Archived: Tieve Tara Medical Centre

Updated 27 January 2017

The medical centre is located at Park Dale, Airedale, Castleford, West Yorkshire, WF10 2QP. The practice serves a patient population of around 5,200 patients and shows a slow annual rise in patient list size. It is a member of NHS Wakefield Clinical Commissioning Group.

The practice has operated on the site for over 100 years although the current premises has been considerably expanded and dates from 2004. The building has three floors, the ground floor and first floor being utilised for patient consultations. The premises is readily accessible for those with a disability, for example the first floor consulting rooms can be accessed via a passenger lift and the reception area has a drop desk which is at a suitable height for wheelchair users. There is ample parking available on site for patients and an independent pharmacy is attached to the practice. In addition to the practice and pharmacy a number of community health services operate from the premises, these include health visitors, physiotherapists and members of the local Vanguard integrated care team.

The practice age profile shows that 25% of its patients are aged under 18 years (compared to the CCG average of 20% and the England average of 21%), whilst it is below both the CCG and England averages for those over 65 years old (11% compared to the CCG average of 18% and England average of 17%). Despite the youthful demographic the practice has a significant nursing home population of 74 patients (over 1% of its practice list). Average life expectancy for the practice population is 76 years for males and 80 years for females (CCG average is 77 years and 81 years and the England average is 79 years and 83 years respectively). The practice population has a higher than average number of patients with a long standing health condition at 67% compared to the CCG average of 58% and the national average of 54%.

The practice serves an area of high deprivation and is located in the 10% most deprived areas in the country. Figures from 2014/2015 showed the local unemployment rate to be 9% compared to a local average of 6% and a national average of 5%. The practice population is primarily composed of British/Mixed British patients, although there are patients from other ethnic backgrounds which include patients from Eastern Europe.

The practice provides services under the terms of the Personal Medical Services (PMS) contract. In addition the practice offers a range of enhanced local services including those in relation to:

• Childhood vaccination and immunisation

• Influenza and Pneumococcal immunisation

• Meningitis immunisation

• Rotavirus and Shingles immunisation

• Dementia support

• Risk profiling and case management

• Support to reduce unplanned admissions.

• Minor surgery

• Learning disability support

As well as these enhanced services the practice also offers additional services such as those supporting long term conditions management including asthma, chronic obstructive pulmonary disease, diabetes, heart disease and also offers healthy lifestyle advice to support wider community health and wellbeing.

Attached to the practice or closely working with the practice is a team of community health professionals that includes health visitors, midwives, and members of the district nursing team. In addition the practice operates shared care arrangements with a local substance misuse service.

The practice has four GP partners (one male, three female) and utilises GP locum support when required. In addition the clinical team also comprises of two practice nurses and one health care assistant (all female). Clinical staff are supported by a practice manager and an administration and reception team.

The practice appointments include:

• Pre-bookable appointments

• On the day/urgent appointments

• Telephone triage/consultations where patients could speak to a GP or nurse.

• Home visits

Appointments can be made in person, via telephone and in the near future online.

The practice is open between 8am and 6.30pm Monday to Friday, with extended opening on alternate Wednesdays 6.30pm to 8pm. 

Appointments are available 8.30am to 6.30pm Monday to Friday, with late bookable GP appointments available alternate Wednesdays 6.30pm to 8pm.

The practice is accredited as a training practice and supports GP registrars for appointed periods.

Out of hours care is provided by Local Care Direct Limited and is accessed via the practice telephone number or patients can contact NHS 111.

Updated 27 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tieve Tara Medical Centre on 13 December 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Incidents were investigated and actions put in place to prevent recurrence.
• The practice maintained a good understanding of local need and used this to design and deliver services.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Information about services and how to complain was available and easy to understand. Complaints were investigated and when appropriate, reviewed and discussed at team meetings. Where improvements were identified these were implemented.
• 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 provider was aware of and complied with the requirements of the duty of candour.

There were areas where the provider should make improvement:

• Patient engagement was limited due to the lack of an active patient participation group. The practice should continue to take steps to reform and establish the group.

• The practice should review and take action to improve areas of low patient satisfaction in relation to access and care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 January 2017

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

• Both GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. As part of this work the practice kept condition registers and regularly recalled and reviewed patients and updated care and treatment plans. Staff within the practice had gained additional qualifications and training to support this work such as training in diabetes and Chronic Obstructive Pulmonary Disease (COPD).

• The practice proactively worked with long term condition patients who had recently been discharged from hospital in order to prevent readmission.

• Quality and Outcome Framework indicators for the practice showed some below average performance in relation to long term conditions in 2015/2016. For example, indicators with regard to reviews carried out for COPD and asthma were below local and national averages.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP or nurse. For those patients with the most complex needs, these staff worked with relevant health and care professionals to deliver a multidisciplinary package of care.  

Updated 27 January 2017

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 and young people living in disadvantaged circumstances and who were at risk. The practice worked closely with other health and care professionals with regard to these patients. This contact was facilitated by the fact that other community health services such as health visitors and midwives shared the same premises with the medical centre.

• Immunisation rates were relatively high for all standard childhood immunisations and above local and national averages.

• The practice told us, and we saw evidence to support this, that children and young people were treated in an age-appropriate way.

• The practice offered family planning services which included contraceptive implants and Intrauterine Contraceptive Devices (a device inserted into the uterus(womb) to prevent pregnancy).

• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 83% and the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. In addition the practice offered two ring-fenced appointments on a daily basis to meet the needs of teenagers

• A weekly baby clinic was held by a GP (who had previously trained as a paediatrician). This dealt predominantly with six week baby checks.

Updated 27 January 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, the practice made regular reviews of older and frail patients with complex needs and long term conditions.

• The practice delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and were at risk of an unplanned hospital admission. The practice used a risk profiling tool to identify these patients. The practice then carried out advanced care planning and regular patient reviews, which involved multi-disciplinary working across health and social care providers. At the time of inspection over 2% of the practice population were on their avoiding unplanned admission register and of these patients 56% had a completed care plan in place.

• The practice participated in the local CCG Vanguard programme for care homes. This scheme saw weekly clinical visits being made to a care home for young people with chronic neurological conditions. During these visits patients had their needs reviewed, were offered treatment and had care plans updated. Care was also offered to other care home patients in Castleford should this be requested or needed. (Vanguard programmes seek to develop new care models which support the improvement and integration of services. Within Wakefield there are two programmes - enhanced health in care homes; andthe improved provision of specialist integrated services into the community).

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 27 January 2017

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. For example, the practice offered extended opening on alternate Wednesdays 6.30pm to 8pm. In addition there were early and late pre-bookable appointments available to patients.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. Patients of working age and others could access services delivered by providers which operated out of the same premises. These included physiotherapy and musculoskeletal services and ATOS Healthcare (Atos Healthcare conducts assessments on behalf of the Department for Work and Pensions for Personal Independence Payments.

Updated 27 January 2017

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

• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months, which had been agreed between individuals, their family and/or carers as appropriate. This was comparable to the local average of 90% and the national average of 89%.

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was slightly below the local and national averages of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice included patients with mental health issues on their avoiding unplanned admissions register. Such patients received care planning support and were subject to hospital discharge reviews to assess ongoing need.

• Staff had a good understanding of how to support patients with mental health needs and dementia and had received specific dementia support training.

Updated 27 January 2017

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 which included those with a learning disability. At the time of inspection 35 patients were on the learning disability register. These patients were offered regular reviews and health checks.

• The practice offered longer and more flexible appointments for patients who required additional time with a clinician such as patients with a learning disability or the frail elderly.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• Staff knew how to recognise signs of abuse in vulnerable adults and children and the practice had appointed child and adult safeguarding leads. 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 informed vulnerable patients about how to access various support groups and voluntary organisations. For example, these included contacts for local carer’s organisations.

• We were told that the local population was characterised by a higher than average prevalence of drug use. In response to this the practice provided services to meet the needs of patients with substance misuse issues which included shared care. These services were led by a GP who had received specialist training in this field and who liaised with local addiction services. In addition the practice hosted a twice weekly substance misuse service which was delivered from the surgery.