Fearnhead Cross Medical Centre

Updated 11 November 2016

Fearnhead Cross Medical Centre is located in, Warrington, Cheshire. The practice was providing a service to approximately 14,160 patients at the time of our inspection.

The practice is part of Warrington Commissioning Group (CCG) and is situated in an area with higher than average levels of deprivation. The number of patients with a long standing health condition is 59% which is higher than the national average of 54%.

The practice is run by six GP partners. There are an additional two salaried GPs (six male and two female). There are three practice nurses, two nurse clinicians, two health care assistants, a practice manager and a team of reception/administration staff. The practice is open from 8am to 6.30pm Monday to Friday with extended opening hours until 9.15pm on Wednesdays. Patients could also access a GP at a Health and Wellbeing Centre in the centre of Warrington from 6.30pm until 8pm Monday to Friday and Saturday mornings by pre-booked appointment. Outside of practice opening hours patients can access the Bridgewater Trust for primary medical services.

The practice provides placements for medical students and mentoring for student nurses.

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

The practice has a Personal Medical Services (PMS) contract. 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 11 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fearnhead Cross Medical Centre on 31 August 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, there were regular checks on infection control practices, the environment and on equipment used.

• 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.

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

• Staff felt well supported and they were kept up to date with appropriate training. Staff we spoke with told us they had the skills, knowledge and experience to fulfil their roles and responsibilities.

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

• Overall, patients told us they could get an appointment when they needed one though some felt they waited too long to be seen as a result of appointments over running. Urgent appointments were available the same day and routine appointments could be booked in advance.

• The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

• Complaints had been investigated and responded to in a timely manner although improvements were required to the way in which patients were informed about the complaints process.

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

• 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).

Areas where the provider should make improvement are:

• Review the complaints process to ensure patients are provided with appropriately detailed information about how they can make a complaint and what action they can take if they are not satisfied with the outcome of a complaint.

• Develop a programme of clinical audit linked to national benchmarking, best practice guidance or research in order to drive improvements in outcomes for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 November 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.

• Regular, structured health reviews were carried out for patients with long term conditions.

• Clinicians held lead roles in chronic diseases.

• Nurses held qualifications in supporting patients with long term conditions.

• Bespoke templates were used within the clinical system to ensure patients were assessed in line with best practice guidance.

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

• Drop in clinics were provided for flu vaccinations and Saturdays flu clinics were provided.

• The practice provided an enhanced service to prevent high risk patients from unplanned hospital admissions. This included these patients having a care plan, a review of their medicines, a named GP and access to an alternative phone number for more immediate access to the practice.

• Patients were provided with advice and guidance about health prevention and the management of their conditions and were signposted to support services.

• A dietician attended the practice twice per month.

Updated 11 November 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 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.

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

• A baby and children’s notice board was available to provide information for parents.

• A weekly antenatal clinic was provided.

• Child surveillance clinics were provided for 6-8 week olds and immunisation rates were comparable to the national average for all standard childhood immunisations.

• Opportunistic immunisations were provided to encourage uptake. 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.

• 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.

• The practice worked with the local community PART (Paediatric Acute Response Team) and CREST (Community Respiratory Team) to monitor unwell children at home.

• Family planning services were provided.

• Cervical screening was provided and the percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 77% which was comparable to the national average of 81%.

Updated 11 November 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.

• Patients with multiple conditions were reviewed in one appointment when possible.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar comparable to local and national averages.

• The practice provided a range of enhanced services, for example, the provision of care plans to prevent an unplanned hospital admissions for those patients most at risk. A dedicated telephone number and same day access was also provided for patients at risk.

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

• Home visits and urgent appointments were provided for elderly 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.

• One GP had a special interest in intermediate care.

• Staff worked closely with community teams such as the district nursing team to co-ordinate the care provided to older patients.

Updated 11 November 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.

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

• The practice offered a nurse led telephone advice line and nurse led minor ailments clinic.

• The practice provided extended hours appointments one evening per week until 9.15pm.

• The practice was part of a cluster of practices whose patients could access appointments at a local Health and Wellbeing Centre up until 8pm Monday to Friday and Saturday mornings by a pre-booked appointment system.

• A Saturday flu clinic was provided.

• 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 but lower than national averages. For example 65% 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 request for repeat prescriptions. Electronic prescribing was also provided.

Updated 11 November 2016

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.

• The practice had a designated lead for mental health.

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were comparable to local and national averages.  

• One of the GPs made direct contact with patients registered with mental health concerns to ensure they attended for health reviews. This resulted in the vast majority of these patients having undergone a review of their health.

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

• The practice took part in a shared care agreement with a local psychiatric hospital.

• The practice worked with other health and social care professionals in the case management of people experiencing poor mental health, including those with dementia.

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

• 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.

• The practice hosted a psychotherapy service and patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

Updated 11 November 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.

• The practice had a GP lead and nurse lead assigned to patients with a learning disability.

• Staff were aware of their responsibilities to recognise adult abuse, for information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• Vulnerable or at risk patients were discussed at weekly clinical meetings.

• 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.

• Reception staff had been provided with training in improving communication with patients who were deaf or had hearing difficulties.

• Patients who had any potential communication difficulties had been identified and contacted about their preferred method of communication.

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