patients with learning disabilities were offered a health check every year during which their long term care plans were discussed with the patient and their carer if appropriate.

Practice staff were able to refer patients with drug and alcohol addictions to a drug and alcohol service for support and treatment. The support service visited the practice if the patient chose this.