Tri-Links Medical Practice

Updated 8 August 2017

Tri Links Medical Centre is registered with the Care Quality Commission as a two partner provider. The provider holds a General Medical Services (GMS) contract with NHS England, an agreement for the practice to deliver General Medical Services to the local community or communities. At the time of our inspection 6,162 patients were registered at the practice. The practice has a lower proportion of patients aged 65 years and over when compared with the practice average across the Clinical Commissioning Group (CCG) and nationally. For example, the percentage of patients aged 65 and above at the practice is 8%; the local CCG practice average is 21% and the national practice average, 17%. The practice population has a higher percentage of patients aged 18 years and under. The percentage of patients aged 18 years and under at the practice is 27%; the local CCG practice average is 20% and the national practice average 21%.

Tri Links Medical Centre has three sites on the outskirts of Tamworth in Amington, Belgrave and Wilnecote. As well as range of primary medical services, the practice provides additional services including:

• Childhood vaccination and immunisation.
• Venepuncture (blood sample taking).
• Minor surgery and procedures.

The buildings at Amington and Belgrave are purpose built and owned by the GP partners. The premises at Wilnecote is owned by NHS Properties and shared with another GP practice and members of the community health team including health visitors and community nurses.

The sites open each weekday from 8am to 6.30pm. Extended hours are provided between 6.30pm and 8pm on a Tuesday at the Amington branch. The practice has opted out of providing cover to patients outside of normal working hours. The Belgrave site closes on a Thursday but patients are able to visit alternative sites. The out-of-hours services are provided by Staffordshire Doctors Urgent Care.

Staffing at the practice includes five GPs (two male, three female), a part time clinical pharmacist and two practice nurses (equivalent to 1.8 whole time equivalent). The practice administration team includes a practice manager, a practice administrator and six reception/administration staff. There are 15 staff in total, working a mixture of full and part time hours equivalent to three point one whole time equivalent GPs and four point five whole time equivalent reception/administration staff.

Updated 8 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Tri Links Medical Centre on 27 July 2016. The overall rating for the practice was good with requires improvement for providing a safe service. The full comprehensive report on the 27 July 2016 inspection can be found by selecting the ‘all reports’ link for Tri Links Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 and 14 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified at our previous inspection on 27 July 2016. This report covers our findings in relation to those requirements.

Our key findings were as follows:

• Appropriate recruitment checks were completed on all staff employed including locum staff.
• A system had been implemented to ensure alerts were communicated to appropriate staff and appropriate actions taken.
• Learning outcomes from significant events were seen to have been shared with the wider practice team.
• The emergency medicines held at the practice had been risk assessed.
• The business continuity plan was kept off site so that access was possible should access to the building be restricted.

Further improvements included:

• Appropriate training and annual appraisals were provided for all staff.
• The provider had implemented procedures aimed at improving the uptake rates of cancer screening.
• The practice had taken steps to proactively identify more patients who also acted as carers.
• The complaints procedure had been revised to advise patients of their options should they not be satisfied with the response from the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 October 2016

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

• Patients at the highest risk of unplanned hospital admissions were identified and care plans had been implemented to meet their health and care needs.
• 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 people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The clinical pharmacist employed at the practice ran hypertension clinics and managed most patients with chronic obstructive pulmonary disease (COPD, a group of lung diseases that restrict breathing).
• There was an effective recall system that ensured patients with long term conditions were regularly reviewed by a clinician.

Updated 11 October 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 and those with non-accidental injury.
• Immunisation rates were generally similar to local and national averages for all standard childhood immunisations.
• The practice had a policy of seeing any child on a same day arrive and wait basis. When an appointment was unavailable, the request was forwarded to a GP.
• 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.
• The practice’s uptake for the cervical screening programme was 83% which was higher than the CCG average of 81% and national average of 82%.
• The practice was young person-friendly and offered chlamydia testing packs for all patients.
• The practice nurse ran immunisation clinics and patients who did not attend these clinics were followed up by the practice and referred to the health visitor.

Updated 11 October 2016

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

• The percentage of patients over 65 years of age was low (8% compared to the national average of 17%). All patients over 75 years of age had a named GP.
• The practice offered proactive, personalised care to meet the needs of the older people in its population. They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice participated in the local enhanced service for the avoidance of unnecessary admissions to hospital. Care plans had been completed for patients identified, these plans were reviewed every year as a minimum and discussed at regular multi-disciplinary team meetings.
• The practice had an assigned care co-ordinator for each patient with a care plan. They were able to refer patients who were isolated and in need of support, provide information and signposting to other services and could organise day centre and support for carers.
• The practice carried out opportunistic pulse checks on patients over 65 years of age to reduce the risk of a stroke through a pro-active approach to detecting asymptomatic atrial fibrillation (an irregular heart beat not detectable by the presence of other symptoms).

Updated 11 October 2016

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

• The practice offered appointments outside of core working hours, opening at 7am once a month for a ‘commuter clinic’ and until 8pm on a Tuesday.
• The practice provided online services to enable patients to book appointments, order repeat medicines and access some parts of their health records online.
• Health promotion and screening services reflected the health needs of this group.
• Patients were able to request telephone advice/consultation and the response to this was made the same day, or the evening of the request.

Updated 11 October 2016

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• A service was provided by the practice GPs to a local home that accommodated patients with severe and enduring mental health problems.
• The practice 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 identify and support patients with mental health needs and dementia.
• Patients experiencing poor mental health were offered longer appointments and subject to their consent could bring a carer, family member or friend. Flexible appointments were offered to support attendance.
• The practice had 37 patients on their mental health register, 34 (92%) had care plans agreed and had received an annual review.
• There were 19 patients on the patient dementia register. All of these patients had their care plan reviewed in the previous 12 months.
• The practice team had undertaken Dementia Friends Training.

Updated 11 October 2016

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

• The practice held a register of patients living in vulnerable circumstances including known vulnerable adults, those who were housebound and patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• A translation service was available to non-English speakers and a signing service was available to patients with hearing difficulties.
• The practice held a learning disability register of ten patients and six of these patients had received an annual health check in the preceding 12 months. Longer appointments were made available if required.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice facilitated patients requiring GP services with drug and alcohol rehabilitation needs.