Health and Social Care Act 2008

Version: 5 (August 2023)

Date of Next Review: August 2024

Service Provider Details

Name: Tamar Valley Health

Address: Callington Health Centre, Haye Road, Callington, PL17 7AW

Telephone: 01579 382666

Email: Mark.stone1@nhs.net

Website: www.tamarvalleyhealth.org.uk

Provider ID: ID: 1-199760492

Legal Status: Partnership

Partners
Dr Jennifer Early (f) BM, MRCGP, DRCOG, DFSRH, DPD GMC 4317959	Dr Alison Farr (f) BSc(Hons), MBBS, MRCGP, DRCOG, DFSRH GMC 3494356
Dr Suzanne Porter (f) BSc, MB ChB, DRCOG, DFSRH GMC 4176624	Mark Stone (m) MPharmS, BSc Hons, IP
Ajay Patel (m) BPharm, MPharmS (IP)	Dr Samer Darwich (m) MD FRCS Qualified University of Damascus, Syria 1986. GMC 4493112
Dr Emma Blundy (f) MB ChB, MRCGP, DRCOG, DFFP GMC 6052687
Associate GPs
Dr David Harris (m) BSc(Hons), PhD, MB ChB(Hons), MRCGP, DFSRH, MSc GMC 4101905	Dr Michelle Raspa (f) MBBCh, DRCOG, MRCGP GMC 7015062
Dr Tom Brogden (m) MBChB(Hons) MRCGP MRCSEd PGCert MedEd
Retained GPs
Dr Rhiannon Starks (f) BMBCh (BA Hons) GMC 7016225
Remote GPs
Dr Maxine Mitchell (f) Bsc Hons, MBChB and MRCGP GMC 7334252	Dr Niamh O’Keefe (f) MB BCh BAO BA MRCGP GMC 7542795

Aims and Objectives

The practice provides patient-centred healthcare for all members of the community. This is based on an understanding of health and illness as a uniquely personal experience, shaped by past experience, cultural, social and contextual dimensions.

The practice aims include helping patients achieve better health outcomes, reducing health inequalities and being cost effective so as to use resources to best effect.

This approach is based on the following principles:

• the patient is the centre of concern, with GPs as their advocates when navigating the wider healthcare system;
• the patient-clinician relationship is the basis of the therapeutic process, supported by an infrastructure which respects and facilitates this approach and protects patient confidentiality;
• a holistic perspective to care involves a multi-disciplinary team;
• a comprehensive scope includes services provided locally by the practice where appropriate and possible, including dispensing services for our partly rural communities;
• a community-based context involves patients, carers and the wider community in practice development; and
• a collaborative approach is supported by other health and social care providers and commissioners.

The practice constantly strives to improve and expand its services and systems. In addition, it seeks to provide a nurturing and supportive environment for its team members whilst also facilitating professional development.

Locations

Name: Callington Health Centre

Address: Haye Road, Callington, PL17 7AW

Telephone: 01579 382666

Location ID: 1-545669523

Service Types: Doctors consultation service, Doctors treatment service

Regulated Activities: Treatment of disease, disorder or injury, Surgical procedures, Diagnostic and screening procedures, Maternity and midwifery services, Family planning service.

Service Users: Open for registration to patients resident and temporarily resident in the practice area

We are a split site practice with our second, branch health centre located at:

Name: Gunnislake Health Centre

Address: The Orchard, Gunnislake, PL18 9JZ

Telephone: 01822 832641

All systems and procedures are the same across both sites and all patients are registered at the Callington Health Centre location.

Our practice is located in south-east Cornwall, with some patients also living in west Devon across the Tamar River. It has two purpose-built health centres, at Callington and Gunnislake, which are situated about 5 miles apart in the centre of the practice area.

Callington is a small town with a population of around 4,500, situated about 14 miles from Plymouth, and Gunnislake is large village on the Devon-Cornwall border. The practice area encompasses a number of villages and hamlets across south-east Cornwall, including Calstock and the historic Cothele estate. It was once a busy mining area but its main industries are now farming and tourism.

The practice population has a fairly standard demographic spread, being older than the English average but only average for Cornwall. We are a semi-rural dispensing practice, providing dispensing and associated services to approximately 66% of our patients. Both health centres offer dispensing and Gunnislake Health Centre also has a practice-owned pharmacy, the closest alternative ones being Callington (5 miles) and Tavistock (5 miles). Rural transport services are poor and Gunnislake Pharmacy offers a delivery service across the whole practice area.

Due to practice growth and the nature of services offered due to the practice’s rurality, both health centres are constrained by severe space limitations. All rooms have to be booked using a centralised booking system and meetings are often held off site at two local farms that provide meeting facilities. Despite this, we are currently renovating an area at each site to provide an isolation room for our patients when required.

Parking is available at, or close to, both surgeries although we are not able to provide as much as we would like due to local issues.

Although we are one practice, with standard systems and procedures to minimise risks, there are some differences between the two sites. Callington has on-site parking as well as street parking whereas Gunnislake patients have the use of a council car park which is free for the first 2 hours and some street parking. Disabled parking is available at both health centres. There is protected parking for the GPs due to the need to do urgent visits at short notice and some double parking is available for staff at each health centre which, by its nature, is unsuitable for patient or visitor use.

The practice is comprehensively staffed, with GPs (partners, salaried (known as associate doctors) and retainers); general practice paramedics, advanced nurse practitioners, a physicians associate, specialist nurses, practice nurses, healthcare assistants and phlebotomists; primary-care pharmacists and qualified dispensers; and admin, data, facilities, reception and secretarial teams. Each team has a team leader and these meet monthly, as do the partners and management staff. The practice also has a Practice Business Manager, HR Manager and Operations Manager who deals with the day to day running of the Practice.

Communication is a key feature of the practice team, both through meetings and the team leader structure but also through an extensively used internal e-mail system which supports split-site working. There is an internal post and supplies-transfer system with deliveries between the two health centres twice daily. There is an extensive bookmark system within our clinical system which provides a wealth of information for all the clinicians and staff.

The practice is a GP training practice again, now that we have increased our clinical space. We also host medical students. Our Practice Nurse Lead is a MacMillan champion for the Practice.

There are regular meetings at both health centres for reviewing terminally ill and at-risk patients, child protection issues, and Hub (mental health) patients. Clinical case reviews meetings are held quarterly, open to all team members, and there are combined significant event and complaint reviews, also held quarterly.

The practice offers a wide range of services, most of which are not held in clinics so as to support patient requirements for flexible timings. All patients with a long term condition or needing review are contacted at least annually, in the month prior to their birthday, and invited in for reviews. These usually begin with appointments with healthcare assistants or phlebotomists who will take blood and do other essential measurements, including peak flow and FeNo measurements for patients with respiratory illnesses, before consultations with nurses and/or pharmacists for specialist reviews with their test results. Those patients requiring GP input will receive this while others with less complex needs may be offered telephone reviews. Patients with greater need will be offered interim reviews mid year.

All patients requiring same-day appointments are accommodated, and no patient is ever asked to call back on a subsequent day because they cannot be seen. Due to our rural location, we offer walk-in minor injury services at both health centres and we also care for terminally ill patients in their own homes whenever possible.

Staff employed by Cornwall Foundation Trust (community matron, district nurses, health visitors and other community-based healthcare staff) are accorded full access and support but unfortunately can no longer be accommodated within the health centres due to lack of space. However, the practice has provided access to its computer network in the form of terminals located in the neighbouring Callington Community Clinic, and CFT staff members are invited to relevant meetings, significant event and complaint reviews, training sessions and social events. We also have a First Contact Physiotherapist working the clinic who offers patients an assessment of a range of muscular skeletal problems.

Out of Hours care is currently provided by Kernow Message Handling and Cornwall 111.  Outlook South West provides counselling and psychological services locally for conditions such as depression and anxiety. These used to be provided within the practice but, as with other non-GMS services, have had to be moved elsewhere due to lack of space.

The practice has an active Patient Participation Group (PPG) who holds meetings every two months. Members of the management team and clinical team are invited to all meetings and attend every meeting.

We are well equipped clinically, partly due to our very supportive League of Friends, and have diagnostic equipment which includes ECGs and portable ECG machines, ambulatory blood pressure and ECG monitors, nebulisers, peak flowmeters, pulse oximeters, bladder scanners, obstetric and vascular sonic aids. We are also able to offer blood pressure monitors and nebulisers for patient use at home and have wheelchairs available at each health centre for patients with mobility problems.

Health and Care Needs

We respect the privacy and dignity of our patients and endeavour to treat all of our patients with respect and honesty.

Access

GP and nurse appointments are available to book in advance as well as urgent appointments on the day. Home visits are available for patients unable to visit the practice. A 5 day repeat prescription service is available from our dispensaries. If the practice is not able to meet an individual patient’s health needs, a referral to an appropriate health professional or service will be made if permitted under local guidelines.

For patients that do not speak English, a telephone translation service is available. We are also able to provide information in larger fonts or electronically as requested. The practice is accessible to wheelchair patients and each health centre has a hearing loop.

Consent and Chaperones

Consulting rooms are away from the reception area where no conversation can be overheard or examination seen. No patient is ever examined or procedure undertaken without consent. A chaperone is available upon request.

Carers

We encourage patients to let us know if they are a carer or are cared for by another person as this helps to alert us to possible needs in this role.  A carer is someone who, without payment, provides help and support to a partner, child, relative, friend or neighbour who could not manage daily living without their help.

Confidentiality and Access to Patient Information

All patient information is considered to be confidential and we comply fully with the Data Protection

Act to keep confidential data safe and secure.  All employees have access to this information in relation to their role and have signed a confidentiality agreement. Relevant information may be shared within the multi-disciplinary health care team at the practice and with other health care professionals to whom a patient is referred. Those individuals have a professional and contractual duty of confidentiality.

Confidential and identifiable information relating to patients will not be disclosed to other individuals without their explicit consent, unless ordered to do so by court order or where it is in the public interest to do so to prevent harm. The Data Protection Act and The Access to Health Records Act allow a patient to find out what information is held in their health records.

Comments, suggestions and complaints

We welcome comments and suggestions on our service and have a protocol for dealing with complaints. Complaints should be made to the Operations Manager who will ensure all relevant details are recorded, arrange for the complaint to be investigated, and respond in a timely manner. If the complaint is not resolved to the satisfaction of the complainant, advice will be given on how to take the complaint outside the practice.

Services

NHS services provided by our GPs and clinical staff are defined under the General Medical Services Contract, including Essential Services for people who have health conditions from which they are expected to recover, chronic disease management, and general management of terminally ill patients. This care is shared within the practice between GPs, specialist-trained practice nurses and practice pharmacists. GMS Services, which encompass those classified as Additional and Enhanced, include:

• Management of chronic diseases such as Diabetes, Asthma, COPD, Hypertension, Heart Disease, Epilepsy, etc.
• Repeat prescription service and medication reviews
• Home visits for housebound patients
• Mental health care
• Palliative care for patients who are terminally ill
• Facilitating timely diagnosis and support for people with dementia
• Phlebotomy (blood tests)
• Warfarin management, with in-house INR testing
• Monitoring of drugs such as Methotrexate, Amiodarone and Carbimazole (Near Patient Testing)
• New patient checks
• New baby checks
• Child health surveillance
• NHS Health Checks
• Learning disabilities annual health checks
• Minor surgery, including joint injections
• Contraception services, including contraceptive devices and implants (fitting and removal)
• Cervical cytology screening
• Chlamydia screening
• Minor injuries
• Wound management and suture removal
• MRSA checks for pre-operative patients
• Pre- and post-operative care, such as removal of sutures, wound dressings, injections, blood and urine tests, and blood pressure checks
• Immunisations, including Childhood, Shingles, Pertussis (pregnant women), HPV, Childhood influenza, Seasonal influenza, Pneumococcal, Covid, Rotavirus, MMR (aged 16 and over), and Hepatitis B (newborn babies)
• Travel advice and vaccination
• Smoking cessation advice
• Alcohol-related risk reduction scheme, and Home & Dry (alcohol detox)
• Blood pressure checks, including 24-hour BP monitoring
• Spirometry
• ECGs, including 24-hour ECG monitoring
• Insulin starts

The practice also provides TicTac, a term-time drop-in service at the Callington Community College, the local secondary school. There is a daily co-ordinator, who provides signposting for general help and advice or arranges individual consultations, and a GP or nurse who attends most days, at lunchtime.

This service provides confidential access for students, who are not required to be practice patients, and enables support and advice for issues such as teenage sexual health and contraception, health concerns and mental health issues. A counsellor is also employed to assist with the latter. It was recently assessed by the CCG Governance department and found to be offering an appropriate, cost-effective service.

The Practice has a Social Prescriber who runs clinics to help patients manage their needs and help direct them to local services. A Mental Health Practitioner also runs clinics to help support the GPs in managing patients with mental health problems. Both of these roles have been funded by the additional roles and responsibilities scheme within our Primary Care Network. Through this scheme the Practice has also employed care-coordinators to oversee various aspects of patient centred care. A Pharmacy Technician has also been employed via the PCN to help support our Practice Pharmacists.

Non-NHS Services

Where capacity allows we also provide services which are non NHS and are paid for by the patient or requesting organisation, including:

• Private medical insurance reports and medicals
• Sports, pre-employment and HGV medicals
• Private fitness certificates
• Private vaccinations e.g. yellow fever (at Callington Health Centre)