Western Ave Medical Centre

Updated 30 August 2017

Western Ave Medical Centre is responsible for providing primary care services to approximately 3,900 patients. The practice is situated in Gordon Road, off Western Avenue, Chester. The practice is based in an area with higher levels of economic deprivation when compared to other practices nationally. The number of patients with a long standing health condition is slightly higher than average when compared to local and national averages.

The staff team includes two partner GPs, two salaried GPs, two practice nurses, a phlebotomist, pharmacist, practice manager and administration and reception staff. Two GPs are male and the remaining GPs and nursing team are female. The practice is open 8am to 6.30pm Monday to Friday. An extended hour’s service for routine appointments and an out of hour’s service are commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust.

The practice has a Personal Medical Services (PMS) contract. The practice offers a range of enhanced services such as flu and shingles vaccinations, minor surgery, near patient testing anti-coagulation and spirometry.

Updated 30 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Western Ave Medical Centre on 26 July 2016. The overall rating for the practice was good, however the practice was rated as requires improvement for providing safe services. We carried out a desk-based review on 20 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 26 July 2016. The practice had met the legal requirements and continued to be rated as good, however we rated the practice as requires improvement for providing effective services as staff had not received the training needed for their roles. The full comprehensive report on the July 2016 inspection and the desk based review in January 2017 can be found by selecting the ‘all reports’ link for Western Ave Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 18 July 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 20 January 2017. This report covers our findings in relation to those requirements.

Overall the practice is rated as good.

Our key findings were as follows:

• Staff were receiving the training needed for their roles.

We found that the provider should make the following improvements:

•  The practice should develop a system to support annual updates of training in safe working practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 September 2016

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 such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. This included a text messaging reminder service informing patients that their review was due. The practice had received the West Cheshire CCG award for asthma clinical care in September 2015. The clinical staff took the lead for different long term conditions and kept up to date in their specialist areas. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice referred patients who were over 18 and with long term health conditions to a well-being co-ordinator for support with social issues that were having a detrimental impact upon their lives. The practice provided information to patients to encourage them to manage their long term conditions and provided care plans to patients to assist with this. Patients were also referred to educational courses on how to manage their conditions.

Updated 22 September 2016

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Appointments for young children were prioritised. The practice had a large number of children who had been identified by social services as needing support. There were robust systems in place to safeguard children. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. The safeguarding lead staff liaised with the health visiting service, school nurses and midwife to discuss any concerns about children and how they could be best supported. The practice was planning to deliver a patient education event for parents covering common childhood conditions and when to worry signs. Child health promotion information was available on the practice website and in leaflets displayed in the waiting area. Family planning and sexual health services were provided.  The practice had achieved the highest chlamydia screening rate in West Cheshire CCG 2014/2015.

Updated 22 September 2016

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice was working with neighbourhood practices and the CCG to provide services to meet the needs of older people. They provided an Acute Visiting service which had the aim of improving patient access to GP services and to the resources needed to support patients at home therefore reducing emergency admissions to hospital and use of emergency services. The group of neighbourhood practices had employed a GP to offer a frailty service. The GP worked with the community care team to identify patients over 75 at risk of unplanned hospital admission. The GP visited these patients and drew up a care plan on how best to manage their condition and prevent a re-admission. The practice had employed a pharmacist to focus on poly pharmacy with the aim of reducing falls and unplanned hospital admissions amongst its older patient population. Annual health checks for patients over 75 years of age were carried out.

Updated 22 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments, book on the day appointments and telephone consultations. Patients could order repeat prescriptions and book appointments on-line which provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday allowing early morning and late evening appointments to be offered to this group of patients. An extended hour’s service for routine appointments was commissioned by West Cheshire CCG. The practice website provided information around self-care and local services available for patients. Reception staff had received training on sign-posting patients who do not necessarily need to see a GP. For example to services such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP) and the Physio First service (this provided physiotherapy appointments for patients without the need to see a GP for a referral). The practice hosted clinics provided by charitable organisations such as Remploy which provides support to patients with illness/stress related to employment/lack of employment.

Updated 22 September 2016

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. The practice worked with multi-disciplinary teams 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. The practice had a large number of patients who experienced poor mental health. The practice had employed a mental health nurse and a psychological wellbeing co-ordinator to provide quicker access to mental health services and reduce prescribing. The practice had information in the waiting areas about services available for patients with poor mental health. For example, services for patients who may experience depression. Clinical and non-clinical staff had undertaken training in dementia to ensure all were able to appropriately support patients.

Updated 22 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient had a learning disability to enable appropriate support to be provided. There was a recall system to ensure patients with a learning disability received an annual health check. The staff we spoke with had appropriate knowledge about adult safeguarding and how to report any concerns. Staff had attended training on domestic abuse to help them to provide appropriate support to patients. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff was the carer’s link. A representative from the Carers Trust visited the practice and provided information for patients about the services provided. The practice had received a Carers Trust Award for increasing the number of carers identified. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the wellbeing coordinator. The practice hosted clinics provided by charitable organisations such as Stonham Housing which provided support to people experiencing housing issues.