Archived: Heald Green Health Centre 2 Also known as Dr Wright & Partners

Updated 12 July 2017

Heald Green Health Centre 2 is located in Heald Green, Cheadle, Cheshire. The practice was providing a service to approximately 6,535 patients at the time of our inspection.

The practice is part of Stockport Clinical Commissioning Group (CCG) and is situated in an area with lower than average levels of deprivation when compared to other practices nationally. The percentage of the patient population who have a long standing health condition is 47% which is lower than the national average of 54%.

The practice is run by one female GP provider and there are three salaried GPs (one male and two female). There are two practice nurses, a business manager, a pharmacist, an operation manager and a team of reception/administration staff. The practice is open from 8.00am and 6.30pm on Mondays and Fridays and 7.30am to 7.30pm on Tuesdays, Wednesdays and Thursdays.

When the surgery is closed patients are directed to the GP out of hour’s service provided by ‘Mastercall’ by contacting NHS 111.

The practice is a training practice for trainee GPs.

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice has a General Medical Services (GMS) contract. The practice provides a range of enhanced services, for example: extended hours, childhood vaccination and immunisations and avoiding unplanned hospital admissions.

At the time of this visit two of the partners had left the practice and the third partner was in the process of submitting an application to the CQC to register the practice as a sole provider.

Updated 12 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Heald Green Health Centre 2 on 30 November 2016. At the inspection in November the overall rating for the practice was good, although the key question Safe was rated requires improvement. This was specifically in relation to the management of medicines that required patients to receive regular health care checks and the systems to ensure medicines were changed and checked appropriately when requested by a secondary care provider such as a hospital consultant. We also identified some areas where the practice could improve other aspects of the service they provided. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Heald Green Health Centre 2 on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 30 November 2016. This report covers our findings in relation to those requirements and also the additional improvements made by the practice since our last inspection.

The practice is now rated as good for providing safe services, and overall the practice is rated as good.

Our key findings were as follows:

• Since the previous inspection the practice had employed a pharmacist to assist the GPs with the management of medicines. This included identifying and monitoring those patients who required regular health checks and those patients discharged from hospital with changes to their prescribed medicines.
• A protocol had been established so that prescriptions for repeat requests for medicines such as for example Warfarin (blood thinning medicine) were only issued if an up to date blood result (INR)was available.
• The systems to ensure the practice received Warfarin blood results in a timely manner had been reviewed and improved communication links had been established with a local hospital that carried out the INR blood testing.
• Patients prescribed other high risk medicines such as disease-modifying anti-rheumatic drugs (DMARDs) were monitored with monthly searches on patient records to ensure the appropriate checks such as blood tests had been undertaken. In addition a screen message had been added to each patient’s electronic record so that staff could easily identify those patients requiring these checks.
• The practice management team had reviewed their procedure in relation to monitoring and responding to pathology tests results. The practice ensured that all pathology test results were allocated out to those GPs on duty each day. This ensured that these were checked within the appropriate timescale.
• The practice had made improvements to the practice’s record systems. For example a safety alert log was now established and accessible to staff. This provided a brief record of actions taken and hyperlinks to the relevant documents.
• The practice also maintained a log of significant events with a brief description of the incident and log of action taken all staff. A log of all meetings was also maintained.
• The practice had undergone some staff changes since the last inspection and this had enabled the practice to review its staffing establishment and the activities undertaken by the different staff teams. This had resulted in a streamlining of the nursing team and appointments scheduling and a change in how GP appointments were scheduled.
• As part of the local Clinical Commissioning Group (CCG) initiative the practice has had a new telephone system installed however the additional benefits from the system had yet to be ‘switched’ on by the CCG.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 February 2017

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

• The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required immunisations received these.

• Practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health.

• Patients with several long term conditions could be offered a single, longer appointment to avoid multiple visits to the surgery.

• Data from 2015 to 2016 showed that the practice was performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions.

• The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

• One of the practice nurses led on supporting pre-diabetic patients and they were looking to develop this aspect of the service further.

• The practice provided an in house phlebotomy service which was convenient for patients especially those requiring regular blood monitoring.

• Patients were provided with advice and guidance about ill health prevention and management of their health and were signposted to support services.

Updated 20 February 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 living in disadvantaged circumstances and those who were at risk, for example, children and young people who had a high number of A&E attendances.

• A GP was the designated lead for child protection. All hospital letters for children were assigned to the lead GP in order to identify any child protection concerns.

• Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.

• Regular safeguarding meetings took place with health visitors to share information or concerns about child welfare.

• Child health surveillance clinics were provided for 6-8 week olds.

• Immunisation rates were comparable to the national average for all standard childhood immunisations. One of the practice nurses monitored non-attendance of babies and children at vaccination clinics and they told us they would report any concerns they identified to relevant professionals.

• Babies and young children were offered an appointment as a priority and appointments were available outside of school hours.

• The premises were suitable for children and babies and baby changing facilities were available.

• Family planning services were provided.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 94% which was higher than the national average of 81%.

Updated 20 February 2017

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

• The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population.

• The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

• The practice provided a range of enhanced services, for example, the provision of care plans for patients at risk of an unplanned hospital admission.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to outcomes for patients locally and nationally.

• GPs carried out regular visits to a local nursing home to assess and review patients’ needs and to prevent unplanned hospital admissions.

• Home visits and urgent appointments were provided for patients with enhanced needs.

• The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.

• Two of the GP partners had an interest in end of life care.

Updated 20 February 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.

• The practice provided extended hours appointments three days per week to accommodate working patients.

• Telephone consultations were provided and patients therefore did not always have to attend the practice in person.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group.

• The practice was proactive in offering online services including the booking of appointments and requests for repeat prescriptions. Electronic prescribing was also provided.

Updated 20 February 2017

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

• The practice held a register of patients experiencing poor mental health and these patients were offered an annual review of their physical and mental health.

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were better than local and national averages.

• The practice worked with other health and social care professionals in the case management of people experiencing poor mental health, including those with dementia.

• The practice referred patients to appropriate services such as psychiatry and counselling services.

• A system was in place to follow up patients who had attended accident and emergency and this included where people had been experiencing poor mental health.

• Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

Updated 20 February 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 in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these.

• The practice worked with other health and social care professionals in the case management of vulnerable people.

• Regular safeguarding meetings were held that covered both children and vulnerable adults.

• 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 provided appropriate access and facilities for people who were disabled.

• Information and advice was available about how patients could access a range of support groups and voluntary organisations.