Archived: The Schoolhouse Surgery

Updated 5 March 2015

The Schoolhouse Surgery is located on the edge of Stockport, Cheshire. The practice is run by the three partners and a salaried GP.

The practice has two nurses, a healthcare assistant and phlebotomist.

The practice is a training practice and delivers services under a Primary Medical Services (PMS) contract. The practice register is made up of approximately 4,500 patients. The practice is based in an old schoolhouse which has been converted to provide treatment and consultation rooms on the ground floor which is wheelchair accessible. There are further treatment and consultation rooms on the first floor of the building. Parking is available immediately outside the building; parking for disabled patients is clearly marked. The doorway to the practice has push button opening for ease of access. The practice is open from 8.00am to 6.30pm Tuesday to Friday and offers extended hours surgeries on Monday of each week, from 8.00am to 8.30pm. Patients requiring services beyond these times are directed through the telephone service at the practice to an out of hours service from another provider.

The practice has an active Patient Participant Group (PPG) which has been in place since 2010. Regular updates from the group are posted on the practice website; a notice board for patient information on how to contact group members or find out dates of next meetings is prominently placed in the reception area of the practice.

The practice supports two residential care homes for elderly patients, two nursing homes for older patients, a residential facility for patients with learning disabilities and a residential educational facility for children not in mainstream education. The practice works with neighbouring practices to maximize resource and facilities. In doing this, it has been able to provide further services to all patients in the community, for example ultrasound scanning, audiology, physiotherapy, ophthalmology and counselling services. The PPG described the impact this had made; we were told that those patients who were in poor health, frail, or relied on public transport, found the journey to Macclesfield hospital particularly difficult and arduous, so the additional services where highly valued by the community.

Updated 5 March 2015

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of The Schoolhouse Surgery. Our inspection was a planned comprehensive inspection, which took place on 4 December 2014. The Schoolhouse Surgery delivers services under a Primary Medical Services (PMS) contract.

The service provided by The Schoolhouse Surgery is rated as outstanding.

Our inspection showed all care and treatment was safe, effective, caring and well-led.

Our key findings were as follows:

• The practice provides safe care and treatment to its patients. The practice had systems in place to identify report and investigate any serious incidents. Patient safety was upheld and protected by all clinicians.
• The practice delivered evidenced based care and treatment which was shown to be effective through the monitoring and review of patient outcomes.
• We saw and were told by patients that the practice and staff were responsive to feedback and that patients felt privileged to be treated by clinicians at the practice
• The practice and all staff were well-led; a clear vision and strategy was in place to deliver the best possible care and treatment for patients.

We saw several areas of outstanding practice including:

• Audits were targeted and carried out in response to data or reports on clinical findings. Examples we saw of completed audit cycles showed patient outcomes were improved; rates of hospital admissions from nursing and care homes dropped significantly and the length of any patient stay in hospital was also reduced.
• GPs had a clear vision and this was shared by all staff. The partners recognised that engagement with patients, beyond time spent in the consulting room was key in getting health initiatives off the ground. GP’s encouraged families and young people to use technology to help make health and lifestyle decisions. Examples included use of applications on computers or smart phones to help calculate calorie intake, or the use of pedometers to measure the contribution community walks made to exercise needed each day. GP registrars on training placement with the practice were taught to ‘view excellence as the norm rather than the exceptional’.
• The practice included all community stakeholders in their weekly practice meetings, for example community pharmacists and managers and carers from the local domiciliary care agency. Evidence was available to demonstrate that this reduced the instance of more vulnerable patients being re-admitted to hospital care.
• GPs at the practice were committed to providing support to older patients who wished to remain at home rather than be admitted to hospital. Patients receiving palliative or end of life care were helped to make advanced decisions about their care and treatment, which were recorded. GPs were innovative in the use of technology to ensure those patients whose verbal skills were impaired by illness, could communicate their wishes.

On the basis of the findings of this inspection the provider is rated outstanding.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 March 2015

The practice is rated as outstanding for the care of patients with long term conditions. In the most recent Patient Survey results (2013-14), all responses to questions asked of patients with long-term conditions were positive and the practice scored higher than the England average and the average scores of other practices within Eastern Cheshire. Patients commented that the nurse gave them enough time (84.2%), that the nurse listened to them (84.7%), that the nurse explained test results to them (82.0%), and that they had confidence and trust in the nurses at the practice (92.5%). We saw several examples of outstanding care and treatment particularly for patients who had chronic, degenerative illnesses, with regard to helping patients make informed decisions about their future care, and where and how this could be delivered. The clinical team at the practice had been nominated for, and were finalists at the National General Practice Awards 2014 in recognition of their successful treatment, support and management of patients’ long term conditions.

Updated 5 March 2015

The practice is rated as outstanding for the care of families, children and young people. All practice staff showed a good understanding of consent issues and Gillick competency for those patients who attended the practice without an adult. Health visitors and midwives visited the practice on a regular basis to see patients who required their services. All community health care professionals were invited to and attended meetings at the practice, to discuss patient care. A chaperone policy was in place and this service was advertised in practice leaflets and on notice boards in reception and waiting areas. Patients we spoke to from this population group told us they had always be seen by a GP ‘on the day’ if they had needed to. Patients we were able to speak to on the day of our inspection told us the practice was central to the community. Patients described how the GPs and nurses worked hard to help them take ownership of their health, encouraging them to take part in activities and interests that would boost their overall health and well-being. We spoke to a patient who had recently become a parent; they told us GPs were always understanding of their concerns, were patient and listened to them giving enough time for them to talk about their concerns.

Updated 5 March 2015

The practice is rated as outstanding for the care of older patients. GPs’ supported patients in two nearby residential care homes and two nursing homes. Weekly ‘ward rounds’ at the nursing homes by the GPs meant that patients received pro-active care and treatment. Work carried out by one of the partners at a care home was highlighted by the Clinical Commissioning Group (CCG) for the way in which admissions to hospitals had been significantly reduced and the positive impact of this on the well-being of patients. The manager and care co-ordinator from one of the local care homes had seen posters advising of our inspection and came to the practice to talk to us about the level of outstanding support patients at the home received from the practice.

Updated 5 March 2015

The practice is rated as outstanding for the care of working age patients and those recently retired. The practice opening times and availability of GPs met the needs of this population group. Reception staff had the autonomy to offer lunch time appointments if working age people required them. Appointments with the practice nurses were also available during these surgeries. The practice recently moved to an on-line system of booking appointments which was something that working age patients had requested. Repeat prescriptions could also be ordered on line. A number of clinics and services were available at the practice, including minor surgery, joint injections, dermatology, and scans. Working age patients and those recently retired told us this was particularly valuable to them.

Updated 5 March 2015

The practice is rated as outstanding for the treatment and support of patients experiencing poor mental health. We saw how GPs had supported patients in the community and in some cases this had meant patients had been able to stay in their home environment. Practice staff had worked with all stakeholders to reduce the number of 999 ambulance call-outs, to patients who did not fully understand the definition an emergency medical situation. All GPs and nursing staff showed a good understanding of legislation in place to protect a patient’s right to choose how and where they could be treated and we saw how this was working in everyday situations that the GPs dealt with. The practice partners had worked with other surgeries to share resources and to bring counselling services to patients at the practice. We saw two outstanding examples of how this had helped patients recover from episodes of poor mental health.

Updated 5 March 2015

The practice is rated as outstanding for the care of vulnerable patient groups. The practice supported a residential centre close by for adult patients with learning disabilities. Following introduction of new guidelines from the Royal College of General Practitioners on the care and support of patients with a learning disability, the practice carried out an audit and review of care for patients in this population group. As a result, a far more comprehensive health review for these patients was formulated and delivered annually, with more focus on identifying health conditions in their early stages and screening for syndrome specific illness. The practice demonstrated how it had adapted communication materials to involve patients more in their health check and to empower patients to be proactive at maintaining a healthy lifestyle.