Background to this inspection
Updated
16 April 2020
Tawstock Medical Centre, St Marys Crescent, Chard, Somerset, TA20 2DZ is located within the Somerset local authority and is one of 65 practices serving the NHS Somerset Clinical Commissioning Group (CCG) area.
The practice was established in 1994 and has grown steadily over the last 25 years. In 2014, when the patient list size had reached 4,800 patients, a purpose-built surgery was erected on the current site. Since then the practice has continued to grow and the list is now just over 7,000 patients. To ensure future proofing of the practice, an additional 2 consultation/treatment rooms have been added to the existing building. All services and facilities, including the reception desk, waiting areas, consulting and treatment rooms, non-clinical support and management offices are located on the ground floor.
Various issues around the operational, financial and managerial aspects of the practice were identified during 2019 and measures were put in place to address these. This led to some major changes within the management and staffing of the practice, covering both clinical and non-clinical areas. Some of these were planned, including partnership changes, whilst some were un-planned, but all were required as part of the recovery plan put in place to address the issues identified. Whilst there was still further work required, it was noted the practice had made significant improvements whilst introducing change and re-organisation.
In addition to housing routine medical services, the practice also has a treatment room which is used for minor operations. Many community team members (including Counsellors, Somerset Drug Service, Midwives, leg ulcer clinic, research, and palliative care) operate from the site and contribute towards the care that the practice can offer to its patients.
Tawstock Medical Centre provides general medical services to approximately 7,000 patients and is part of the Chard, Langport, Ilminster & Crewkerne (CLICK) Primary Care Network (PCN). PCNs are a key part of the NHS Long Term Plan, with general practices being a part of a network, typically covering 30,000-50,000 patients. These networks then provide the structure and funding for services to be developed locally, in response to the needs of the patients they serve.
The practice has a comparable proportion of registered patients (58.2%) who are of working age when compared to the CCG and national averages of 56.58% and 62% respectively. It has a lower percentage (22%) of elderly patients over 65 years of age when compared to the local average (24.4%) but a higher percentage when compared to the national average (17.3%).
Information published by Public Health England rates the level of deprivation within the practice population group as sixth on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.
The practice partners are contracted to provide Personal Medical Services (PMS). PMS contracts offer local flexibility compared to the nationally negotiated General Medical Services (GMS) contracts by offering variation in the range of services which may be provided by the practice, the financial arrangements for those services and the provider structure. They are also registered with the CQC for the following regulated activities: diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.
The two partners (a GP and a practice nurse) are supported by four salaried GPs, two paramedic practitioners, one practice nurse, a trainee nursing associate, two healthcare assistants (HCAs) and a phlebotomist. The practice patients also benefited from the work provided by a clinical pharmacist and a social prescriber.
For non-clinical activities, the partners are supported by a Practice Manager, an IT and Finance Lead and twelve additional administrative, secretarial and reception staff.
Out of hour’s services are not provided as these are provided by 111 whose contact details are available in the practice and on the website.
Updated
16 April 2020
We carried out an announced comprehensive inspection at Tawstock Medical Centre on 27 February 2020 as part of our inspection programme and following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a change (either deterioration or improvement) to the quality of care provided since the last inspection in October 2015.
When we last inspected Tawstock Medical Centre in October 2015 it had been rated as Good overall; Good for providing safe, effective, caring, responsive and well-led services and Good for all the population groups.
This inspection focused on the following key questions:
- Are services safe?
- Are services effective?
- Are services caring?
- Are services responsive?
- Are services well led?
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated Tawstock Medical Centre as Requires Improvement for providing effective services and Requires Improvement for the two population groups which includes people with long term conditions and People experiencing poor mental health (including people with dementia) because:
- Quality Outcome Framework (QoF) clinical indicators were below local and national averages for long-term conditions and People experiencing poor mental health (including people with dementia) and exception reporting was above local and national averages with no clear clinical reason for this.
- The practice participated in national priorities and initiatives to improve the population’s health. However, there were variation in the uptake of national screening programmes. The practice demonstrated awareness of this and were taking some action to improve the uptake of cervical screening.
We have rated Tawstock Medical Centre as Good overall; Good for providing safe, caring, responsive and well led services and Good for all population groups other than the two population groups which includes people with long term conditions and People experiencing poor mental health (including people with dementia) because:
- At this inspection, we found all the areas of concern from the last inspection had been addressed and improved.
- We found the practice had successfully coped with a significant change and re-organisation of the management team.
- Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
- The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
- Staff had the skills, knowledge and experience to deliver effective care, support and treatment.
- Staff worked together and with other organisations to deliver effective care and treatment.
- There was compassionate, inclusive and effective leadership at all levels. This included working with and supporting the practice Patient Participation group (PPG).
- The practice had a clear vision and set of values that prioritised quality and sustainability.
- The practice had a culture that drove high quality sustainable care.
- There were clear responsibilities, roles and systems of accountability to support good governance and management.
- There were processes for managing risks, issues and performance.
- We provided the practice with Care Quality Commission feedback cards prior to the inspection and we received 22 completed cards. Patients were extremely positive about the practice staff, their experiences, and the care and treatment they received.
Although we did not find any beaches of regulation at this inspection, we did see some areas where the provider should make improvements. These are:
- Continue monitoring the uptake of cervical screening in line with national guidance.
- Continue monitoring exception reporting and associated performance data to support patients with long term conditions and those experiencing poor mental health (including people with dementia).
- Consider reviewing the emergency medicines that are held and that would be used in the event of drug overdoses or completing a risk assessment which would sufficiently mitigate the risk and explain why the practice did not stock it.
- Implement systems to ensure that training and infection control audits are up to date.
- Continue implementing the changes identified within the practice recovery plan.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care