Caritas General Practice Partnership Also known as Dial House Medical Centre

Updated 12 July 2017

Caritas General Practice Partnership also known as ‘Dial House Medical Centre’ is located in Stockport, Greater Manchester. The practice also has a branch surgery ‘Ellesmere Medical Centre’ located at: 262 Stockport Road, Cheadle Heath, Stockport SK3 0RQ. The practice was providing a service to approximately 13,330 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 lower than average levels of deprivation when compared to other practices nationally. The percent of the patient population with a long standing health condition is 49% which is lower than the nation average of 54%.

The practice is run by six GP partners. There are an additional four salaried GPs (two male and eight female). There are four practice nurses, four health care assistants, a practice manager and a team of reception/administration staff.

The practice is open at the main location from 8am to 6.30pm on Mondays, Tuesdays and Fridays and from 7am to 6.30pm on Wednesdays and Thursdays. The branch surgery is open from 8am to 6.30pm Mondays, Thursdays and Fridays and 7am to 6.30pm on Tuesdays and Wednesdays. The practice is open two Saturdays per month from 8am to 11am. When the surgery is closed patients are directed to the GP out of hour’s service provider ‘Mastercall’ by contacting NHS 111.

The practice is a training practice for trainee GPs and also hosts medical students.

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. An open surgery is also available and any patient who attends between 9.30am and 10.30am will be seen by one of three GPs. 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 immunisations, checks for patients who have a learning disability and avoiding unplanned hospital admissions.

Updated 12 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Caritas General Practice Partnership also known as ‘Dial House Medical Centre’ on 9 November 2016. At the inspection in November the overall rating for the practice was good, although the key question Safe was rated requires improvement. This was because a system to ensure appropriate action was taken in response to safety alerts was not in place. We also identified some areas where the practice could improve other aspects of the service they provided. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Caritas General Practice Partnership on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 14 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 9 November 2016. This report covers our findings in relation to that requirement and also additional improvements made by the practice since our last inspection.

The practice is now rated as good for providing safe services, and overall the practice is rated as good.

Our key findings were as follows:

• Since the previous inspection the practice had taken action to strengthen the arrangements in response to safety alerts. The practice had invested in a web based GP management system. This was used to log all alerts, with a description and record of the action status. This was supported by an annual GP partner allocation for the management and leadership of the alerts. Relevant issues identified were discussed with the staff team at regular clinical meetings.

In response to the areas we identified of where the practice should make improvements:

• The practice had reviewed its management of patients prescribed high risk medicines such as disease-modifying anti-rheumatic drugs (DMARDs). The practice improved its protocol to ensure a systematic and regular review of patients prescribed these medicines was undertaken.
• Systems to ensure staff had easy access to the variety of meetings minutes that staff attended had improved. Meeting minutes, patient safety alerts and significant events were were now accessible to staff through web based GP management system.
• The practice had ensured all staff who undertook chaperone duties were trained and had disclosure and barring checks (DBS).
• The practice had reviewed and updated its complaints procedure to include the details of NHS England, should patients wish to complain directly to them.

In addition, in response to our previous inspection report, the practice had reviewed its risk assessment in relation to not having a defibrillator available at the practice. Defibrillators were now available at both the main and the branch locations of practice.

The practice had also trained a staff member in additional duties so that they could continue with the referrals process in the absence of the practice secretary.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 January 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.

• Patients with a long term condition had a named GP and regular, structured health reviews were carried out for these patients.

• Data from 2015 to 2016 showed that the practice was performing comparably to other practices nationally for the care and treatment of people with chronic health conditions such as diabetes.

• Newly diagnosed diabetic patients were referred to a six session diabetes educational course. The practice provided insulin initiation for diabetic patients.

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

• Regular clinical meetings were held to review the clinical care and treatment provided and ensure this was in line with best practice guidance.

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

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

• The practice hosted a Macmillan nurse clinic to support patients with a diagnosis of cancer.

• A care co-ordinator contacted patients following discharge from hospital to check if they required any additional services.

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

• A range of information was provided to patients about specific health conditions and about support available locally. A file was located in reception with an A-Z of health information.

Updated 23 January 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 safeguarding 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 standard childhood immunisations. The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report 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.

• A number of designated notice boards were provided in the waiting area to differentiate information for women’s health and men’s health.

Updated 23 January 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.

• 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 comparable to those for patients locally and nationally.

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

• Home visits were provided to patients who could not visit the surgery.

• Longer appointments were provided for people with multiple conditions to reduce visits to the practice.

• GPs and practice nurses carried out regular visits to a local care home to assess and review patients’ needs and to prevent unplanned hospital admissions.

• A care co-ordinator liaised with community services to help co-ordinate patients’ care and support following discharge from hospital.

• 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.

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

Updated 23 January 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 three days per week and an early morning surgery two Saturdays per month.

• An open surgery was provided 9.30 to 10.30 each day Monday to Friday.

• Patients could also access appointments for health screening or chronic disease management at evenings and weekends provided by Stockport CCG’s out of hours provider ‘Mastercall’.

• The practice provided a 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.

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

Updated 23 January 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.

• A regular visit was provided to a care home for people with dementia to provide proactive care.

• Screening was carried out for patients at risk of dementia.

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

• The practice worked with multi-disciplinary professionals 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.

• Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations and a designated notice board provided information and advice for patients with mental health concerns.

Updated 23 January 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 health and social care professionals in the case management of vulnerable people.

• Staff were aware of their responsibilities to report safeguarding concerns for vulnerable adults 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 accessible facilities were provided.

• The practice provided open access for patients receiving support from a local alcohol and drug rehabilitation service.

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