Archived: Warwick House Medical Centre

Updated 6 October 2017

Warwick House Medical Practice, Upper Holway Road, Taunton, Somerset TA1 2QA is located a short distance from the centre of Taunton. The practice serves a mixed semi-rural and urban population of approximately 7,102 patients in the south east of Taunton.

The practice premises are a purpose built two storey building with an onsite pharmacy. All patient services are located on the ground floor of the building which is mainly on one level with a lift to a lower level.

Data from Public Health England show that the practice had a higher than average population of patients over 65, 25%, in comparison with the clinical commissioning group (CCG) average of 23% and a national average of 17%. Average male and female life expectancy for the area is the same as the national average of 79 and 83 years respectively and one year less than the clinical commissioning group (CCG) average. The practice is situated in an area with less deprivation with a deprivation score of 17% compared to the CCG average of 18% and the national average of 22%.

In April 2017 the six GP partners took the decision to enter into a contractual arrangement with Taunton and Somerset NHS Foundation Trust (T&SFT) to become a semi-autonomous directorate of the Trust. The practice sub contracts the General Medical Services (GMS) contract to T&SFT to deliver health care services. In addition to the GMS contract the practice provides a weekly violent patient scheme, a vasectomy clinic and provision of a weekly service to a local 45 bed high needs dementia hospital. A private Botox service was also offered by one GP and acupuncture was available privately.

As part of the merger the GP partners became salaried GPs along with the existing salaried GP to provide a whole time equivalent of four GP posts. There are four are female and three male salaried GPs. The clinical team includes three practice nurses and a health care assistant. A musculoskeletal practitioner provided 16 appointments per week and a physiotherapist provided weekly appointments. Non-clinical staff included secretaries, receptionists and administrators and a practice manager. The practice also employs a full time apprentice studying business administration. A wellbeing advisor (as part of a test and learn for the local GP federation) provided support and advice to patients with long term conditions including carers. For example, medicine concerns and education.

The practice is a teaching practice and registrar GPs were placed with them at the time of our inspection. The practice also hosts placements for medical students. Two of the GPs are GP trainers.

Warwick House Medical Practice is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8.30am and emergency telephone access is available from 8am. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day. Extended hours appointments are offered on Tuesdays, Wednesdays and Thursdays from 6.30pm until 7pm and the practice also offers telephone consultations. Saturday appointments were available as part of a shared acre arrangement within the GP federation. This meant patients could access an appointment with a GP although this may not be a GP at their practice. GP appointments are 15 minutes each in length and appointment sessions are typically 8.30am until 11.30am and 3pm until 6pm. 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 opted out of providing Out Of Hours services to their own patients. Patients can access a local provider which provides an NHS111 and an Out Of Hours GP service.

We inspected this GP practice under the previous provider in June 2015.

Updated 6 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Warwick House Medical Practice on 10 August 2017. 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.
• There was an innovative approach to continuous improvement with action plans in place to develop a more integrated model of care between primary and secondary care services.

The areas where the provider should make improvement are:

• Have a document system to record the regular monitoring of infection prevention control measures.

• Review and improve the system in place to track blank prescriptions.

• Undertake administrative staff appraisals.

• Have a system to actively monitor performance for the Somerset Practice Quality Scheme (SPQS). (SPQS is a system intended to improve the quality of general practice).

• Embed clinical audits and re-audits to improve patient outcomes and ensure all audits contain a measurable action plan where required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 October 2017

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

• Practice nurses had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health and patients were provided with clear care plans and medicines to prevent escalation of their condition.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that additional needs were identified and met.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 6 October 2017

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

• There were systems 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 accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• 82% of women between the ages of 25 and 65 had received a cervical screening test.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses such as quarterly meetings.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• One GP kept up to date with contraception and sexual health by providing a session per week at the local sexual health clinic.

Updated 6 October 2017

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

• Staff were able to recognise the signs of abuse in older people and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older people in its population which included using frailty scoring to identify those most at risk.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. For example, GP’s provided primary medical care to specific nursing homes.
• The practice identified at an early stage older people who may be approaching the end of life. It involved older people in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were offered health promotional advice and support through a wellbeing advisor to help them to maintain their health and independence for as long as possible.

Updated 6 October 2017

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. NHS health checks were provided by an external organisation and the results were monitored by the practice.

Updated 6 October 2017

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

• 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• People at risk of dementia were identified and offered an assessment.
• Patients diagnosed with dementia received follow up consultations following attendance to accident and emergency.
• The practice had a system for monitoring repeat prescribing for people receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice worked with the local community mental health team which carried out advance care planning for patients with dementia.
• The practice specifically considered the physical health needs of people with poor mental health. For example, 45 minute appointments were offered for annual mental health reviews.
• 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 patients with mental health needs and dementia. They provided primary medical care for a local hospital for older people with enduring mental illness.

Updated 6 October 2017

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, those receiving end of life care and patients and families where there were safeguarding concerns.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients 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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.