Archived: North Tawton Medical Practice

Updated 28 January 2016

North Tawton Medical Practice is located within the small town of North Tawton, in Devon. The practice benefits from good transport links for patients living outside of town. There were 2127 patients on the practice list and the majority of patients are of British white background. There is a higher percentage of patients over 45 years registered at this practice. Social deprivation is mid-range in a predominantly rural area.

Since 1 April 2015 Dr AMJ Bower & Partners, which also runs Bow Medical Practice, has been responsible for providing medical services and care to the patients registered at North Tawton Medical Practice. Since taking over the partners have invested significantly to improve the premises in order to make them safe for staff and patients. The practice is six months into a 12 month contract term. On commencing the contract urgent work had taken place as there had been no hot water available in the premises or a fire system in place. A tendering process is currently underway to determine who will run the service from April 2016. The practice has seen three changes in contract holders since the original single-handed GP retired in 2009.

The practice is managed by two GP partners, one male and one female and a non clinical managing partner, the practice manager. They are supported by two female salaried GP’s, two female practice nurses and two female Health Care Assistants and an administrative team led by the practice manager. 

The practice is open 8am to 1pm and 2pm – 6.30 pm Monday, Tuesday, Thursday and Friday and 8am – 1pm on Wednesdays. Patients can access care via Bow Medical Practice when North Tawton Medical practice is closed, or are advised to contact the out of hour’s service provided by Devon Doctors. The practice closes 4 half days a year for staff training and information about this is posted on the website. The practice is not contracted to offer extended hours but are currently consulting with their patients via the PPG (Patient Participation Group) as to their requirements in the future.

The practice has an Alternative Primary Medical Service (APMS) contract and also offers enhanced services:

• Minor surgery (curettage & cautery)

• Child health surveillance
• Influenza, pneumococcal, rotavirus and shingles immunisations for children and adults
• Patient participation in development of services.
• Learning Disability health check scheme
• Pertussis vaccinations for pregnant women
• Women’s health – maternity medical care, cervical screening and contraceptive services

Patients are able to access additional services such as monthly carer support meetings and physiotherapy at Bow Medical Practice

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Tawton Medical Practice on 4 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.
• The practice premises had recently been upgraded significantly to provide safe facilities and were 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 2016

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.
• Patients diagnosed with long term conditions were supported through a range of clinics held for specific conditions such as, asthma, chronic obstructive pulmonary disease (COPD) and diabetes.
• 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.
• Patients receiving palliative care, those with cancer diagnosis and patients likely to require unplanned admissions to hospital were added to the Out of Hours system to share information and patient choices and decisions with other service providers.

Updated 28 January 2016

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 and comparable with local and national rates 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, and we saw evidence to confirm this. In the first six months of being the provider for North Tawton Medical practice cervical cytology screening uptake had increased to levels comparable with local and national averages.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Significant improvements to the premises had recently been made to provide a child friendly environment.

Updated 28 January 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example emergency admission avoidance.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Specifically the GP’s were proactive in visiting older people without an acute medical need. We found integrated working arrangements with community teams.
• The practice worked closely with carers and liaised well with Devon Carers to provide the support and advice they might need.

Updated 28 January 2016

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 such as NHS Health checks for those between 40 and 74 years and flu clinics outside of working hours.
• The practice was proactive in accessing working age people to provide health promotion by working with the local community and participating in Healthy Living days at the weekend.

Updated 28 January 2016

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

• People with suspected diagnosis of dementia were screened using nationally recognised assessment tools and referred on to the memory clinic and/or other support agencies according to their needs. When the partners took over Tawton Medical Practice they recognised that diagnosis rates were lower than local and national levels and have highlighted this as an area for development.
• 77% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months with consultation lengths appropriate to an individual’s needs.
• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Community mental health workers remarked that the practice was responsive and caring.
• It 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. We saw that information was available on the practice website and that the practice provided information about available talking therapies provided by the local NHS anxiety and depression service.
• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support people with mental health needs and dementia. The practice had a lead GP partner with extended skills and qualifications in mental health care.

Updated 28 January 2016

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

• The practice held a register and alerts were in situ on the practices computer system for patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice was proactive inviting people with learning disabilities for an annual health check. It offered longer appointments for people with a learning disability
• 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. 
• 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.