Archived: Priorslegh Medical Centre

Updated 21 November 2016

Priorslegh Medical Centre is located in Poynton, Stockport. The practice was providing a service to approximately 11,300 patients at the time of our inspection.

The practice is part of Eastern Cheshire Clinical Commissioning Group (CCG). The practice is situated in an area with low levels of deprivation when compared to other practices nationally. The percentage of patients with a long standing health condition is 55% which is similar to the national average of 54%. The practice has a higher than average elderly population with 17% of patients over the age of 75 compared to the national average of 10%.

The practice is run by five GP partners. There are an additional three salaried GPs (four male and four female). There are six practice nurses one of whom is an advanced nurse practitioner, one health care assistant, a practice manager and a team of reception/administration staff. The practice is open from 8am to 7.30pm on Mondays and from 8am to 6.30pm Tuesday to Friday. When the surgery is closed patients are directed to the GP out of hours service provider (East Cheshire NHS Trust) by contacting NHS 111.

The practice is a training practice for trainee GPs and also hosts medical students.

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

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 21 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Priorslegh Medical Centre on 28 September 2016. Overall the practice is rated as good. Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Significant events had been investigated and action had been taken as a result of the learning from events.

• Systems were in place to deal with medical emergencies and all staff were trained in basic life support.

• There were systems in place to reduce risks to patient safety. For example, infection control practices were good and there were regular checks on the environment and on equipment used.

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

• Feedback from patients about the care and treatment they received from clinicians was very positive. Patients told us they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• Data showed that outcomes for patients at this practice were comparable to those of patients locally and nationally.

• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• The appointments system was flexible to accommodate the needs of patients. Urgent appointments were available the same day and routine appointments could be booked in advance.

• Patients said they found it easy to make an appointment and there was good continuity of care.

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

• Information about services and how to complain was available. Complaints had been investigated and responded to in a timely manner.

• The practice had a clear vision to provide a safe and high quality service.

• There was a clear leadership and staff structure and staff understood their roles and responsibilities.

• The practice provided a range of enhanced services to meet the needs of the local population.

• The practice sought patient views about improvements that could be made to the service. This included the practice having and consulting with a patient participation group (PPG).

We saw areas of outstanding practice:

• The practice provided an in house physiotherapy service which resulted in patients receiving timely support and in fewer patients requiring referral to secondary care.

• A care co-ordinator role had been established. This involved proactively contacting patients or their families to support and co-ordinate patient care between services. We saw examples of the effectiveness of this service and the outcomes for patients.

• One of the practice nurses worked with the local authority to provide health education sessions to children and young people at a local school.

Areas where the provider should make improvement are:

• For audit purposes, the practice should consider introducing read coding when chaperoning has been offered or provided to patients.

• A review of the decision not to carry emergency medicines on home visits should be carried out and a risk assessment should be in place to support this.

• The practice should review and update information provided to patients about the complaints process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 November 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 regular checks received these.

• Practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health. The practice employed two specialist nurses to provide this for patients with diabetes and with respiratory disease.

• A range of services were provided to support patients with diabetes and this resulted in fewer patients needing to attend secondary care. These included insulin initiation and management. Educational sessions were also provided for patients with diabetes.

• Data from 2014 to 2015 showed that the practice was performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes.

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

• Regular clinical meetings were held to review the clinical care and treatment provided and ensure this was in line with best practice guidance.

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

• Patients with multiple long term conditions were offered a single appointment to avoid multiple visits to the surgery.

• The practice provided an in house phlebotomy service which was convenient for patients especially those requiring regular blood monitoring.

• A care co-ordinator contacted patients following discharge from hospital to check if they required any additional services.

Updated 21 November 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.

• A regular meeting was held with health visitors to discuss child protection concerns.

• 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.

• Immunisation rates were comparable to the national average for all standard childhood immunisations. Opportunistic immunisations were given to encourage uptake.

• 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.

• Two of the GPs had interests in women’s health, family planning and paediatrics.

• Babies and young children were offered an appointment as priority and appointments were available outside of school hours.

• The premises were suitable for children and babies and baby changing facilities were available.

• A practice nurse provided educational/awareness sessions at a local high school covering topics relevant to the age group.

• Family planning and contraceptive services were provided.

• The practice had a high uptake of chlamydia screening due to a proactive approach taken by the clinicians.

Updated 21 November 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 had a higher than average number of older people in its population. Up to date registers of patients with a range of health conditions (including conditions common in older people) were maintained and these were used to plan reviews of health care and to offer services such as vaccinations for flu. Immunisation rates for flu were high.

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

• The practice provided an enhanced service to prevent high risk patients from unplanned hospital admissions. This included these patients having a care plan detailing the care and treatment they required.

• GPs and practice nurses carried out regular visits to a local care home to assess and review patients’ needs and to prevent unplanned hospital admissions. As a result clinicians were reported to have become familiar with patient’s complex medical conditions resulting in effective and timely treatment for patients.

• A care co-ordinator liaised with community services to help co-ordinate patients’ care and support following discharge from hospital.

• 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.

• Monthly multi-disciplinary meetings were held to discuss the care and treatment for patients with complex needs.

Updated 21 November 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 provided and patients therefore did not always have to attend the practice in person.

• The practice provided extended hours appointments one evening per week until 7.30pm.

• 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 77% of females aged 50-70 had been screened for breast cancer in the last three years compared to a national average of 72%.

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

Updated 21 November 2016

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

• The practice held a register of patients experiencing poor mental health and these patients were offered an annual review of their physical and mental health.

• The practice referred patients to appropriate services such as psychiatry and counselling services. A trainee counsellor was provided as an additional support to patients.

• The practice regularly worked with multi-disciplinary teams including in the case management of patients experiencing poor mental health.

• A system was in place to follow up patients who had attended accident and emergency and this included where people had been experiencing poor mental health.

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

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

Updated 21 November 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.

• The practice worked with relevant health and social care professionals in the case management of vulnerable people.

• 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 in normal working hours and out of hours.

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

• Patients with communication or sensory difficulties had been contacted to ask them how the practice could best communicate with them and their requests had been acted upon.

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