Archived: Drs Hanson, Perry, Paisley, Ashworth, Hammerton and Symons Also known as Warwick House Medical Centre

Updated 30 July 2015

Drs Hanson, Perry, Paisley, Ashworth, Hammerton and Symons, Warwick House Medical Centre, Holway Green, Upper Holway Road, Taunton. TA1 2QA is located a short distance from the centre of Taunton. The premises are purpose built and mainly on one level with a lift to a lower level. The practice has approximately 6,750 registered patients, this figure is growing monthly. The practice accepts patients from an area including Southern Taunton, Monkton Heathfield to the north East of Taunton, Knapp and Hatch Green to the East, Curland to the South and Poundisford and Corfe to the South West of Taunton. Full details are on the practice website.

There are six GP partners and a salaried GP and a team of clinical staff including a lead nurse, two practice nurses and a health care assistant. Four GPs are female and three are male, the hours contracted by GPs are equal to 5.5 whole time equivalent GPs based on 8 sessions per week. Collectively the GPs provide 48 patient sessions each week. Additionally the three nurses employed equal to 1.6 whole time equivalent employees and a health care assistant (HCA) equal to 0.6 whole time equivalent HCA employed. Non-clinical staff included secretaries, support staff and a management team including a practice manager, patient services team, medical secretaries, practice administrator and other administrative and reception staff. The practice is a registered training practice with the Severn Deanery and supported an ST1 doctor at the time of our inspection (ST! doctors are in year one of their GP training).

The practice population ethnic profile is predominantly White British with an age distribution of male and female patients’ broadly equivalent to national average figures. However the practice has noticeable fewer patients in the 20 to 39 years age categories. Practice data from the patient participation group report, March 2015 indicates there are approximately 9.5% of patients from other ethnic groups, the majority being patients from Eastern Europe. The average male life expectancy for the practice area is 80 years compared to the National average of 79; the female life expectancy for the practice is 84 years compared to the National average of 83 years.

The National GP Patient Survey published in January 2015 indicated just over 89% of patients said they would recommend the practice to someone new to the area. This was above the Somerset Clinical Commissioning Group average of about 83%. Local Public Health statistics (January 2014) demonstrate that Warwick House medical centre has a low level of social deprivation, the Index of Multiple Deprivation being 17.8 in compared to the National average of 23.6.

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 living with dementia and minor surgery services. It also provides minor surgery such as vasectomy and nail care as well as 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 South Western Ambulance Service NHS Foundation Trust and patients are directed to this service by the practice during out of hours.

Updated 30 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Hanson, Perry, Paisley, Ashworth, Hammerton and Symons (Warwick House Medical Centre) on 10 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older patients, patients with long term conditions, families, children and young patients, working age patients (including those recently retired and students), patients whose circumstances may make them vulnerable and patients experiencing poor mental health (including patients living with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report accidents, incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and learnt from their investigations.
• Risks to patients were assessed and appropriately managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Care and treatment of patients was carried out effectively by appropriately skilled staff.
• Patients said they were treated with compassion, dignity and respect by all staff 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 always available the same day.
• The practice had suitable 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.

We saw several areas of outstanding practice including:

• One of the nurses had a lead role in a local peer group for respiratory care and delivered learning sessions to the network four times a year. They also benefitted from peer support through the network and were able to share best practice with colleagues which benefitted patients at the practice and the wider community.
• The practice had undertaken a Medical Protection Society safety culture survey in February 2015 to ensure a “safety first “approach guided the practice’s approach to support patient safety.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure arrangements are in place to agree the frequency of fire evacuation test procedures.
• Consider ways to ensure consistent recording of best interest decisions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 July 2015

The practice is rated as good for the care of patients 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 medication 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. A nurse had received additional training in respiratory conditions and gained a diploma in Asthma care as a direct result of a financial donation. This enabled significantly more patients to attend clinics in respiratory care.

Updated 30 July 2015

The practice is rated as good for the care of families, children and young patients. 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. 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. The practice had completed the Royal College of General Practitioners safeguarding self-assessment tool for children and had implemented systems to ensure vulnerable children known to the practice were kept safe.

Updated 30 July 2015

The practice is rated as good for the care of older patients. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 30 July 2015

The practice is rated as good for the care of working-age patients (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.

Updated 30 July 2015

The practice is rated as good for the care of patients experiencing poor mental health (including patients with dementia). The majority of patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice informed patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for patients with mental health needs and dementia.

Updated 30 July 2015

The practice is rated as good for the care of patients whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. It had carried out annual health checks for patients with a learning disability and 95% of these patients had received a follow-up. It offered longer appointments for patients with a learning disability.

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