Heald Green Health Centre 1 Also known as Dr Dean & Partners

Updated 14 February 2017

Heald Green Health Centre 1 is located in Heald Green, Cheadle, Cheshire. The practice was providing a service to approximately 6,350 patients at the time of our inspection.

The practice is part of Stockport Clinical Commissioning Group (CCG). The practice is situated in an area with low levels of deprivation when compared to other practices nationally. The percentage of patients with a long standing health condition is 47% which is lower than the national average of 54%. The practice has a higher than average elderly population with 36% of patients over the age of 65 compared to the national average of 27%.

The practice is run by five GP partners (one male and four female). There are two practice nurses, three health care assistants, a business manager, an operations manager and a team of reception/administration staff.

The practice is open from 7am to 7.30pm on Mondays, Tuesdays and Thursdays, 8am to 7.30pm on Wednesdays and 8am to 6.30pm on Fridays. The practice is also open one in every four Saturdays from 9am to 11am.

When the surgery is closed patients are directed to the GP out of hours service provider ‘Mastercall’ by contacting NHS 111.

The practice is a training practice for trainee GPs. At the time of the inspection the practice was supporting medical students.

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations up to four weeks in advance, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice provides a range of enhanced services, for example: extended hours, childhood vaccination and immunisation schemes, checks for patients who have a learning disability and avoiding unplanned hospital admissions.

Updated 14 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heald Green Health Centre 1 on 14 December 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 good and there were regular checks on the environment and on equipment used. However, the system in place for managing safety alerts required review as there was no overview to demonstrate/ensure that all alerts had been acted on appropriately.

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

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

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

• The appointments system provided a range of appointments to meet patients’ needs including urgent and on the day appointments. Feedback from some patients was that they had difficulty getting through to the practice by phone and that they sometimes waited too long for a routine 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.

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

• There was a clear leadership and staff structure. Staff understood their roles and responsibilities. However, some staff told us their roles were more challenging as a result of working across two practices.

• 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).

Areas where the provider should make improvements:

• Review the system for managing safety alerts to ensure an overview of actions taken.

• Improve procedures for the storage of vaccines.

• Review the procedures for checking emergency medicines.

• Review the effectiveness of the telephone/call management system following completion of the installation of the system.

• Continue to monitor and review back office staffing arrangements in relation to the role of staff working across two practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 February 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 regular checks received these.

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

• Data from 2015 to 2016 showed the practice was performing similar to or better than other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. The provider told us they had already achieved the previous years achievement for diabetes related indicators.

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

• Longer appointments and home visits were available for patients with long term conditions when these were required.

• Patients with multiple long term conditions could be offered a single appointment to avoid multiple visits to the surgery.

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

Updated 14 February 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.

• A regular safeguarding meeting was held with health visitors to discuss child protection concerns.

• 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.

• Immunisation rates were comparable to 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 a practice nurse told us they reported any concerns to relevant professionals.

• Babies and young children were offered an appointment as 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 and contraceptive services were provided.

Updated 14 February 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 had a higher than average number of older people in its population. Up to date registers of patients with a range of health conditions (including conditions common in older people) were maintained and these were used 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 or better than local and national averages.

• The practice provided an enhanced service to prevent high risk patients from unplanned hospital admissions. This included these patients having a care plan detailing the care and treatment they required.

• The GPs carried out regular visits to a local care home 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.

• The practice used an electronic palliative care co-ordination system known locally as EPAC (End of life Portal for Anticipatory Care) to share key information about patients receiving end of life care with other agencies to promote more joined up working and better co-ordination of care and treatment.

• The practice had a GP lead for end of life care.

• Regular multi-disciplinary meetings were held to discuss the care and treatment provided to patients with complex needs.

Updated 14 February 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.

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

• The practice provided extended hours appointments four evenings per week and on Saturdays mornings once every four weeks.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group. Screening uptake for people in this age range was comparable to national averages. For example, 73% of females aged 50-70 had been screened for breast cancer in the last three years compared to a national average of 72%.

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

Updated 14 February 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 at least an annual review of their physical and mental health. So far this year 45 of the 47 patients on this register had undergone a review.

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

• The practice regularly worked with multi-disciplinary teams including in the case management of patients experiencing poor mental health.

• 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.

• Processes 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.

• The GPs carried out at least weekly visits to a care home for people living with dementia and care planning was carried out to support these patients.

Updated 14 February 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.

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

• Staff knew how to recognise signs of abuse in vulnerable adults and children. 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 such as a hearing loop system (used to support patients who wear a hearing aid) was available.

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

• Some information had been produced in an easy read format.

• The practice supported patients residing in two residential care homes for younger adults. We saw some very positive feedback about the effectiveness of this and of the working relationships between the practice and the care provider.