Church View Medical Centre

Updated 8 May 2018

Church View Medical Centre is located at Broadway Road, Broadway, Ilminster, Somerset TA19 9RX.

The service has approximately 2,386 patients registered from around the local and surrounding areas, including Horton, Ilminster, and Hatch Beauchamp. Patients can access information about the service at www.chuchview.gpsurgery.net.

The registered location is located in a residential area in Broadway. There is adequate car parking and disabled parking bays to the side of the building. The building is purpose built with patient accessible facilities on the ground floor and a lift to the first floor. The practice has a dispensary and was able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy.

The practice partnership consists of two GP partners, one male and one female. The practice employs two part time practice nurses and one part time health care assistant. The practice has a practice manager who is supported by a team of management staff, reception staff, administrators and secretary. There are four members of dispensing staff to provide a service during the practice opening hours.

The practice is open Monday, Wednesday and Friday 8.30am -1.00pm and 2.00pm - 6.00pm; on Tuesdays until 7pm. The practice is part of a new initiative across Somerset whereby patients can make appointments at extended times (up until 8pm at night Monday-Friday and on Saturday mornings) at other practices across the local area. Practices working together to deliver extended access to appointments in this local area are: Springmead, Tawstock, Essex House, Church View, The Meadows, Summervale and West One. The practice does not provide out of hour’s services to its patients, this is provided via NHS111 Contact information for this service is available in the practice and on the practice website.The practice provides support to patients living in two care homes in the local area.

Church View Medical Practice is part of the CLICK Federation, a group of GP practices who have agreed to work collaboratively, for the benefit of the patients, the local population, local health services and the wider NHS. This includes sharing aspects of services including an Emergency Care Practitioner, pharmacist and a GP service to undertake Nursing Home Patient reviews.

The practice has a General Medical Services (GMS) contract with NHS England (a locally agreed contract negotiated between NHS England and the practice).

Demographic data from 2015/2016 that is available to the CQC shows:

The age of the patient population was similar to the national averages for patients under the age of 18 years at 15%, the national average being 21%. For patients over 65 years the practice has 37% with the national average being 17%.

Other Population Demographics included that 69% of the practice population have a long standing health condition, which was above the national average of 54%. Also 52% of patients were in paid work or full time education which was below the national average of 62%. Information from the

Index of Multiple Deprivation 2015 (IMD): showed the practice population is at 15 (the national average is 24). The lower the number the more affluent the general population in the area is.

Income Deprivation Affecting Children (IDACI): is 10% (the national average 20%)

Income Deprivation Affecting Older People (IDAOPI): is 10% (the national average 21%).

Updated 8 May 2018

This practice is rated as Good overall. (Previous inspection 26 November 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Church View Medical Centre on 7 March 2018. We carried out this inspection under Section 60 of the Health and Social Care Act2008 as part of our regulatory functions. This inspection was planned as our inspection programme to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

• Practice staff were responsive and accommodating to patient’s individual needs.

The areas where the provider should make improvements are:

• Review the way training records are kept so that they provide good oversight of the training needs and achievements of staff.

• Review systems for ensuring prescription paper and prescription pads are held securely and tracked in line with national guidance..

• Review governance arrangements to ensure the dispensary activities were in line with practice protocols and standard operating procedures.

• Review security of the dispensary regularly and put actions in place to maintain safety in this area.

• Review the oversight of risk assessments with a planned approach to developing or updating.

• Review the practices oversight of chemicals used at the practice in regard to Control of Substances Hazardous to Health (COSHH) and the management of legionella.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 March 2015

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

Patients with long term conditions had a nominated GP and tailor-made care plans in place. Patients were pleased with the care they received for their long term conditions and were offered specific clinics for monitoring and treatment of conditions. These included warfarin monitoring, asthma, diabetes, family planning and ante-natal care. Health promotion for patients at the practice included those with long term conditions.

The diabetic clinics supported and treated patients with diabetes which included education for patients to learn how to manage their diabetes through the use of insulin. Health education about healthy diet and life style was provided. Patients were issued with insulin information cards which could be used for reference if the patient was on holiday or away from the practice. Diabetic patients had a twice yearly health check.

Home visits and medication reviews were provided for patients with long term conditions who had been recently discharged from hospital.

Patients receiving certain medicines were able to access screening services at the practice to make sure the medication they received was effective. This included, for example, patients on warfarin medicine (a blood thinning medicine) early or mid-week appointments to check blood levels. This was so that results were back before the weekend allowing any adjustments to medicines to be made before the weekend closure of the practice.

The practice used a specific computerised patient record system allowing out of hours service providers to access information on specific patients with the aim of treatment being seamless for the patient. GPs and out of hours doctors were thus aware of any treatment that had been given to people with long term conditions or those at the end of their life.

Updated 19 March 2015

There were baby and child immunisation programmes available to ensure babies and children could access a full range of vaccinations and health screening.

Ante-natal care was provided by a midwife who held clinics at the practice. The midwife had access to the practice computer system and could speak with a GP should the need arise. The practice also had relationships with health visitors and the school nursing team, and was able to access support from children’s workers and parenting support groups.

Parents were invited to bring their children to regular developmental check-ups with their GP. The practice referred patients to a local family and child service to discuss any vulnerable babies, children or families.

Men, women and young people had access to a full range of contraception services. Men, women and young people had access to sexual health screening including chlamydia testing and cervical screening for women.

There were not specific clinics or services for younger people but staff were aware of steps to take to report safeguarding concerns about children and young people. All staff had attended safeguarding training appropriate to their roles.

Updated 19 March 2015

Patients aged 75 and over had their own allocated GP but could also see an alternative GP if they preferred. Pneumococcal, shingles and flu vaccines were provided at the practice. The GPs ensured they visited housebound patients on their caseload and practice nurses visited housebound patients in their homes to administer vaccinations. The practice had a dispensary. This ensured patients could obtain their prescribed medications at the practice as it was situated in a rural setting which was a set distance from a pharmacy. Pharmacy staff also on occasion delivered prescribed medicines to housebound patients who needed medicines urgently. The GPs visited older patients who required a visit following discharge from hospital or arranged for the community matron to do this on their behalf if appropriate.

Clinics specifically for older people were not held at the practice, but treatment was organised around the individual patient and any specific medical condition they had.

The practice had a system to identify older patients and was appropriately involved in the local complex care team (CCT). Vulnerable patients were discussed at meetings held on alternate weeks to identify and review any patients at risk. The work undertaken by the GP team had contributed to the practice’s participation in the national initiative to avoid unplanned admission to hospitals by providing an enhanced service.

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

Consulting rooms were located on the ground floor, with level access, avoiding the need to climb stairs. In waiting areas there were chairs of varying heights, some with arms, for ease of use for older patients with mobility problems.

Updated 19 March 2015

Health checks were available to patients aged between 40 and 74.

The practice offered one evening surgery until 7pm, outside of normal opening times to help patients of working age attend appointments. Patients could request appointments in person or by phone. Telephone consultations were also available.

Travel advice was available from the GPs and nursing staff within the practice and supporting information leaflets were available. Pneumococcal vaccination and shingles vaccinations were provided for patients at risk.

The staff carried out opportunistic health checks on patients as they attended the practice. This included offering referrals for smoking cessation, providing health information, routine health checks and reminders to have medicine reviews. The practice also offered age appropriate screening tests including for prostate cancer and cholesterol testing.

Updated 19 March 2015

The practice had a register of patients with mental illness, depression and dementia. All were offered regular checks, opportunistically and by invitation. For example, homeless patients with mental health needs were able to see a GP on the day if they came to the practice reception.

GPs, nursing and administrative staff had attended dementia and learning disability awareness sessions.

Mental health medicine reviews were conducted to ensure that patients’ medicines remained appropriate and that the dose was still correct. Blood tests were regularly performed on patients receiving certain mental health medications to provide the GP with the information they needed to adjust the dosage.

Updated 19 March 2015

The practice had a very low number of registered patients with a learning disability. They were offered an annual health check, during which their long term care plans were discussed with them and their carer if appropriate.

Patients for whom English was not their first language were offered interpretation and translation services. The practice had low numbers of registered patients speaking English as a second language.

Patients with alcohol and drug addictions were referred to the local treatment service.

GPs had often referred vulnerable, housebound patients to the community nurses who visited them at home to assess their needs. Staff from the practice also visited patients at home when they have expressed reluctance to attend the practice for either emotional or health reasons. The practice had patients registered at two local nursing homes, where GPs made regular calls to review these patients’ health needs.

The practice worked with community health care professionals including physiotherapists and mental health workers to make sure vulnerable patients were visited in their homes to assess needs and facilitate provision of any equipment, mobility or medication.