Background to this inspection
Updated
23 February 2017
Bridgewater CHCFT took over the operational responsibility for The Willaston Surgery in July 2014. The practice is responsible for providing primary care services to approximately 4,331 patients. The practice is situated in Neston Road in Willaston, Cheshire. The practice is based in an area with lower levels of economic deprivation when compared to other practices nationally. The practice has a higher than average number of patients over the age of 65 and an about average number of patients with a long standing health condition when compared to other practices locally and nationally.
The staff team includes one full time and three part time salaried GPs, a practice nurse, a health care assistant, practice manager and administration and reception staff. Two GPs are female and two are male. The practice nurse and health care assistant are female.
The practice is open 8am to 6.30pm Monday to Friday and offers extended hours 9am to 12pm on Saturdays and Sundays. 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. Patients are also able to access the out of hour’s service provided by Wirral Community NHS Trust. The practice is on two floors with access via the stairs to the first floor treatment room. Arrangements were in place to ensure patients unable to access the first floor were seen in a ground floor room. The practice has a small car park for on-site parking.
Bridgewater CHCFT has an Alternative Provider Medical Services (APMS) contract which means that the services offered are targeted to meet the healthcare needs of the locality. The practice offers a range of enhanced services including spirometry, minor surgery, anticoagulation and near patient testing.
Updated
23 February 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of Bridgewater CHCFT The Willaston Surgery on 24 August 2016. The overall rating for the practice was Good. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Bridgewater CHCFT The Willaston Surgery on our website at www.cqc.org.uk.
This inspection was a desk-based review carried out on 19 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 24 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice is rated as Good.
Our key findings were as follows:
The following improvements to the service had also been made:
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Evidence was provided to demonstrate that significant events were reviewed at practice level to enable patterns and trends to be identified and any appropriate action to be carried out.
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Further improvements had been made to the system for ensuring adult patients with depression were receiving a review at the recommended frequencies following a new diagnosis.
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A plan had been put in place to ensure all staff received training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
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The induction records for clinical and non-clinical staff and the GP locum pack had been reviewed to provide greater detail and to ensure staff were provided with the information they needed.
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The protocol for incoming correspondence had been reviewed to ensure clarity of what should be sent to the GPs for review and action.
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A planned programme of audits had been put in place.
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Information about how patients can make a complaint had been revised to include who complaints should be directed to at the practice.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
11 October 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 such as screening programmes and vaccination programmes. The practice had a system in place to recall patients for reviews of long term conditions. Alerts were placed on patient records to ensure same day access where necessary. Nurses made visits to housebound patients with long term conditions. Quality and Outcome Framework (QOF) data 2014 -2015 showed there were areas where the practice was not performing as well as other practices nationally in the monitoring of some long term conditions. The practice was aware of these shortfalls and had taken action taken to improve the QOF results. We reviewed data for QOF for 2015/2016 and found that improvements had been made in all areas where shortfalls had been identified apart from reviews of patients with depression. The systems for monitoring that patients were receiving the health care checks they needed at the recommended frequencies needs to continue to ensure that there is an improvement to patient outcomes.
The nursing staff took the lead for different long term conditions and kept up to date in their specialist areas. Longer visits and home visits were made available as required. Patients were provided with a personalised care plan and there was a system in place to offer an annual review of patients with long term conditions. 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.
Families, children and young people
Updated
11 October 2016
The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Appointments for young children were prioritised. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. The safeguarding lead liaised with the health visiting service, school nurses and midwives to discuss any concerns about children and how they could be best supported. Family planning and sexual health services were provided.
Updated
11 October 2016
The practice is rated as good for the care of older people.
Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients.
The practice was working with neighbourhood practices and the Clinical Commissioning Group (CCG) to provide services to meet the needs of older people. The practice had provided an Early Visiting Service over the last two years. This had the aim of improving patient access to GP services, enabling quicker access to the resources needed to support patients at home where possible and reducing emergency admissions to hospital and the use of emergency services. The practice reported that accident and emergency attendance and emergency admissions were lower than the CCG average for 2015/2016 which demonstrated the success of this approach. The practice was also working with two other practices to set up more community led services, for example the practices were setting up a service for a practice nurse to visit elderly housebound patients to carry out medication reviews and health checks. Weekly visits were made to local nursing homes to review the needs of patients and respond to any health issues identified.
Working age people (including those recently retired and students)
Updated
11 October 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 order repeat prescriptions and book some appointments on-line which provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday allowing early morning and evening appointments to be offered to working patients and from 9am to 12pm on Saturdays and Sundays providing flexibility for patients unable to attend week day appointments. The practice had adjusted its services to meet the needs of patients by also offering weekend and evening drop in flu clinics. An extended hour’s service for routine appointments and an out of hour’s service were commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. Patients were also able to access the out of hours service provided by Wirral Community NHS Trust. The practice website provided information around self-care and local services available for patients. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening.
People experiencing poor mental health (including people with dementia)
Updated
11 October 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice ensured that patients diagnosed with dementia had their care reviewed annually and that patients experiencing poor mental health such as schizophrenia, bi-polar affective disorder and other psychoses had an agreed, documented care plan. The practice worked with two neighbourhood practices to ensure follow up of patients attending accident and emergency where they may have poor mental health. The practice referred patients to appropriate services such as psychiatry and counselling services. Clinical and non-clinical staff had undertaken training in dementia to ensure all were able to appropriately support patients. The QOF data for 2014-2015 showed the practice was performing in line with local and national averages in relation to mental health in most areas. However, the practice had scored significantly below the CCG average and national average in relation to reviews of patients with a new diagnosis of depression:-
We spoke to the assistant general manager about this who advised that little improvement had been made in this area in 2015-2016 period. The practice was aware of this shortfall and had undertaken an analysis of a sample of patient records and found that reviews had taken place but were not recorded correctly. The practice had a plan in place to improve patient outcomes in this area by reviewing the records of all patients diagnosed with depression to determine if a review was needed, review the patient recall system for these patients and provide further training for staff around recording.
People whose circumstances may make them vulnerable
Updated
11 October 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.
The staff we spoke with had appropriate knowledge about adult safeguarding and how to report any concerns. The practice worked with health and social care services to support the needs of vulnerable patients.
Se
rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff was the carer’s link. The practice referred patients to local health and social care services for support, such as drug and alcohol services.