Wrenbury Medical Practice

Updated 6 May 2016

Wrenbury Medical Centre is located in the Cheshire village of Wrenbury. The practice provides a service to 3,586 patients. The practice is situated in an area with low levels of deprivation when compared to other practices nationally. The percentage of patients with long standing health conditions and health related problems in daily life is lower than the national average. Unemployment levels are lower than the national average. The percentage of patients aged 65 years and over and 75 years and over is higher than average.

The practice is run by two GP partners and an additional salaried GP (all female). There are two practice nurses and a health care assistant (HCA), a practice manager and team of reception and administration staff. The practice is a training practice. Wrenbury Medical Centre is a dispensing practice and a team of dispensing staff manage this area of work.

The practice is open from 8.00am to 6.30pm Monday to Friday and appointments are available within these times. The practice had signed up to providing longer surgery hours as part of the Government agenda to encourage greater patient access to GP services. Patients requiring GP services outside of normal working hours are referred on to the local out of hour’s provider N.E.W. operated by the East Cheshire Trust.

The practice has a General Medical Services (GMS) contract and offers a range of enhanced services for example; childhood vaccination and immunisation, facilitating early diagnosis and support to patients with dementia and health checks for patients who have a learning disability.

Updated 6 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wrenbury Medical Centre on 14th March 2016. 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 all staff were trained in basic life support.

• There were systems in place to reduce risks to patient safety. For example, infection control practices were generally good and there were regular checks on the environment and on equipment used. Some staff required further training in the prevention of infection control and protocols around staff handling samples required putting in place.

• Staff assessed patient’s needs and delivered care in line with current evidence based guidance.

• Feedback from patients about the clinical care and treatment they received was very positive.

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

• Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Staff felt well supported in their roles; however additional training was required in some areas.

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

• Feedback from patients showed that there were very high levels of satisfaction with access to appointments and they had no difficulty contacting the practice and speaking to clinicians.

• 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; some minor complaints were not recorded.

• The practice had vision to expand and staff strived to provide high levels of service, however there was no documented vision on which to base staff objectives.

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

• 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).

We saw one area of outstanding practice:

• Access for patients to appointments, telephone consultations and the use of “catch up” periods led to very high levels of patient satisfaction.

Areas where the provider should make improvements:

• Implement a more effective system to record/demonstrate the actions taken in response to significant events and safety alerts.

• Review training needs to ensure all mandatory training is provided to staff and there is an effective system is put in place to manage and monitor this.

• Increase security arrangements for rooms containing equipment, cleaning products and fridges where immunisation/vaccinations are stored.

• Fridges used to store temperature sensitive medicines to be hard wired or otherwise clearly signed to ensure they are not exposed to inadvertent power loss.

• Review the documentation in recruitment files to ensure all relevant checks are made and documented in relation to the recruitment of staff.

• Introduce and embed a protocol for dealing with patient samples brought to reception.

• Review the policy relating to medicines management, particularly around signatories for delivery of controlled drugs and checking of nomad packs (medicines in sealed packs).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 May 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. 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.

• Some of the GPs had lead roles in chronic diseases and practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patient’s health.

• Data from 2014 to 2015 showed that the practice was comparable with other practices for the care and treatment of people with chronic health conditions such as diabetes. For example, the percentage of patients with diabetes, on the register, who have had influenza was 98% compared to a national average of 94.4%.

• Patients with long term conditions could make pre-bookable appointments with the practice nurses. Longer appointments and home visits were available for patients with long term conditions when these were required.

• The practice contacted patients following admission to hospital to check if they required any services from the practice.

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

Updated 6 May 2016

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 who were at risk, for example, children and young people who had a high number of A&E attendances.

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

• Child surveillance clinics were provided for 6-8 week olds and immunisation rates were comparable to the national average for all standard childhood immunisations. The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report any concerns they had identified to relevant professionals.

• 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 89.6% which was comparable to the national average of 81.8%.

• Appointments were available outside of school hours. The practice had run tours and information giving sessions for children from the primary school located nearby.

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

Updated 6 May 2016

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.The practice provided a range of enhanced services, for example, the provision of care plans for patients over the age of 75 and screening patients for dementia.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or better than local and national averages. Screening uptake for bowel cancer and breast cancer were considerably higher than local and national averages.

• The practice contacted patients following admission to hospital to check if they required any services from the practice.

• GPs carried out regular visits to local care homes to assess and review patient’s 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.

• A number of GPs held a special interest in elderly care including for those with complex conditions and one GP had a special interest in end of life care.

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

• The practice promoted healthy lifestyles and encouraged people to increase their participation in activities.

Updated 6 May 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• GPs contacted working patients outside of practice opening hours if they required this. The practice had adjusted the appointments system sufficiently to ensure the service was flexible to meet the needs of this group.

• The telephone consultation system was advantageous for some people in this group as they did not always have to attend the practice in person. Results of tests could be texted to patients if they preferred providing speedy information exchange.

• The practice offered a range of online services as well as a range of health promotion, NHS screening and health checks that reflected the needs for this age group. 

Updated 6 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were similar to or better than average. For example, data showed that 86.7% patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This compared to a national average of 84%.

• Practice staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs. An “in house” counsellor was available for patients who required support.

• The practice worked with multi-disciplinary professionals in the case management of people experiencing poor mental health, including those with dementia.

• A system was in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they took.

Updated 6 May 2016

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 was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available. The practice had undergone an assessment by the ‘Deaf support network’ to ensure the services provided met the needs of deaf people and those with hearing difficulties.

• The practice told us they had strong links with travelling community and they tailored the way they communicated with patients from the travelling community to ensure it was to best effect.

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