Archived: Creech Medical Centre

Updated 24 December 2015

Creech Medical Centre is located about four miles from Taunton. The practice serves a rural population of approximately 3570 patients from Creech St Michael, East Taunton and the surrounding villages. The practice building was purpose built in August 2012 and in addition to the practice staff, provides accommodation for district nurses, health visitors and a pain clinic.

Creech Medical Centre has two partner GPs. They provide 14 GP sessions each week and are equivalent to 1.5 whole time employees. One GP is female and the other is male. There are two female nurses including a lead nurse and a nurse practitioner whose working hours are equivalent to 1.1 whole time employees. A health care assistant is also employed by the practice. The GPs and nurses are supported by six management and administrative staff including a practice manager. A small team of community based nurses are located in the practice including a health visitor, a midwife and two district nurses. The practice had experienced recent staff turnover. They recently appointed a new practice manager and were seeking to employ another receptionist to strengthen the team.

The practices patient population is expanding rapidly and has a higher proportion of patients over the age of 65 years, with approximately 25% of patients being over this age compared with the national average of 17%. Almost 4% of the patients are over the age of 85 years compared to a national average of 2.2%. Approximately 63% of patients have a long term illness compared to a national average of 54% resulting in a higher demand for GP and nurse appointments. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the second least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas).

The practice is open between 8:30am and 1pm and 2pm and 6:30pm Monday to Friday; appointments are available during these times with telephone access available from 8am and 6:30pm. Extended hours are offered on Monday, Wednesday and Thursday evenings between 6:30pm and 7pm and between 7am and 8am on Thursday mornings for pre-booked appointments for those patients who cannot visit the practice during normal hours. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. Patients need to contact the practice first to arrange for access to these services.

The practice has a General Medical Services (GMS) contract to deliver health care services; the contract includes enhanced services such as extended opening hours, childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. It provides an influenza and pneumococcal immunisations enhanced service. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by Somerset Doctors Urgent Care (SDUC), patients are directed to this service by the practice outside of normal practice hours.

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Creech Medical Centre on 24 November 2015. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw two areas of outstanding practice:

• The patient participation group (PPG) was prominently active within the practice and was involved in staff recruitment. They sat on the interview panel during recent interviews for a new practice manager; had arranged patient educational events; and as a result of their patient survey feedback, the appointment system had been revised and improved.

• The practice worked with local ‘Village Agents’ to help provide support to isolated patients on their lists by providing information to patients who might benefit from extra support or contact.

The areas where the provider should make improvement are:

• Review systems for recording alerts on the patient record system to ensure GPs, particularly locum GPs, are made aware of any concerns about patients.

• Review the programme of audits to ensure practice performance can be measured effectively in the absence of the Quality and Outcomes Framework measures.

• Review care plans to ensure they are routinely updated as well as following changes to patients’ needs or diagnosis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 December 2015

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The nursing team were experienced and qualified in all chronic disease management and provided regular nurse led patient reviews for patients with long term conditions. Longer appointments were provided, usually 30 minutes, for these patients. Patients were reminded of their appointment and had their regular investigations in advance of their appointment.

• The practice had recently started working with a ‘Well-being Advisor’ via a local Symphony project (A project to support patients with three or more illnesses to be maintained in the community rather than in hospital). This advisor was the point of contact for patients with long term illnesses in order to stream line patient care.

Updated 24 December 2015

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow 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 children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 78.98%, which was comparable to the national average of 81.88% and in line with other Taunton and Dean practices.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw good examples of joint working with midwives, health visitors and school nurses.

• GP’s carried out paediatric phlebotomy to help reduce the need to send patients to hospital based paediatric phlebotomy services, and provide the service in a familiar less stressful environment.

• One of the GPs provided sex education talks to nine and ten year olds at the adjacent primary school as part of their education programme.

Updated 24 December 2015

The practice is rated as good for the care of older people.

• The practice offered personalised care to meet the needs of the older people in its population. However, care plans were not always reviewed unless a change in the patient’s diagnosis prompted an update.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice kept a list of patients from whom they would accept telephone prescription requests. The attached pharmacy, in conjunction with the practice, arranged home delivery of medicines to the patients as well as organising dossett boxes and trays to minimise any errors of taking medicines.

• The practice worked with local ‘Village Agents’ (a Somerset community project) to help provide support to isolated patients on their list by providing information to patients who might benefit from extra support or contact.

Updated 24 December 2015

The practice is rated as good for the care of working-age people (including those recently retired and students).

• 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 online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Extended hours were offered on Monday, Wednesday and Thursday evenings between 6:30pm and 7pm and on Thursday mornings from 7am until 8am for pre-booked appointments for those patients who could not visit the practice during normal hours.

• The practice offered online booking facilities for non-urgent appointments and an online repeat prescription service.

Updated 24 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• All patients over the age of 75 years

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• They carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 24 December 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice offered longer appointments for people with a learning disability if required and provided the appointments at times which suited the patient.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• They told vulnerable patients and their carers about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• Patients diagnosed with learning difficulties received an in-depth medical examination annually. During this examination, the problems of their disability were investigated, as well as considering general health promotion, for example, smoking cessation, alcohol use status and cardiovascular risk stratification.

• Meetings were held every four weeks with the palliative care team to discuss any needs in the care of terminally ill patients.

• Patients requesting an appointment for emotional or mental health concerns were given a double appointment.