Updated
19 September 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of this practice on 3 December 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drs Macdonald, Guinan, Charles-Jones & Anderson on our website at www.cqc.org.uk
Our key findings were as follows:
-
A Disclosure and Barring Service (DBS) check had been carried out to confirm the suitability of all clinical staff for their roles.
-
The procedures for the management of vaccines had been reviewed to ensure they were safely managed.
The areas where the provider should make improvements are:
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
11 February 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. GPs and practice nurses were responsible for different long term conditions which meant they kept up to date in their specialist areas. The lead nurse in chronic disease management had recently been awarded Practice Nurse of the Year by the CCG for her work in this area. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice held an annual “Flu Fun Day” where all patients with a long term condition were invited to be immunised and to access additional help if needed. These events were attended by services such as smoking cessation and the falls prevention team. The practice was piloting a “telehealth” service which enabled patients to monitor their health at home and report their results to an advisor who advised on any action needed if there were changes to their conditions. This service was being piloted with a small group of patients and its aim was to improve access to health services and reduce unnecessary admissions or readmissions to hospital.
Families, children and young people
Updated
11 February 2016
The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. A drop-in service for baby immunisations had been introduced to encourage uptake. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding children. The safeguarding lead GP liaised with and met regularly with the health visitor to discuss any concerns about children and how they could be best supported. The practice was planning to be part of a project looking at improving patient care by moving some paediatric care from hospital settings into the community.
Updated
11 February 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 carried out home visits and also visited care homes in the area. The practice worked with other local practices to enhance patient care. For example, the practices had developed a role for a GP with a specialist interest in elderly care. The aim of this role being to complement the work of community Geriatricians and prevent hospital admissions where possible. This year the practice had funded research to review polypharmacy (polypharmacy is the use of four or more medications by a patient, generally adults aged over 65 years) to enhance the care of patients who may not attend the practice regularly and to review their medication. Services for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. The healthcare assistant was the carers link and had recently received an award from the West Cheshire Clinical Commissioning Group (CCG) for Carer’s Link of the year.
Working age people (including those recently retired and students)
Updated
11 February 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 book appointments on-line or via the telephone and repeat prescriptions could be ordered on-line which provided flexibility to working patients and those in full time education. The practice was open from 08:00 to 18:30 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.
People experiencing poor mental health (including people with dementia)
Updated
11 February 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 health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice carried out assessments of patients at risk of dementia to encourage early diagnosis and access to support. The majority of staff had recently attended training in dementia to highlight the issues patients living with dementia may face. Patients were referred to health and social care services to support them with their mental health such as counselling and psychiatry services.
People whose circumstances may make them vulnerable
Updated
11 February 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. One of the nurses took the lead for working with patients with a learning disability and provided advice and guidance to staff. There was a recall system to ensure patients with a learning disability received an annual health check and the practice followed up any missed appointments at hospital or at the practice to ensure this group of patients received the care they needed. Staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and they had access to the practice’s policy and procedures and had received training in this.