North Curry Health Centre

Updated 17 September 2015

North Curry Health Centre is a rural practice providing services to over 3,900 patients in an area of approximately 40 square miles from Curland to Burrowbridge and Fivehead to Henlade.

It is located at Greenway, North Curry, Taunton, Somerset TA3 6NQ. The practice is a medicines dispensing practice and almost all patients take advantage of this facility. The practice is part of the Taunton Deane GP Federation.

The partnership comprises two male GPs who employ two further GPs, both female. The practice supports a female GP registrar. Between them the GPs provide 23 sessions each week. The practice employs a manager, three nurses, a health care assistant, five dispensary staff and four administrators along with, a medical secretary.

The premises were purpose built in 1981 and include five consulting rooms and two treatment rooms.

The practice patient population is weighted towards older patients with some commuters, locally employed patients and those whose work involves farming. Patients are from a wide range of social background. There is high employment levels and low deprivation in the area.

The practice is open from 8.00 am until 6.30 pm each weekday. The dispensary is open from 9.00 am until 6.30 pm each weekday. Appointments are available from 9.00 am until 11.45 am and from 4.40 pm until 6.10 pm each day.

In addition to a general medical services contract (GMS) the practice held contracts for enhanced services. An enhanced service is above what is expected from the GMS contact. These included contracts for avoiding unplanned hospital admissions, responding to minor injuries and immediate care and first response services along with a range of enhanced service contracts for immunisation and monitoring.

The practice contracts it’s Out Of Hours service to Somerset Doctors Urgent Care and patients can gain assistance by telephoning the NHS 111 telephone number.

Updated 17 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Curry Health Centre on 2 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for older patients, patients with long-term conditions, the working aged, recently retired and students. It was also good for providing services for families, children and young patients, patients whose circumstances make them vulnerable and patients with poor mental health including those 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 incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well 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.
• Patients said they were treated with compassion, dignity and respect 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 available the same day.
• The practice had good 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 some outstanding practice:

• The provider had good systems in place to monitor, manage and audit anticoagulation and identification of atrial fibrillation (abnormal heart rhythm) which enhanced patient care and showed that the practice achieved standards above best practice guidelines.
• The practice had increased provision of palliative care for the practice population including opportunities for admission to the local hospice and access to out of hours emergency care by raising in excess of £28,700 for the local hospice.
• The practice had regular and innovative training for clinical staff on dealing with emergencies in primary care. We saw that this focused training had resulted in successful outcomes for patients with a medical emergency.

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

Importantly the provider should:

• Consider how it could maintain one database system for all staff training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 September 2015

The practice is rated as good for the care of people 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 people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice had guidelines for all major chronic long term conditions in line with national guidance and used these in combination with templates to guide chronic disease management.

Updated 17 September 2015

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. Immunisation rates were relatively high for all standard childhood immunisations. 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 a dedicated noticeboard with information and resources for young patients.

Updated 17 September 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people 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 people, and offered home visits and rapid access appointments for those with enhanced needs.

The practice, in association with Age UK hosted gentle exercise classes one afternoon each week.

Updated 17 September 2015

Updated 17 September 2015

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

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had received training on how to care for people with mental health needs and training was planned for staff to consider the needs of patients living with dementia.

The mini mental state examination (MMSE) devised by the Alzheimer’s Society or the Test Your Memory (TYM) test (Royal College of Psychiatrists) was used to assess patients where there were concerns they were possibly developing dementia.

Updated 17 September 2015

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 those with a learning disability. It offered longer appointments for people with a learning disability.

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

The practice used the County Council and NHS integrated independent living service (‘Enablement’ service) to make referrals when they could recognise patients were in need of additional support to maintain their independence.