Archived: Culcheth Health Plus

Updated 3 July 2017

Culcheth Health Plus is located in Culcheth, Warrington, Cheshire. The practice was providing a service to approximately 13,500 patients at the time of our inspection. The main practice is located at Jackson Avenue, Culcheth, Warrington, WA3 4DZ. The practice has two branch surgeries; at CCA Care Partnership Chapelford, Burtonwood Road, Great Sankey, WA5 3AN and CCA Care Partnership Appleton, 45 Dudlow Green Road, Appleton, WA4 5EQ. We visited the main site and both branch surgeries as part of the inspection.

The practice is part of Warrington Commissioning Group (CCG) and is situated in an area with lower than average levels of deprivation when compared to other practices nationally. The practice has a higher than average elderly population and the percentage of patients who have a long standing health condition is lower than the national average.

The practice is run by Warrington Primary Care Home C.I.C. which is governed by Warrington Health Plus, a community interest company. All 26 GP practices across Warrington are members. Warrington Health Plus are acting in a ‘care taking’ capacity until such times as an alternative provider is found. Across the three sites there are; five salaried GPs, four practice nurses, three health care assistant, three location managers and a team of reception/administration staff.

The surgeries are open from 8am to 6.30pm Monday to Friday. Patients could access a GP at a Health and Wellbeing Centre in Warrington town centre from 6.30pm until 8pm Monday to Friday and between 8am to 8pm Saturdays and Sundays. This was by pre-booked appointment. Outside of practice hours patients can access the Bridgewater Trust for primary medical services by contacting NHS 111.

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 has an Alternative Provider Medical Services (APMS) contract. The practice provides a range of enhanced services, for example: extended hours, childhood vaccination and immunisation programmes and checks for patients who have a learning disability.

Updated 3 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Culcheth Health Plus on 9 May 2017. 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 staff were trained in basic life support.

• There were systems in place to reduce risks to patient safety. For example, infection control practices were carried out appropriately 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 positive.

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

• Patients told us they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• 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.

• 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.

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

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

• 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).

The areas where the provider should make improvement are:

• Review the information provided to patients about the complaints process.

• Ensure emergency medicines include all required equipment.

• Introduce a periodic check on uncollected prescriptions.

• Review the training provided to the staff team at the CCA Care Partnership Chapelford surgery.

• Increase the number of identified carers to ensure these patients are provided with information about the support available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 July 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. 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 immunisations received these.

• Practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health.

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

• Data from 2015 to 2016 showed that the practice was performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions.

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

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

• Patients were provided with advice and guidance about prevention and management of their health and were signposted to support services.

Updated 3 July 2017

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.

• Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.

• Child health surveillance clinics were provided for 6-8 week olds.

• Immunisation rates were comparable to the national average for all standard childhood immunisations. Non-attendance of babies and children at vaccination clinics was monitored and staff told us they would report any concerns they identified to relevant professionals.

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

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

Updated 3 July 2017

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 kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to outcomes for patients locally and nationally.

• GPs worked with other practices in the locality in carrying out regular visits to local care homes to assess and review patients’ needs and to prevent unplanned hospital admissions.

• 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.

• Practice staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.

Updated 3 July 2017

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.

• The practice was part of a cluster of practices whose patients could access appointments at a local Health and Wellbeing Centre up until 8pm in the evenings Monday to Friday, and from 8.00am to 8.00pm Saturdays and Sundays, through a pre-booked appointment system.

• Telephone consultations were provided and patients therefore did not always have to attend the practice in person.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group.

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

Updated 3 July 2017

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.

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were comparable to local and national averages.

• The practice referred patients to appropriate services such as psychiatry and counselling services.

• 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.

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

• Patients with a new diagnosis of depression were automatically recalled for review at two and four weeks and alert was flagged if they do not attend.

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

Updated 3 July 2017

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.

• 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 provided appropriate access and facilities for people who were disabled.

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

• All carers for people who have a learning disability had been contacted to ask if they would like to be referred for a carers assessment with the local authority.

• A system was in place to alert staff if a vulnerable patient had failed to attend an appointment and these patients were then contacted by the practice.

• Patients with drug or alcohol dependency were referred to local support services.