The Weaver Vale Surgery

Updated 8 June 2017

The Weaver Vale Surgery is located in Winsford, Cheshire. The practice was providing a service to approximately 8,050 patients at the time of our inspection.

The practice is part of Vale Royal (CCG) and is situated in an area with higher than average levels of deprivation when compared to other practices nationally. The practice has a higher than average patient population 63% with a long standing health condition compared to the national average of 53%.

The practice is run by two GP partners. There are an additional two salaried GPs (three male and one female). The practice team included an advanced nurse practitioner, two practice nurses, one health care assistant, two full time pharmacists, a practice manager, assistant practice manager and a team of reception/administration staff. A physiotherapist was also employed.

The practice is open from 7.15am to 8.30pm on Mondays, 7.15am to 6.30pm Tuesday to Friday and alternate Saturdays from 8am to 11am. When the surgery is closed patients are directed to the GP out of hours service provider ‘Nights, Evenings, Weekends Service (NEWS) by contacting 01270273666 or 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 a General Medical Services (GMS) contract. The practice provides a range of enhanced services, for example: extended hours, childhood vaccination and immunisations, checks for patients who have a learning disability and avoiding unplanned hospital admissions.

Updated 8 June 2017

Letter from the Chief Inspector of General Practice

We had carried out an announced comprehensive inspection at The Weaver Vale Surgery on 16 June 2015. The overall rating for the practice was ‘requires improvement’. The full comprehensive report on the June 2015 inspection can be found by selecting the ‘all reports’ link for The Weaver Vale Surgery on our website at www.cqc.org.uk.

At our previous inspection in June 2015 we rated the practice as ‘requires improvement’ for providing a safe service and for providing a well-led service. As a result the practice was rated as ‘requires improvement’ overall. We issued two requirement notices to the provider relating to leadership of the practice and recruitment procedures.

This inspection visit was carried out on 4 April 2017 to check that the provider had met their plan to meet the legal requirements and as part of a comprehensive inspection of the service.

The findings of this inspection were that the provider had taken action to meet the requirements of the last inspection. The service is now rated as ‘good’ for providing safe and well-led services. The practice is now rated as ‘good’ overall.

Our key findings 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 evidence based guidance.

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

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

• Patients gave us positive feedback about all aspects of the service.

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

• 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 consulting with their patient participation group (PPG).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 June 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.

• Clinical staff provided regular, structured reviews of patients’ who had long term conditions.

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

• The practice was taking part in the NHS ‘National Diabetes Prevention Programme’ whereby patients at risk of developing diabetes were identified and encouraged to be referred for healthy lifestyle advice and support.

• 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 enhanced service to prevent high risk patients from unplanned hospital admissions.

• 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. A dietician was hosted at the practice on a regular basis and a smoking cessation clinic was also provided.

Updated 8 June 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.

• A daily check was conducted of all A&E attendances for children at risk or vulnerable families and these were flagged to the GPs for action.

• Regular meetings took place with health visitors to share information or concerns about child welfare.

• 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 higher than 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 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.

• Family planning services were provided.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 83% which was comparable to the national average of 81%.

Updated 8 June 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.

• Patients over the age of 75 had a named GP and were offered health checks.

• The practice provided a range of enhanced services, for example, the provision of care plans for 5% of the patient population at most risk of an unplanned hospital admission.

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

• Clinical staff provided support to a local care home as part of a local agreement. This involved carrying out care plans with people who lived at the home and reviewing these on a regular basis. GPs also carried out regular visits to local care homes to assess and review patients’ needs and to prevent unplanned hospital admissions.

• A meeting was held on a monthly basis to review the needs of patients who were living in care homes.

• 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.

• The practice had a system in place to proactively contact patients post hospital discharge to ensure they had the right medicines and support.

Updated 8 June 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 provided extended hours appointments. This included early morning appointments five days per week, late appointments one day per week and Saturday morning appointments on alternate weeks. As a result working age patients were provided with a range of accessible appointments suitable to their needs.

• Patient satisfaction with access to the practice and to obtaining a timely appointment was high. The practice received scores that were higher than local and national average for matters relating to access and the 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.

Updated 8 June 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 worked with other health and social care professionals in the case management of people experiencing poor mental health, including those with dementia.

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

• The practice participated in the dementia identification scheme for early diagnosis.

• Care plans were drawn up for patients living with dementia.

• 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.

• Systems 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 8 June 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.

• Alerts were added to patients’ records to ensure staff were aware of their risks or vulnerability.

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

• Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns for vulnerable adults and how to contact relevant agencies in normal working hours and out of hours. Staff provided a recent example of how they had recognised signs of potential abuse in a vulnerable adult and how they had acted upon their concerns.

• Staff had been provided with training in domestic abuse and the system alerted staff to patients known to be at risk of this.

• 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.