Archived: Hulme Hall Medical Group Cheadle Hulme Also known as Dr A M Shipston & Partners

Updated 23 January 2017

Hulme Hall Medical Group is part of NHS Stockport Clinical Commissioning Group (CCG) and provides services to a patient population of 11025. Hulme Hall Medical Group is registered with the CQC at two locations Handforth and Cheadle Hulme. However, the practice patient population is on one register, so that patients can potentially attend appointments at either location.

Two inspections of both locations have been undertaken at Hulme Hall Medical Group Handforth 166 Wilmslow Road, Wilmslow Cheshire SK9 3LF on 14 December 2016 and Hulme Hall Medical Group Cheadle Hulme, Cheadle Hulme Heath Centre, Cheadle Stockport, SK8 6LU on 15 December 2016. Services provided at both locations are provided under one personal medical service (PMS) contract. Therefore, data referred to in both reports including the Quality and Outcomes Framework (QOF) and GP Patient Survey results are the same. The two locations are situated about 2.5 miles apart.

All staff including GPs, nursing staff, the management team and administrative staff work at both locations flexibly to ensure patients are supported appropriately at both registered locations.

The practice is a registered partnership between three female GPs and two male GPs.

Staff include one male and one female salaried GP, two practice nurses, one trainees assistant practitioner, one health care assistant, one phlebotomist, one practice manager, one assistant practice manager, a pharmacist, an IT lead, a clinical data lead and 19 medical administrators. The practice is a training practice for foundation year two doctors and year three GP trainees.

Information published by Public Health England rates the level of deprivation within the practice population group as nine on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male and female life expectancy at 81 and 85 years respectively in the practice geographical area is higher than the England and CCG averages of 79 and 83 years.

The practice’s patient population has a similar rate of long standing health conditions at 54% compared to 53% locally and 54% nationally. The percentage of people living in the localities in paid work or full time education at 51% is lower than the regional and national average of 62%.

Hulme Hall Medical Group Handforth GP surgery is located in a large Victorian semi-detached house which has been adapted to assist patients with mobility issues. There is a small car park at the side of the building. All consultation rooms are on the ground floor.

Hulme Hall Medical Group Cheadle Hulme is located within a NHS property service health centre. Another GP practice is also located within the building. The building provides seven consultation rooms all with ground level access, which is suitable for people with mobility issues. Limited car parking is available at the practice.

The practice reception desk based at Cheadle Hulme is open from 8am until 6.30pm Monday to Friday. Patients can access appointments for both registered locations (Handforth and Cheadle Hulme) with one telephone number and they can also choose which GP surgery they prefer to attend.

Appointments are available at the Handforth location from 8 am Monday to Thursday and from 7am on Fridays. Later evening appointments are available on Mondays until 8pm and Tuesday until 7.30pm. Wednesday to Friday appointments are available until 6.30pm. Extended hours appointments are available with the GPs, practice nurses and health care assistants.

Appointments are available at the Cheadle Hulme location Monday to Friday from 8am until 6.30pm. The practice is open one Saturday each month and the location alternates between surgeries. Telephone appointments are also available.

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 access their medical records, book appointments with GPs and practice nurses and order prescriptions.

Updated 23 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at on 15 December 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make urgent appointments when needed but some patients expressed dissatisfaction that they had to wait up to two weeks for a routine appointment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice had a patient participation group (PPG). Feedback from members of the PPG indicated that communication between the practice and the group was infrequent.
• The practice responded to both written and verbal complaints, appropriate records were maintained and improvements implemented as a result.
• Evidence was available that demonstrated the practice complied with the Duty of Candour requirement.

We saw one area of outstanding practice:

• The practice was proactive in promoting the online patient access to full medical records and had been awarded NHS England Beacon status for this work. The practice had consulted with their patient participation group in 2015 and developed a patient consent form to agree to online access. We heard that the consent form had been adopted by number of other clinical commissioning groups. 46% of the practice’s patient list was registered for online access with approximately 280 patients registered for full access to their records.

The areas where the provider should make improvement are:

• Establish a rolling programme of regular clinical audit and re-audit.
• Continue to review patient access to routine appointments.
• Continue to review and develop the practice’s patient participation group by facilitating access for those who do not have access to IT or have no wish to use IT.
• Provide opportunities for members of the patient participation group to become more actively involved in the development of the practice by improving communication channels.

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 achieved higher percentages for the diabetes indicators outlined in the Quality and Outcomes Framework (QOF) for 2015/16 when compared to local and national averages.
• The practice encouraged patients to self refer to education programmes for the management of diabetes and other long term conditions.
• Longer appointments and home visits were available when needed.
• The practice had introduced two new software programmes, one to ensure that patients with a chronic health condition were recalled within appropriate timescales and the second programme was used to identify patients who had not been coded has a having a long term condition and therefore were being missed from the patient recall system. 
• All patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. 

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 who were at risk, for example, children and young people who had a high number of A&E attendances.
• The practice held regular meetings to review patients considered at risk or with a child protection plan in place.
• Immunisation rates were comparable to the Clinical Commissioning Group (CCG) rates 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. Systems were in place to safeguard young adults confidentiality.
• Quality and Outcome Framework (QOF) 2015/16 data showed that 76% of patients with asthma on the register had an asthma review in the preceding 12 months compared to the CCG and England average of 75%.
• The practice’s uptake for the cervical screening programme was 82%, which reflected the CCG and the national average.
• The practice provided a comprehensive contraceptive and post-natal service. 

Updated 23 January 2017

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.
• It was responsive to the needs of older people, and offered a mixture of pre-bookable, on the day urgent appointments and telephone appointments.
• Home visits were available for those with enhanced needs. The practice pharmacist also visited house bound patients to discuss prescribed medicines.
• Planned weekly visits to a local care homes were undertaken by the GPs. This provided continuity of care.
• The practice met regularly with the neighbourhood multidisciplinary team including the advanced nurse practitioner to discuss the complex care needs of patients. Regular palliative care meetings were held with the district nurses and Macmillan nurses.
• Patients over the age of 70 were sent a questionnaire about their health and wellbeing. This was returned to Age UK who could offer support to older patients based on their individual needs. However the practice did not have any data to indicate how effective this was in supporting patients.

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.
• The practice offered flexible surgery times including two later evening appointments until 8pm on Mondays and 7.30pm on Tuesdays and from 7am on Fridays. The practice was also open one Saturday per month. Telephone appointments were also available.
• The practice was proactive in promoting and offering online services such as full patient record access, booking appointments and ordering prescriptions.
• The practice website also offered information on health promotion and screening.

Updated 23 January 2017

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

• Data from 2015/16 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 better than the Clinical Commissioning Group (CCG) average of 85% and the England average of 84%.
• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months, which was slightly lower than the CCG average of 92% and similar to the England average of 89%.
• Data supplied by the practice showed their performance in undertaking a review within 10-56 days after a diagnosis of depression was 84% compared to the CCG average of 71% and England average of 65%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• 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.

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 including those with a learning disability.
• The practice offered longer appointments for patients who were vulnerable and those 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.