High Street Medical Practice - Winsford

Updated 7 January 2016

High Street Medical Practice -Winsford is located in the town centre of Winsford, Cheshire. The practice was providing a service to approximately 5433 patients. The practice is situated in an area with average levels of deprivation when compared to other practices nationally. The number of patients with a long standing health condition and health related problems in daily life is slightly higher than average when compared to other practices nationally.

The practice is run by two GP partners (application pending for an additional partner GP) and there is an additional salaried GP (two male and two female). There are two practice nurses, two health care assistants, a practice manager, reception and administration staff. The practice is open 8.00am to 7.30pm Mondays, 8.00am to 7pm Tuesdays, Wednesdays and Thursdays and 8.00 to 6.30 on Fridays. When the practice is closed patients access NHS East Cheshire Trust for primary medical services.

The practice has a General Medical Services (GMS) contract and also offers enhanced services for example; extended hours and childhood vaccination and immunisation schemes.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at High Street Medical Practice - Winsford on 4 November 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and that overall they were involved in decisions about their care and treatment.

• There were systems in place to reduce risks to patient safety for example, infection control procedures.

• Patients found it easy to make an appointment with a named GP and there was good continuity of care. Urgent appointments were available the same day.

• The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

• There was a clear leadership and structure and staff understood their roles and responsibilities. The practice proactively sought feedback from patients and acted upon it.

• Complaints were investigated and responded to appropriately.

• The practice learned from events and complaints and used this learning to drive improvements.

• The practice made good use of audits and the results of these were used to improve outcomes for patients.

The areas where the provider should make improvement are:

• Ensure the policy and procedure for managing significant events is followed at all times. The practice should also consider putting checks in place to ensure that any learning from significant events has been embedded into staff practice

• Extend the training record to include all clinical and non clinical staff groups.

We saw one area of outstanding practice:

The GP lead for mental health had recognised that physical health could be poor for patients with enduring mental health conditions. The practice provided primary care to people living in a psychiatric unit and the practice had tailored care towards these patients by ensuring they received health screening and information about their health conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management. Data showed that people with diabetes were overall above the national average for having appropriate health checks. Care plans had been developed for patients with long term conditions such as asthma, epilepsy and rheumatoid arthritis. Longer appointments and home visits were available when needed. Patients with a long term condition had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care and treatment.

Updated 7 January 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 who were at risk. For example, alerts on medical records identified children at risk. Regular meetings were held with a health visitor linked to the practice to share information or concerns. This linked in with an ‘early intervention’ strategy whereby children who presented at any level of risk were highlighted by the practice and information shared with relevant professionals. Appointments were available outside of school hours and children were always given appointments at short notice. The premises were suitable for children and babies and baby changing facilities were provided. The practice supported children with special needs to attend appointments that suited their needs. A system had been set up whereby carers could be contacted on their mobile number to alert them that their child’s appointment was ready and they could then have direct access to the surgery. Child immunisation rates were in line with average rates and on the spot immunisation appointments were available to encourage uptake. Pre-conception planning was in place for women of child bearing age who had medical conditions such as epilepsy or diabetes. The practice provided a ‘one stop shop’ for six week baby checks and post natal checks to be carried out simultaneously.

Updated 7 January 2016

The practice is rated as good for the care of older people. The practice offered proactive and personalised care and treatment to meet the needs of the older people in its population. Home visits and urgent appointments were provided for those with enhanced needs. The appointments system included a ‘Rapid Response’ to ensure frail patients who were at risk of an unplanned admission to hospital were seen quickly and early in the day. Patients at risk of an unplanned hospital admission had been offered an appointment to develop a care plan to help them manage their health conditions. The practice maintained a record of people who were elderly and vulnerable and worked on a multi-disciplinary basis to meet people’s needs. GPs carried out a weekly visit to a local nursing home to assess and review patient’s needs. The practice also met on a monthly basis with neighbouring practices to review the care and treatment provided to people living in residential care homes. This included carrying out an analysis of events across the care homes and setting objectives to improve the quality of care and treatment provided to patients.

Updated 7 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students) . The needs of this population group had been identified and the practice had adjusted the services it offered to ensure the service was accessible, flexible and offered continuity of care. Late appointments were available four days per week until 7pm. Telephone consultations were also available every day. The practice was proactive in offering online services, enabling people to book appointments on line, view their records and order repeat prescriptions. A full range of health promotion and screening that reflects the needs for this age group was available to patients.

Updated 7 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 86.2% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. One GP was the lead for mental health within the practice and within the Clinical Commissioning Group (CCG). The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice carried out regular visits to a local residential care home and care planning was carried out for patients with dementia. The practice provided primary care to patients living in a psychiatric unit and we heard examples of the positive impact this had on patient care. The practice was aware of people who were subject to restrictions under the Mental Health Act. Patients experiencing poor mental health were provided with information about how to access support groups and voluntary organisations.

Updated 7 January 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. Longer appointments were available for people with a learning disability. Annual health checks were provided for people with a learning disability. Arrangements were made for travelling families to be seen on an opportunistic basis for immunisations, vaccinations and screening. The practice worked with multi-disciplinary teams in the case management of vulnerable people. Vulnerable patients had been provided with advice and support about how to access a range of support groups and voluntary organisations. Staff had been provided with training in domestic abuse. 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.