Archived: Gunnislake Health Centre

Updated 16 April 2015

The practice is one of two health centres under the management of Tamar Valley Health. Both practices provided primary medical services to approximately 16,230 patients of which 6,200 attend the health centre at Gunnislake. The practice was located in a rural area of Cornwall and was a dispensing practice. A dispensing practice is where GPs are able to prescribe and dispense medicines directly to patients who live in a rural setting which is a set distance from a pharmacy. The practice provided a service to a diverse age group.

There was a team of nine GP partners, six associate GPs and a strategic management partner within the organisation. Partners hold managerial and financial responsibility for running the business. There were three GP partners based at Gunnislake Health Centre and two associate GPs. There were two female and three male GPs. The team were supported by a nurse prescriber, five practice nurses and five health care assistants who worked across both practices. The practice employed two pharmacists who were both able to prescribe and review medicines. There were also additional administrative, reception and dispensary staff.

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

The practice is open from Monday to Friday, between the hours of 8.30am and 6pm. Evening appointments were available with a GP one day a week and each Saturday morning at either of the two health centres to help those patients who worked during routine office hours.

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

Updated 16 April 2015

Letter from the Chief Inspector of General Practice

Gunnislake Health Centre was inspected on Wednesday 29 January 2015. This was a comprehensive inspection.

The practice is one of two health centres under the management of Tamar Valley Health. Both practices provided primary medical services to approximately 16,230 patients of which 6,200 attend the health centre at Gunnislake. The practice was located in a rural area of Cornwall and was a dispensing practice. A dispensing practice is where GPs are able to prescribe and dispense medicines directly to patients who live in a rural setting which is a set distance from a pharmacy. Approximately 5,500 patients at the practice were able to use the dispensary at the health centre. The practice provided a service to a diverse age group.

There was a team of nine GP partners, six associate GPs and a strategic management partner within the organisation. Partners hold managerial and financial responsibility for running the business. There were three GP partners based at Gunnislake Health Centre and two associate GPs. There were two female and three male GPs. The team were supported by a nurse prescriber, five practice nurses and five health care assistants who worked across both practices. The practice employed two pharmacists who were both able to prescribe and review medicines. There were also additional administrative, reception and dispensing staff.

Patients using the practice also had access to community staff including district nurses, 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. There was a proven track record and a culture of promptly responding to incidents and near misses and using these events to learn and change systems changed so that patient care could be improved.

There were systems in place to support the GPs and other clinical staff to improve clinical outcomes for patients. According to data from the Quality and Outcomes Framework (the annual reward and incentive programme detailing GP practice achievement results) outcomes for patients registered with this practice were equal to or above average for the locality. Patient care and treatment was considered in line with best practice national guidelines and staff are proactive in promoting good health. There were sufficiently skilled and trained staff working at the practice.

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

The practice planned its services to meet the diversity of its patients. There were good facilities available, adjustments were made to meet the needs of the patients and there was an effective appointment system in place which enabled a good access to the service.

The practice had a vision and informal set of values which were understood by staff. There were clear clinical governance systems and a clear leadership structure in place.

We saw two areas of outstanding practice including:

The practice employed two pharmacists who were able to treat and prescribe minor illnesses, perform medicine reviews, answer medicine queries and perform basic health reviews. The pharmacists were independent prescribers and were involved with clinical activities in the practice as well as overseeing the dispensary procedures. They had systems in place to ensure any medicines alerts and recalls were assessed and actioned. The role had led to improvements in meeting patient needs during ‘on the day’ appointments and ensured GPs followed the most up to date guidance. The practice provided a service called TIC TAC to the local community college. The TIC TAC service provided a drop in confidential advice and healthcare service to students during their college day. Although this was a funded enhanced service the practice had worked over and beyond the contract and reviewed the service changing it where necessary. For example initially the main services were for sexual health screening and contraception advice but more mental health issues had arisen resulting in the introduction of a counsellor and increased referrals to the community mental health teams. The practice provided a full time coordinator, daily GP and/or practice nurse and counsellor. They also had access to a school nurse. The service mainly provided health education, sexual health advice, contraception, smoking cessation advice and emotional support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 April 2015

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

The practice had a system to identify patients with long term conditions and arrange treatment, reviews and follow up care at a time suitable to the patient. Patients with long term conditions described the practice as efficient and organised when arranging care and treatment and said the practice reminded them of upcoming health care and medicine reviews.

Patients with diabetes were reviewed by the practice staff and community nurse specialist where required. These reviews included a medicines check, health and lifestyle advice, blood tests and foot care. There were clear guidelines and care templates for GPs and practice nurses to follow.

Patients with long term conditions had personal care plans in place. Respiratory and diabetic clinics were run by practice nurses with specialist qualifications. The nurses attended educational updates to make sure their lead role knowledge and skills were kept up to date.

The practice provided clinics for asthma and chronic lung disorders (COPD) including using spirometry, a lung capacity test, as part of its service to assess the evolving needs of this group of patients.

The practice promoted independence and self-care for patients with long term conditions. For example, some patients monitored their own health remotely and contacted the practice should their symptoms change and there was a blood pressure machine in the practice for patients to use.

The computer system contained health promotion prompts so opportunistic screening could take place regardless of for the reason for the patient’s attendance.

All patients with complex needs who were in receipt of a care plan were contacted by the practice following any admission or attendance at A&E and home visits were undertaken if required to ensure medicine reviews were performed.

The practice sent ‘special messages’ to the out of hour’s providers about patients with complex needs so the out of hours service was aware of their care and treatment. For patients at the end of their life the practice used a computerised clinical patient management system to provide continuity of care by automatically sending full consultation details to the out of hours provider.

The practice used the Quality and Outcomes Framework (QOF) which is a national performance measurement tool. The practice used the QOF to identify and support patients with long term conditions to ensure their needs were monitored and gave assurances that they were providing care to set practice standards and working within NICE Guidelines.

Updated 16 April 2015

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

The practice held weekly baby and child immunisation appointments and sent letters of invitation to all parents and carers.

Patients who did not attend for immunisations were reviewed by the practice nurse and GP and contacted by the practice if appropriate. If there were any concerns regarding the reasons for non- attendance these are raised with the health visitor who visited the practice on a daily basis.

Ante-natal care was provided at a community centre next to the practice. Midwives communicated with the GPs and practice team on a daily basis should this be necessary. The practice staff also worked with health visitors, dieticians, school nurses and podiatrists.

Patients had access to contraception advice and had access to a full range of contraception services including the insertion of coils and implants. Patients could also access chlamydia testing and cervical screening. There were private areas 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. All staff had received training on safeguarding children and young people.

Updated 16 April 2015

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

Information from Public Health England showed that the practice’s patient population had a higher than average number of older people compared to the county and the England average.

All patients aged 75 and over had a named GP but were able to choose an alternative if they wished or if this was more convenient for the patient.

Pneumococcal vaccinations and shingles vaccinations were provided for older people. Housebound older patients received immunisations at home where necessary. Specific flu clinics are organised in village halls in the area to enable older patients to access a more local service.

The practice did not provide specific older person clinics. Treatment was organised around the individual patient and any specific condition or need they had. A computer pop up alert system prompted clinicians to offer any tests or routine monitoring.

The practice worked with the community multidisciplinary team to identify patients at greater risk of admission. Practice nurses work with the community nursing team to provide a streamlined service.

The practice identified older patients with life-limiting conditions and co-ordinated a multi-disciplinary team (MDT) for the planning and delivery of palliative care for people approaching the end of life.

Family and Carers were included in patient care where patients requested. The practice communicated with family members (with consent) to clarify information or inviting them to come along with the patient.

The GPs worked to avoid unnecessary admissions to hospital and used care plans which were reviewed every three months to avoid patients being admitted to hospital unnecessarily.

The premises and services were purpose built and had been adapted to meet the needs of people with disabilities. There was level access and a designated accessible toilet.

Updated 16 April 2015

The practice is rated as good for the care of working age people

The practice offered telephone consultations, four week advanced booking for appointments. Weekend and once weekly evening appointments were also available with a GP.

NHS Health checks, weight checks, healthy living advice, blood pressure checks, new patient checks and smoking cessation appointments were offered at a time convenient to the patient.

There was an online appointment booking system and online prescription request via the practice website which patients said was easy and convenient to use. Patients who received repeat medicines were able to collect their prescriptions at a pharmacy of their choice or at the practice dispensary if appropriate.

The practice offered travel advice and vaccinations. The practice was a nominated yellow fever vaccine centre. Nurses who provided this service had received specialist training.

The practice offered services including joint injections, monitoring of patients on blood thinning medicines and electronic cardiograms (ECG-heart tracing).

Updated 16 April 2015

The practice is rated as good for the care of people experiencing poor mental health.

The practice had a register at the practice which identified patients who had mental illness or mental health problems and were assigned a GP of the patient’s choice for continuity of care.

The practice used QOF and recall systems to ensure mental health checks and medicine reviews were conducted to ensure patients received appropriate doses and care plans were in place. Blood tests were regularly performed on patients receiving certain mental health medicines.

Patients were offered appointments at a memory clinic and were then referred or monitored if the result showed an impairment in memory.

The practice worked with the community mental health team and referred patients for urgent intervention when required. The GPs liaised with community psychiatric nurses to discuss vulnerable patients and referred patients to the community mental health team if necessary.

The practice staff had an understanding of the Mental Capacity Act 2005.

Updated 16 April 2015

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

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. Patients who found it stressful to come to the practice were visited in their own home.

Practice staff encouraged patients with alcohol addictions to self-refer to an alcohol service for support and treatment.

The practice had access to language interpretation services but stated that patients usually chose to attend the practice with a family member.

The practice had identified that some patients were vulnerable because of the rural location and reduced public transport network. As a result the practice had enabled patients to use either practice and arranged for some immunisation clinics to be held in some of the villages in the surrounding area. The practice had also established a home delivery service for patients who were unable to collect their prescriptions from the surgery.