Archived: The Surgery

Updated 14 March 2017

The Surgery is located at 28 Holes Lane, Woolston, Warrington, Cheshire, WA1 4NE. The practice was providing a service to approximately 10,800 patients at the time of our inspection. The practice is situated in an area with average levels of deprivation when compared to other practices nationally. The percentage of patients with a long standing health condition is similar to the local and national averages.

The practice is run by five GP partners. There is an additional salaried GP. There are two practice nurses, one health care assistant, a practice manager and a team of reception/administration staff.

The practice is open from 8am to 6.30pm Monday to Friday. The practice had signed up to providing longer surgery hours as part of the government agenda to encourage greater patient access to GP services. As a result patients could access a GP at a Health and Wellbeing Centre in the centre of Warrington during evenings and at weekends by pre-booked appointment. Outside of practice hours patients can access the Bridgewater Trust for primary medical services.

The practice has a Personal Medical Services (PMS) contract. The practice provides a range of enhanced services, for example: extended hours, childhood vaccination and immunisation schemes, checks for patients who have a learning disability and avoiding unplanned hospital admissions.

Updated 14 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery on 23 March 2016. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for The Surgery on our website at www.cqc.org.uk.

At our previous inspection on 23 March 216 we rated the practice as ‘good’ overall but as ‘requires improvement’ for providing a safe service as we identified breaches of Regulations 16 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have a robust system in place for recording, investigating and taking action in response to significant events. The procedures for managing complaints also required improvement to ensure; patients were provided with accessible and accurate information about how to make a complaint, that all complaints were fully investigated in a timely manner and action was taken to prevent a re-occurrence.

This inspection was a desk-based review carried out on 3 February 2017 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulation identified at our previous inspection. This report covers our findings in relation to that and additional improvements made since our last inspection.

The findings of this inspection were that the provider had taken action to meet the requirements of the last inspection and the service is now rated as good for providing safe services. Our key findings were as follows:

• The provider has taken action to review the processes in place for managing significant events. There is now a more robust system in place for recording, investigating and taking action in response to significant events and for oversight and review of events.

• The complaints procedure had been reviewed and updated. Information provided to patients had been reviewed to include details about the different options for making a complaint and the stages of this. Systems for the oversight of complaints had been introduced including ensuring appropriate timescales were in place for responding to complaints. Complaints were discussed at regular clinical meetings and a review of complaints was carried out on a bi-annual basis.

The provider had also made a number of improvements where we had identified these at our last inspection. These included;

• A risk assessment had been carried with regards to whether or not staff required a Disclosure and Barring Service (DBS) check linked to their roles and responsibilities.

• The process for referring patients to secondary care for tests or treatments had been reviewed. The provider had designated additional staffing to improve the efficiency of the referrals process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 May 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. 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.

• The GPs had lead roles in chronic diseases and 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 were offered a single, longer appointment to avoid multiple visits to the surgery.

• The practice was providing a community heart failure service as a pilot project as part of a cluster of practices within the locality.

• Data from 2014 to 2015 showed that the practice was comparable with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. For example, the percentage of patients with diabetes, on the register, who had had an influenza immunisation was 93.03% compared to a national average of 94.45%.

• Longer appointments and home visits were available for patients with long term conditions when these were required.

• The practice contacted patients following admission to hospital to check if they required any services from the practice.

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

Updated 12 May 2016

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.

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

• Child surveillance clinics were provided for 6-8 week olds and immunisation rates were comparable to the national average for all standard childhood immunisations. The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report any concerns they had identified to relevant professionals.

• 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 and the practice had a lead for sexual health and contraception.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 80.47% which was comparable to the national average of 81.83%.

Updated 12 May 2016

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 over the age of 75 and screening patients for dementia.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or better than local and national averages.

• GPs carried out regular visits to local care homes 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.

• The GPs held special interests in conditions commonly found in older people and there was a designated GP lead for the care of patients over 75 years of age.

• Staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.

Updated 12 May 2016

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.

• Telephone consultations were available and this meant patients did not always have to attend the practice in person.

• The practice was part of a cluster of practices whose patients could access appointments at a local Health and Wellbeing Centre up until 8pm in the evenings Monday to Friday, and from 8am to 8pm Saturdays and Sunday mornings, through a pre-booked appointment system.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group. Screening uptake for people in this age range was comparable to or above national averages. For example 78% of females aged 50-70 had been screened for breast cancer in the last three years compared to a national average of 72.2%.

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

Updated 12 May 2016

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

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were similar to or better than average. For example, data showed that 85.11% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This compared to a national average of 84.01%.

• The practice provided an enhanced service for screening patients to identify patients at risk of dementia and to develop care plans with them.

• Practice staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.

• The practice had a designated GP lead for mental health.

• Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they took.

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

Updated 12 May 2016

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.

• A designated GP had a lead role for patients who have a learning disability.

• The practice provided primary care to people who have a learning disability who were living in a local care home.

• 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 was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available.

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