Cheadle Hulme Medical Group

Updated 18 April 2017

Dr Seabrook and Partners is located at Cheadle Hulme Health Centre, Smithy Green, Hulme Hall Road, Cheadle, SK8 6LU. There is also a branch surgery at Bridge House Medical Centre, 11 Ladybridge Road, Cheadle Hulme SK8 5LL. We visited both surgeries during this inspection.

The practice has 12,571 registered patients and they can access services at either surgery. The practice provides primary care under a Personal Medical Services Contract (PMS) and is part of NHS Stockport Clinical Commissioning Group (CCG).

The practice provides a range of enhanced services to its own registered patients as well as patients in several practices in the locality.

Dr Seabrook and Partners are located in an area of considerable affluence but with some pockets of deprivation. Information published by Public Health England rates the level of deprivation within the practice population as 10 on a scale of one to ten. Level one represents the highest areas of deprivation and ten as the lowest.

There are 54% of patients with a long term health condition, which is the same as both the CCG and the national average. The practice also has a higher percentage of patients over 75years at 11% compared with 8.7% CCG and 7.8% national average.

The practice staff consists of seven GP partners, three female and four male. Clinical staff consist of two Advanced Nurse Practitioners, one who is a Diabetic Nurse Specialist, one Specialist Proactive Care Nurse, three practices nurses and four healthcare assistants. The practice is supported by a senior practice manager, a practice manager and a number of administration and reception staff.

The role of senior practice manager has allowed the practice manager to take over the day to day responsibility of the practice, whilst the senior practice manager is focusing on the future NHS agendas such as Devo Manchester and NHS Forward View, and how this will impact on the practice, the locality and neighbourhood.

It is a well-established training practice and supports GPs in training as well as Doctors at foundation level and medical students.

The practice at Cheadle Hulme Health Centre is open between 7.30am and 6.30pm Monday to Friday. Appointment times are from 7.30am to 11.15am and 3pm to 6pm Monday, Wednesday and Thursday and 8.30am to 12.15pm and 3pm to 6pm each Tuesday and Friday. Extended hours surgeries are offered each month when a Saturday morning surgery is available.

Bridge House is open from 9am until 12.30 pm and 1.30pm until 5.30pm each weekday.

Each Monday morning there is also an emergency surgery held at Bridge House from 7.30am as well as additional surgeries before and after a Bank Holiday weekend.

When the practice is closed patients are asked to contact NHS 111 service.

Updated 18 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Seabrook and Partners on 19 January 2017. Overall the practice is rated as Good.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Feedback from patients about their care was consistently and strongly positive. Patients were extremely positive about the practice’s named and usual GP systems.

• 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.

• 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 the practice was working across the locality and with neighbourhood practices to input into future changes in local NHS service delivery.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient reference group (PRG). For example a new telephone system was implemented after patient and Patient Reference Group (PRG) feedback
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw three areas of outstanding practice:

• The practice employed a Proactive Care Nurse. This role was solely to maintain current care plans for all registered patients with complex multiple conditions and those in care and nursing homes. Weekly visits were undertaken to the homes and admissions to hospital had reduced as a result. Staff were also assisted in the homes via training and support sessions on various conditions and their treatments.

• The practice had implemented a primary care specialist diabetes service which gave intense patient centred care for those patients with regular uncontrolled diabetes, multiple clinical risk factors and who were historically hard to engage with conventional treatments in the hospital settings. Audits undertaken had seen a marked reduction in multiple risk factors, such as cholesterol, blood pressure levels and Body Mass Index (BMI) and high patient compliance and satisfaction.

• The practice provided a 24hr BP monitoring service to its own patients and those in locality practices. The service provided 15 appointments per week and had been used by over 1,100 patients, 70% of which were from other practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 April 2017

The practice is rated as outstanding 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 via the additional work undertaken by the proactive care nurse.

• 80% of patients with diabetes, on the register, in whom the last IFCCHbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2015 to 31/03/2016) which was comparable with the CCG and national average of 80% and 78% respectively.

• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less (01/04/2015 to 31/03/2016) was 86% which was comparable with the CCG and national average of 85% and 80% respectively.

• More flexible and longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• These patients were identified on a priority patient system to expedite appointments or home visits.

• The practice had implemented a primary care specialist diabetes service which gave intense patient centred care for those patients with regular uncontrolled diabetes, multiple clinical risk factors and who were historically hard to engage with conventional treatments in the hospital settings. Audits undertaken had seen a marked reduction in multiple risk factors, such as cholesterol, blood pressure levels and Body Mass Index (BMI) and high patient compliance and satisfaction.

• A recent audit for the management of patients on warfarin (a blood thinning medication) had resulted in the practice developing an INR (international normalized ratio or blood clotting times) calculator to establish the optimum treatment times and dosage and was currently undergoing an external quality peer review. This had resulted in a more effective treatment regime and treatments that could be provided “at point of contact” care at the practice rather than attending hospital appointments.

• The proactive care nurse maintained current care plans for all registered patients with complex multiple conditions and those in care and nursing homes. Weekly visits were undertaken to the homes and admissions to hospital had reduced as a result.

Updated 18 April 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 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.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years (01/04/2011 to 31/03/2016) was 81% which was similar to the CCG and national average of 82% and 81% respectively.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 18 April 2017

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

• All patients over 75 years had a named GP.

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

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

• The proactive care nurse maintained current care plans for all registered patients with complex multiple conditions and those in care and nursing homes. Weekly visits were undertaken to the homes and admissions to hospital had reduced as a result.

Updated 18 April 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 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.

• Flexible access was available with an urgent Monday morning clinic. Early  extended hours appointments were available three days per week in addition to a monthly Saturday morning clinic.

Updated 18 April 2017

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

• 80% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national average of 85% and 84% respectively.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 94% which again was comparable to the CCG and national average of 92% and 89% respectively.

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

• The practice carried out advance care planning for patients with dementia and offered reviews every six months.

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

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia, with practice screening and lead GPs.

Updated 18 April 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 including homeless people, travellers and those with a learning disability.

• The practice identified vulnerable patients on a priority patient list.

• The proactive care nurse maintained current care plans and support.

• The practice offered longer appointments for patients with a learning disability.

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

• The practice informed 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.