Archived: Tamar Medical Centre

Updated 7 April 2016

Tamar Medical Centre is a practice located in the large village of Perton, part of the West Midlands conurbation. The practice is situated in a purpose built building that it shares with a dental practice. The practice has a list size of 3,700 patients living in Perton and surrounding villages. The practice population has low deprivation and low unemployment when compared to national averages. Life expectancy is in line with the national average.

The practice was a two partner practice until June 2014 when one partner retired. It is now run by a single handed male GP who employs a salaried female GP. The GPs work a combined number of sessions that equates to 1.7 whole time equivalent. The GPs are assisted by a clinical team consisting of a practice nurse and a healthcare assistant. The administration team consists of a practice manager and four support staff.

The practice is open from 8am to 6.30pm on Mondays, Tuesdays, Thursdays and Fridays and from 8am to 1pm on Wednesdays. The practice is offering extended clinics as part of the winter pressure scheme running from January to March. When the practice is closed patients are told to dial the NHS 111 service and there is an out of hours service provided by Primecare. The nearest A&E unit is situated at New Cross Hospital, Wolverhampton. There are minor injury units at Dudley and Wolverhampton.

Updated 7 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tamar Medical Centre on 25 January 2016. Overall the practice is rated as Good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings 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. Risks to staff were well assessed. For example, staff had been given personal panic alarms and a protocol was in place that stated a minimum of two staff must be present for opening and closing of the building.
• 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.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, a community support group for diabetic patients was formed by the practice.

• Patients said they were treated with 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 told us they could get an appointment when they needed one. Urgent appointments were 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 the management. The practice proactively sought feedback from staff, patients and third party organisations, which it acted on.

• Domiciliary care (care administered in a patient’s home) included chronic disease management, immunisations, new patient checks and international normalised ratio (INR) checks (INR is used to monitor patients who are being treated with the blood-thinning medication warfarin).

We saw some areas of outstanding practice:

• The practice established a diabetes support service for the community. Monthly meetings were held and the average attendance was around 30 patients. The practice employed a specialist diabetes nurse and demonstrated improvements made to the health of diabetic patients. The QOF performance indicators for diabetes had improved from 58.3% in 2013/14 to 84.9% in 2014/15.

The practice had established a ‘singing for lung health’ group in the community targeted at improving the health and well-being of patients with a respiratory condition. The group extended a welcome to patients who experienced social isolation. Weekly meetings were held and the average attendance was around 25 patients.  

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 April 2016

The practice is rated as good for the care of people with long-term conditions. Patients were reviewed in nurse led chronic disease management clinics.  We found that the nursing staff had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as diabetes and asthma. Longer appointments and home visits were available when needed and reviews were coordinated to minimise the required number of patient visits. All patients with a long term condition were offered a review to check that their health and medication needs were being met. Written management plans had been developed for patients with long term conditions and those at risk of hospital admissions. For those people with the most complex needs, the GPs worked with relevant health and social care professionals to deliver a multidisciplinary package of care. The practice nurse helped to set up a singing group in the community for patients with a respiratory condition. The practice evidenced an improvement in the health of patients with diabetes that was attributed to the establishment of a community diabetes support group and the employment of a specialist diabetes nurse.

Updated 7 April 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 who were at risk, for example, children and young people who had protection plans in place. Appointments were available outside of school hours and the premises were suitable for children and babies. Same day emergency appointments were available for children. There were screening and vaccination programmes in place and the practice achieved higher than average uptake rates and had a protocol to follow up the same day when patients did not attend. Child immunisation rates were in line with the local Clinical Commissioning Group averages. The practice worked closely with the health visiting team to encourage attendance. New mothers and babies were offered post-natal checks. The practice engaged with a counselling service for patients under 25 years of age that needed support.

Updated 7 April 2016

The practice is rated as good for the care of older people. Every patient over the age of 75 years had a named GP and all hospital admissions were reviewed. This included patients that lived in nursing and care homes. Staff at the nursing homes had a mobile number for the GP to be used at weekends. An audit of this service evidenced a reduction in unplanned hospital admissions for patients in a care home. 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 case management. All over 75 year olds who were on the avoiding admissions register had a completed care plan. The practice was responsive to the needs of older people and offered home visits and longer appointments as required. The practice identified if patients were also carers. Male patients over 65 years of age were invited to attend an abdominal aortic aneurysm screening (AAA) done at the practice (AAA screening is a way of detecting a dangerous swelling of the aorta, the main blood vessel that runs from the heart to the rest of the body).

Updated 7 April 2016

The practice is rated as good for the care of working-age people (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. A range of on-line services were available, including medication requests, booking appointments and access to health medical records. The practice offered all patients aged 40 to 75 years old a health check with the nursing team. The practice offered a full range of health promotion and screening that reflected the needs for this age group.

Updated 7 April 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients who presented with an acute mental health crisis were offered same day appointments. People experiencing poor mental health were offered an annual physical health check. Dementia screening was offered to patients identified in the at risk groups. It carried out advance care planning for patients with dementia.

The practice regularly worked with multi-disciplinary teams in the case management of patients with mental health needs. This included support and services for patients with substance misuse and screening for alcohol misuse with onward referral to the local alcohol service if required. The practice also worked closely with the health visiting team to support mothers experiencing post-natal depression. It had told patients about how to access various support groups and voluntary organisations and signposted patients to the advocacy service where appropriate.

Updated 7 April 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. We found that the practice enabled all patients to access their GP services and assisted those with hearing, sight and language difficulties. Braille signs were seen on the doors of each clinical room.

The practice held a register of patients with a learning disability and had developed individual care plans for each patient. The practice carried out annual health checks and offered longer appointments for patients 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.