Alvanley Family Practice

Updated 12 September 2016

Alvanley Family Practice is part of the NHS Stockport Clinical Commissioning Group (CCG). Services are provided under a personal medical service (PMS) contract with NHS England. The practice is a partnership between two GPs. The practice has 4644 patients on their register.

Information published by Public Health England rates the level of deprivation within the practice population group as five on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The average male life expectancy in the practice geographical area is 78 years and is reflective of both the England and CCG averages. Female life expectancy is 81 years which is below the CCG and England average of 83 years.

The GP partners (one male and one female) are supported by two female salaried GPs and one long term locum GP. The practice employs a business manager, a practice nurse lead, a practice nurse, a senior receptionist, and range of administration staff covering reception and secretarial roles and two apprentices. The practice was recruiting a health care assistant.

The practice reception is open from 8.30am until 6.30pm Monday to Fridays with late night appointments available with GPs and practice nurses until 8pm on Mondays. GP and nurse appointments were offered from 8am on Monday, Tuesdays and Wednesdays and nurse appointments were also available from 8am on Fridays. The practice closed their telephone line on Wednesday afternoons and calls were routed to the Out of Hours provider Mastercall. Reception was open to patients who called in on Wednesdays and an afternoon surgery was available for planned routine appointments.

When the practice is closed patients are asked to contact NHS 111 for Out of Hours GP care.

The practice provides online access that allows patients to book appointments and order prescriptions.

The practice building is a modern building maintained by NHS Property Services. The practice is located on the first floor. There are also three other GP practices located on the first floor. Patients can access the first floor via the passenger lift. A hearing loop to assist people with hearing impairment is available. Limited car parking was available at the practice, but additional parking was available close by.

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Alvanley Family Practice on 10 August 2016. Overall the practice is rated as good.

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

• The newly formed management team had worked with the whole staff team to identify a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with staff and stakeholders and was regularly reviewed and discussed with staff. The practice values of respect, openness, accountability and reasonableness were driven by the management team and embraced by all practice staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. The practice had a strong commitment to supporting staff training and development.

• Feedback from patients about their care was consistently and strongly positive. Patients described the GPs and staff as caring and professional.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met people’s needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

We saw two areas of outstanding practice:

• The practice had been unsuccessful in getting volunteers for a patient participation group. As an alternative it had been successful in using social media as a communication strategy to engage with their patient population. The practice had established a Facebook page. This provided patients with an opportunity to keep themselves up to date and have their say about the service they received. The Facebook page had over 400 likes. Facebook statistical information identified that the practice responded to a Facebook posts typically within an hour.

• The practice had organised and facilitated new activities for their own patients such as Healthy Walks and a support and advice drop in centre at the practice (Healthy Stockport) for both their own patients and other patients living within the local community.

The areas where the provider should make improvement are:

• Establish a programme of regular clinical audit and re-audit or quality improvement.

• Develop practice policies for the duty of candour and safeguarding adults.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice’s performance was comparable to the Clinical Commissioning Group (CCG) and the England average in all five of the diabetes indicators outlined in the Quality and Outcomes Framework (QOF) for 2014-2015.

• Longer appointments and home visits were available when needed.

• Patients were referred to community support and education initiatives such as Xpert patient.

• The practice had organised and facilitated new activities for their own patients such as Healthy Walks and a support and advice drop in centre at the practice (Healthy Stockport) for both their own patients and other patients living within the local community.

Updated 12 September 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. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Data showed that the practice performed similar to the CCG and England average for the percentage of women aged 25-64 who had received a cervical screening test in the preceding five years with 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

Updated 12 September 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. For example a practice nurse visited housebound and vulnerable patients at home to review their needs and agree a care plan.

• Weekly visits to a local care home were undertaken by the same GP to promote continuity of care.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Regular Gold Standard Framework (GSF) or palliative care meetings were held and community health care professionals attended these. GSF is a systematic, evidence based approach to optimising care for all patients approaching the end of life.

Updated 12 September 2016

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 offered early morning appointments from 8am for GP and nurse appointments three mornings per week and late night appointments once a week until 8pm.

• Arrangements were also in place for patients to attend the local Out of Hours provider for routine appointments at weekends.

• The practice was one of the pilot sites for Stepping Hill hospital whereby a blood samples obtained in later afternoon were collected at 7.45pm. This meant people who worked could arrange to have their bloods taken later in the afternoon.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Online consultations were available (through Skype) if a patient preferred this.

Updated 12 September 2016

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

• Data from 2014-15 showed that 94% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the Clinical Commissioning Group average of 87% and the England average of 84%.

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months which reflected local and the England average.

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

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 12 September 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 including those with a learning disability.

• One GP visited patients living in supported accommodation for people with a learning disability and complex health needs to ensure continuity of care.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.