Heaton Moor Medical Group

Updated 13 September 2017

Heaton Moor Medical Group (HMMG) has a main practice based in Heaton Moor in Stockport (32 Heaton Moor Road, Stockport SK4 4NX). It also has three branch surgeries including Bosden Moor Surgery, Fulmar Drive, Offerton, SK2 5JL, Littlemoor Surgery 10 Offerton Lane, Offerton, SK2 5AR and Dean Lane Medical Centre, 95 Dean Lane, Hazel Grove, SK7 6EJ.

HMMG completed the purchase of Bosden Moor Surgery in February 2017, notified the Care Quality Commission that the location was now a branch GP surgery and undertook a consultation process with patients to rename the practice to Bosden Moor Surgery.

Bosden Moor Surgery patients’ register merged with the patients registered with HMMG in April 2017.

There are approximately 32000 patients on the practice register. The practice is a training and teaching practice managed by five GP partners (two female and three male). There are 13 salaried GPs and three registrars. There are three nurse practitioners, one diabetic nurse specialist, five practice nurses, two assistant practitioners and one healthcare assistant.

The clinical team is supported by a practice management team led by the practice manager, an administration team and a reception team.

The practice main location and the three branch surgeries are open 8am to 6.30pm every weekday. Bosden Moor surgery closes 1pm to 2pm each day. During these periods of closure patients ringing the surgery are diverted to one of the other branch surgeries.

HMMG offers appointments from 7.30am every weekday and until 8pm Monday to Thursday. Weekend appointments with the GP, practice nurse and health care assistant are available on Saturdays from 8am until 2pm and on Sundays from 8am until 12 midday.

Patients requiring a GP outside of normal working hours are advised to contact the GP out of hours service by calling 111.

The practice is part of NHS Stockport Clinical Commissioning Group. The practice has a Personal Medical Services (PMS) contract and has enhanced services contracts which include childhood vaccinations.

HMMG have refurbished the Bosden Moor Surgery building to a high standard. The interior décor is modern and tasteful and is compliant with health and safety and infection prevention and control standards. Action has been taken to allow patients with disabilities easy access from the car park. There are now four consultation rooms available to allow GP, practice nurse and phlebotomy services to be provided. Each consultation room is fully equipped with new, modern equipment. Patients have access to ample car parking space close to the surgery. 

Updated 13 September 2017

Letter from the Chief Inspector of General Practice

This inspection was an announced focused inspection carried out on 9 August 2017 at the branch location Bosden Moor Surgery, (formerly The Surgery) which is now part of the registration of Heaton Moor Medical Group (HMMG).

HMMG was inspected 15 November 2016 and was rated good overall. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Heaton Moor Medical Group on our website at www.cqc.org.uk.

This GP practice was previously registered to another provider (Dr Yogendra Dutt Sharma) and was known locally as The Surgery. However significant concerns were identified in relation to the key questions safe, effective and well led and the practice was rated inadequate overall and placed into special measures following our first inspection of the practice in February 2016.

At our re-inspection of the GP practice in 7 December 2016 Dr Yogendra Dutt Sharma, the registered provider, was no longer contracted with NHS England to provide primary medical services at The Surgery. The NHS England contract as of the 1 December 2016 was with the GP partners from HMMG.

HMMG had been supporting The Surgery from October 2016 and the re-inspection in December 2016 identified major improvements in the quality and safety of the service provided. HMMG had implemented an effective remedial action plan but recognised further work was required to improve services. The practice was rated as requires improvement overall and one requirement notice was issued. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Yogendra Dutt Sharma on our website at www.cqc.org.uk.

HMMG completed the purchase of the GP Surgery in February 2017, notified the Care Quality Commission that the location was now a branch GP surgery and undertook a consultation process with patients to rename the practice to Bosden Moor Surgery. HMMG patients’ register merged with the patients registered at Bosden Moor Surgery in April 2017.

The purpose of this focused inspection was to confirm that HMMG had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection 7 December 2016.

Our key findings across all the areas we inspected were as follows:

• HMMG had successfully implemented a strategy to improve and develop the service provided at Bosden Moor Surgery and had addressed the significant issues, transforming the service provided to one that was safe, effective and well led.
• The practice building had been totally remodelled to a high standard, providing tastefully modern décor and facilities while retaining and enhancing patient access and improving capacity and the variety of the services provided.
• The planned integration of the patient record system with that of HMMG had been completed. This allowed patients to access a range of GP, nurse and specialist appointments across four locations within Stockport.
• Records management was centralised for the majority of administrative tasks, which enabled effective management of patient information.
• The practice had fully implemented and integrated their established governance systems at Bosden Moor Surgery. This ensured all staff had access to standardised policies, procedures and processes regardless of which of the four GP surgeries they were located at.
• Patient medication reviews at Bosden Moor Surgery had been completed and a recall and review cycle established dependent on the individual patient’s needs.
• HMMG were actively trying to engage with patients at Bosden Moor Surgery and invited patients to join the wider HMMG patient participation group.
• HMMG implemented a range of audits including clinical audits.
• Regular multi-disciplinary meetings were held jointly with another of HMMG branch surgery because the same health care professionals covered both localities.
• HMMG was forward thinking and worked collaboratively with the clinical commissioning group (CCG) in piloting new ways of working to improve patient outcomes and to expand the variety of and access to a range of health care and treatment options.
• Staff training plans and annual appraisal were established and implemented.
• We saw that staff treated patients with kindness and respect, and maintained confidentiality.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 September 2017

Under the CQC registration of a different provider the practice was rated as requires improvement for providing effective and well led services. This follow up focused inspection identified that Heaton Moor Medical Group, the new registered providers for this service, had implemented effective action to improve the quality of the service provided for this population group.

• The practice had a team of nurses which included advanced nurse practitioners, practice nurses and health care assistants. Nursing staff had lead roles in the management of long-term disease and worked closely with community and secondary care health professionals to provide comprehensive care to patients.
• Patients now had access to regular practice nurse appointments to review their long-term conditions.
• Open access phlebotomy clinics were held every Monday at Bosden Moor Surgery.
• Unverified data for this current year showed that the provider was on track to meet their targets in meeting the Quality and Outcomes Framework (QOF) indicators.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 13 September 2017

Under the CQC registration of a different provider the practice was rated as requires improvement for providing effective and well led services. This follow up focused inspection identified that Heaton Moor Medical Group, the new registered providers for this service, had implemented effective action to improve the quality of the service provided for this population group.

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
• The new provider ensured there was a practice nurse available at the Bosden Moor Surgery at least three days per week. This provided the female patients living locally increased access to cervical screening. 
• Patients had access to appointments at four locations in Stockport. Appointments were available outside of school hours and the premises were suitable for children and babies.
• HMMG had a good track record in providing childhood immunisation. Data for the vaccinations given in 2015/16 indicated that the practice was achieving above the level expected with 90% or more in all the four indicators
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 13 September 2017

Under the CQC registration of a different provider the practice was rated as requires improvement for providing effective and well led services. This follow up focused inspection identified that Heaton Moor Medical Group, the new registered provider for this service, had implemented effective action to improve the quality of the service provided for this population group.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage those older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice had effectively introduced regular multidisciplinary team meetings to review all those patients assessed as vulnerable or frail and ensured proactive management of these patients to offer more support to them..

Updated 13 September 2017

Under the CQC registration of a different provider the practice was rated as requires improvement for providing effective and well led services. This follow up focused inspection identified that Heaton Moor Medical Group, the new registered providers for this service, had implemented effective action to improve the quality of the service provided for this population group.

• The needs of these populations 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 offered flexible surgery times and patients had access to appointments at four locations. Extended appointment hours were available from 7.30am every weekday and until 8pm Monday to Thursday. Weekend appointments with the GP, practice nurse and health care assistant were available on Saturdays from 8am until 2pm and on Sundays from 8am until 12 midday.
• The practice had promoted patient online access so that patients could now make GP appointments online.
• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

Updated 13 September 2017

Under the CQC registration of a different provider the practice was rated as requires improvement for providing effective and well led services. This follow up focused inspection identified that Heaton Moor Medical Group, the new registered providers for this service, had implemented effective action to improve the quality of the service provided for this population group.

• Patients at risk of dementia were identified and offered an assessment.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 13 September 2017

Under the CQC registration of a different provider the practice was rated as requires improvement for providing effective and well led services. This follow up focused inspection identified that Heaton Moor Medical Group, the new registered providers for this service, had implemented effective action to improve the quality of the service provided for this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.