Archived: Gunnislake Health Centre

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