Townhead Surgery

Updated 12 September 2016

Townhead Surgery is a member of the Airedale Wharfedale and Craven Clinical Commissioning Group (CCG). General Medical Services (GMS) are provided under a contract with NHS England. The practice is registered with the Care Quality Commission (CQC) to provide the following regulated activities: maternity and midwifery services, family planning, diagnostic and screening procedures and treatment of disease, disorder or injury. They also offer a range of enhanced services, which include:

• Childhood vaccination and immunisations

• The provision of influenza and pneumococcal immunisations

• Extended hours access

Townhead Surgery is located in Settle, North Yorkshire which is a rural town which relies on agriculture as its main industry. The catchment area for the practice is Settle and surrounding villages covering 250 square miles.

The practice is situated in a purpose built premises, close to the market square, and a modernised branch surgery in the village of Hellifield. There are facilities for people with disabilities and all patients areas are on the ground floor. There are car parking facilities on site with designated disabled parking.

The practice dispenses prescriptions to eligible patients. The medication is dispensed from Townhead surgery, however the medication can be collected at two other locations which include the branch surgery at Hellifield and a village post office.

The practice has a patient list size of 9428 which is made up of predominantly white British, with an almost 50:50 ratio of male and female patients. There is a higher than CCG and national average number of patients over the age of 50 years. The practice has close links with a local residential home, where some registered patients reside.

There are nine GP partners, four female and five male, who are supported by four practice nurses  and two health care assistants; all female. There is a business manager and a practice manager, along with a team of pharmacy dispensers, administration and reception staff.

The practice is open between 8am to 6.30pm Monday to Friday, with extended hours from 7.30am to 8.00am Monday Tuesday or Thursday mornings and extended hours appointments from 6.30pm to 7.00pm Monday evenings. They are also open alternate Saturday mornings 8.00am to 10.30am. The branch surgery at Hellifield is open Monday Wednesday and Friday 9am to 12.15pm and Tuesday and Thursday 3.00pm to 6.00pm GP appointments are available throughout the day. When the practice is closed out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. (The third sector includes a very diverse range of organisations including voluntary, community, tenants’ and residents’ groups.)

One of the GP partners is the chair of Governing Body for the Airedale Wharfedale and Craven Clinical Commissioning Group. There is also a GP partner who is a special measures advisor for the Royal Collage of General Practitioners (RCGP).

We were informed of the challenges for the practice which included the rurality of the practice and staff recruitment.

Due to the demographics of the practice and its population, the practice accessed a number of hospital trusts in the North of England for example. Airedale General Hospital, Harrogate General Hospital, as well as hospitals in Preston, Morecombe Bay, Bradford and Leeds.

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Townhead Surgery on 30 June 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

• The practice ethos and culture was to provide good quality service and care to patients.
• Patients told us they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. A recognised tool was used to identify patients who were considered to be at risk of frailty.

• The practice had good facilities and was well equipped to treat and meet the needs of patients. Information regarding the services provided by the practice and how to make a complaint was readily available for patients.
• Patients we spoke with were positive about access to the service. They said they found it generally easy to make an appointment, there was continuity of care and urgent appointments were available on the same day as requested.
• The practice had a good understanding of, and complied with, the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)
• The partners promoted a culture of openness and honesty, which was reflected in their approach to safety. All staff were encouraged and supported to record any incidents. There was evidence of good investigation, learning and sharing mechanisms in place.
• Risks to patients were assessed and well managed. There were safe and effective governance arrangements in place.
• There were comprehensive safeguarding systems in place; particularly around vulnerable children and adults.
• The practice sought patient views how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and the patient participation group.
• There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs and manager were accessible and supportive.
• The GP partners were forward thinking, aware of future challenges to the practice and were open to innovative practice.

We saw two areas of outstanding practice:

• The practice had appointed a care co-ordinator to contact all patients immediately following discharge from an unplanned episode of hospital care. This intervention had supported people to get the right level of support in the community to avoid further admissions.
• The health of local farmers was pro-actively managed through a bespoke clinic to ensure that sufficient data was available to identify their health needs. As a result of the initiative health problems were identified and preventative medication, such as statins (drugs that reduce cholesterol in the blood) was commenced.

However there was one area of practice where the provider should make improvements:

• Maintain appropriate records when completing balance checks of controlled drugs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2016

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

• The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support were in place for these patients.

• 98% of newly diagnosed diabetic patients had received the influenza immunisation in the preceding 1 August to 31 March (CCG average 97%, national average 94%).
• 100% of patients diagnosed with atrial fibrillation were treated with anticoagulant or antiplatelet therapy (CCG average 99% and national average of 98%).
• The practice identified those patients who had complex needs and life limiting conditions and ensured they were on discussed at the multi disciplinary meeting and receiving the right care.
• Patients who were at risk of developing diabetes were identified and invited in for relevant tests and follow-up.
• There was a ‘did not attend’ (DNA) protocol in place to follow up routine appointments.

Updated 12 September 2016

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

• The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, the provision of ante-natal, post-natal and child health surveillance clinics.
• Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies. All children who required an urgent appointment were seen on the same day as requested.
• Immunisation uptake rates were in line with the CCG and national rates for all standard childhood immunisations.
• Sexual health, contraceptive and cervical screening services were provided at the practice.
• 84% of eligible patients had received cervical screening, the same as the CCG average, (national average 82%).
• Appointments were available with both male and female GPs.

Updated 12 September 2016

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

• The practice provided proactive, responsive and person-centred care to meet the needs of the older people in its population. All patients over the age of 75 years had a named GP.
• The practice worked closely with other health and social care professionals, such as the district nursing and local neighbourhood teams, to ensure housebound patients received the care and support they needed.
• The practice participated in Airedale Wharfedale and Craven Clinical Commissioning Group (CCG) initiatives to reduce the rate of elderly patients’ acute admission to hospital.
• Patients who were considered to be at risk of frailty were identified and support offered as appropriate.
• Care plans were in place for those patients who were considered to have a high risk of an unplanned hospital admission and patients were reviewed as needed.
• The practice conducted weekly ward rounds at Castleberg Hospital and a local nursing home to ensure the ongoing care needs of those patients were met.
• Patients were signposted to other local services for access to additional support, particularly for those who were isolated.

Updated 12 September 2016

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these patients 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 provided extended hours appointments one evening per week, one early morning per week, alternate Saturday mornings, telephone consultations, online booking of appointments and ordering of prescriptions.
• The practice offered a range of health promotion and screening that reflected the needs for this age group
• Health checks were offered to patients aged between 40 and 74.
• Students were offered public health recommended vaccinations prior to attending university.
• Travel health advice and vaccination were available.
• There was an in-house phlebotomist service to avoid the need for some patients having to access secondary care.
• The health needs of farmers were identified and addressed in a bespoke service.

Updated 12 September 2016

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

• The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team.
• Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• 81% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 89%, national average 84%).
• 96% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, who had a comprehensive, agreed care plan documented in their record in the preceding 12 months (CCG average 94% national averages of 88%)..
• Staff had a good understanding of how to support patients with mental health needs or dementia.

Updated 12 September 2016

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

• The practice did a regular search of patients who were identified as having factors which could contribute to vulnerability. These were discussed at multidisciplinary meetings. Clinicians worked with other health and social care professionals, to ensure those patients had their needs met.
• Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
• The practice could evidence the number of children who were on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).
• Patients who had a learning disability received an annual review of their health needs and a care plan was put in place. Carers of these patients were also encouraged to attend and were offered a health review and signposted to other services as needed.
• Those patients who were hypersensitive to their environment such as those on the autistic spectrum were offered appointments at quiet times in the practice.
• We saw there was information available on how patients could access various local support groups and voluntary organisations.
• Patients with learning disability and other vulnerabilities were actively encouraged to be part of the Patient Participation Group (PPG). There were two people with a learning disability part of the PPG and they were fully supported to take part in decisions.