Archived: The Great Sutton Medical Centre - Blue

Updated 4 May 2017

The Great Sutton Medical Centre – Blue is responsible for providing primary care services to approximately 5825 patients. The practice is situated in Ellesmere Port in Cheshire. The Great Sutton Medical Centre – Blue is one of three group practices based within the same building. The three practices share a practice manager, nursing team and administrative and reception staff. The practice is based in an area with average levels of economic deprivation when compared to other practices nationally.

The staff team includes four partner GPs, one salaried GP, one advanced nurse practitioner, five practice nurses, four health care assistants, practice manager, administration and reception staff. There are both male and female GPs. The nursing team has one male nurse and the health care assistants are female.

The Great Sutton Medical Centre – Blue is open from 8am to 6.30pm Monday to Friday. An extended hour’s service for routine appointments and an out of hour’s service are commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. Patient facilities are located on the ground floor. The practice has a small car park for on-site parking.

The practice has a General Medical Service (GMS) contract. The practice offers a range of enhanced services including minor surgery, timely diagnosis of dementia, preventing unplanned hospital admissions and flu vaccinations.

We undertook a comprehensive inspection of The Great Sutton Medical Centre – Red on 9 March 2016. The practice was rated as requires improvement for providing safe and well led services.

Updated 4 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Great Sutton Medical Centre - Blue on 9 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for The Great Sutton Medical Centre - Blue on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 14 March 2017. Overall the practice is now rated as good with requires improvement for providing safe services

Our key findings were as follows:-

• There were systems in place to reduce risks to patient safety, for example, equipment checks were carried out, there were systems to protect patients from the risks associated with insufficient staffing levels and to control infection and keep the premises clean.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt supported. They had access to training and development opportunities.

• Overall patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.

• Services were planned and delivered to take into account the needs of different patient groups.

• Access to the service was monitored to ensure it met the needs of patients.

• There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

The areas of practice where the provider should make improvements are:

The provider should:

• Make a record of their periodic analysis of significant events and include further information in clinical meeting minutes showing how decisions in relation to these events were reached. Ensure that significant events are shared with all relevant staff and records show any events reported externally.

• Further training on the new electronic system (Intradoc) to record and share information about the operation of the practice should be provided to staff.

• The system for ensuring medication is reviewed when patients do not attend for an appointment should be improved.

• Ensure that a record is maintained of the reason why fridge temperatures are outside the recommended temperature range and the action taken.

• Ensure that emergency medication in glass containers is secure to guard against breakage.

• The systems for using alerts on records should be reviewed to cover patients at risk of self-harm and carers of relatives receiving palliative care.

• The salaried GP should have an in-house appraisal in addition to the external appraisal process.
• Encourage the uptake of carers on the practice register.
• Ensure that patient notes are updated following multi-disciplinary meetings.
• The practice should look at a representative from the nursing team attending their GP clinical meetings which would enable them to feedback to the regular nursing meetings that are now held.
• A survey should be undertaken to establish the current levels of patient satisfaction with access given the number of changes introduced. Surveys should be specific to patients from this practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 May 2017

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 recall patients for reviews of long term conditions. The practice was a pilot site for the year of care and as a consequence was streamlining its management of long term conditions and minimising the number of appointments patients had to attend. A monthly diabetic specialist nurse clinic was held which reviewed patients with complex or poorly controlled diabetes which meant that these patients did not have to go to hospital for appointments. The specialist nurse also met with the clinical staff to provide advice and guidance. Quality and Outcome Framework (QOF) data showed the practice was overall performing in-line with other practices locally and nationally in the monitoring of long term conditions. The practice encouraged patients to monitor their long term conditions where possible. For example, through the use of blood pressure monitoring machines at home or by using a monitor at the practice. Patients were able to access questionnaires for asthma, depression and alcohol use to help identify if clinical services were required. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice referred patients who were over 18 and with long term health conditions to a well-being co-ordinator for support with social issues that were having a detrimental impact upon their lives.

Updated 4 May 2017

The practice is rated as good for the care of families, children and young people. Newly pregnant patients were provided with an information pack and booked in to see the midwife. Post-natal and new baby checks were offered. Baby immunisations were available and the practice ensured that any non-attenders were recalled. Baby change facilities were on site. The website contained information for pregnancy and health care after birth and through childhood. Contraceptive and family planning services were provided. The practice website and information in the waiting room directed young people to sources of support such as “My Wellbeing” an online service for 11-19 year olds run by Cheshire and Wirral Partnership NHS Foundation Trust offering emotional and psychological support. Sexual health screening to patients under 25 was offered and posters were displayed sign posting patients to screening for chlamydia.

Updated 4 May 2017

The practice is rated as good for the care of older people. The practice 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. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients. The advanced nurse practitioner provided an early visiting service to improve patient access to clinical services and to the resources needed to support patients at home. This service had the aim of reducing emergency admissions to hospital and use of emergency services. There was a system in place to identify patients over 75 discharged from hospital following an unplanned admission. This enabled the patient to be contacted by a clinician to discuss support needed to prevent a readmission. The Patient Participation Group had co-ordinated an information giving event around care of the elderly which was attended by a number of local health and social care services.

Updated 4 May 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice had a triage system where all patients received a telephone call from a GP to ensure they received the right type of consultation to meet their needs. This system provided flexibility as the GP was able to offer a time convenient to the patient if a face to face consultation was required.  Patients could order repeat prescriptions on-line and text reminders were sent for some test results. The practice was open from 08:00 to 18:30 Monday to Friday allowing early morning and late evening appointments to be offered. An extended hour’s service for routine appointments was commissioned by West Cheshire CCG. The practice website provided information around women and men’s health and self-care and local services available for patients. Health checks were offered to patients to promote patient well-being and prevent any health concerns. This included blood pressure checks, diabetes and cholesterol screening and smoking and alcohol advice. A phlebotomy service was hosted at the practice with early morning appointments available. Referrals were made to services to support patients with their health, such as weight management programmes.

Updated 4 May 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). GPs worked with specialist services to review care and to ensure patients received the support they needed. The practice attended quarterly meetings with the mental health team to review the needs of patients on the mental health register. The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review. The practice referred patients to appropriate services such as psychiatry and counselling services. Staff who had been in post over 12 months had attended training in dementia to highlight the issues these patients may face.

Updated 4 May 2017

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. A register of patients with a learning disability was maintained to support the practice in offering an annual health check. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the wellbeing coordinator. There was a lead member of staff for carers. A record was made on patients’ notes if they were a carer to enable appropriate support to be offered. Services for carers were publicised and information packs were given to carers to ensure they had access to appropriate services.