Merepark Medical Centre

Updated 4 January 2017

Merepark Medical Centre is registered with the Care Quality Commission to provide primary care services. The practice provides GP services for approximately 5,817 patients living in Alsager and the surrounding rural area. The practice is sited in a purpose built premises, co-located with another GP practice, a pharmacy and other community services. The practice has four female GPs, two male GPs, three nurses, two health care assistants, administration and reception staff and a practice management team. Merepark Medical Centre holds a General Medical Services (GMS) contract with NHS England.

The practice is open Monday to Friday 8.30am to 6.30pm.

Open surgeries are held every weekday between 9am and 12pm.

Early morning appointments are available between 7am and 8am on Tuesdays and Thursdays.

A Saturday morning surgery is held once a month between 9am and 2pm.

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

The practice is part of South Cheshire Clinical Commissioning Group (CCG) and is situated in a more affluent area in Alsager. The practice population is made up of population groups older than the national averages. For example, 21% of people are over 65 years compared to a national average of 17%. Fifty two per cent of the patient population has a long standing health condition which is lower than the CCG and national averages. Life expectancy for both males and females is around the CCG and national average of 79 years for males and 83 years for females.

The practice does not provide out of hours services. When the surgery is closed patients are directed to the local GP out of hours service and NHS 111. Information regarding out of hours services was displayed on the website, on the practice answering machine and in the practice information leaflet.

Updated 4 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Merepark Medical Centre on 8 November 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.

• Infection control procedures were in place.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Staff had been trained to deal with medical emergencies and emergency medicines and equipment were available.

• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear approach to working with others to improve care outcomes with a clear strategy and objectives including engaging with other key partners in providing health services.
• There was a clear leadership structure and staff were well supported by the GP partners.

• Staff were supervised, felt involved and worked as a team.

• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had conducted repeated patient surveys facilitated by the patient participation group (PPG) to continually review the service it provided. This had resulted in the establishment of “open” surgeries carried out daily between 9am and 12pm, the re-introduction of cryotherapy clinics and the extension of appointment times from 10 to 12 minutes.

There were areas of practice where the provider should make improvements, these were:

• Review the management of equipment checks to make it clear that all clinical and electrical equipment is appropriately marked and recorded.

• Review how the results of investigations conducted following safety alerts are recorded.

• Ensure practice polices are reviewed in a timely manner and review the need for a lone worker policy.

• Review the location of the emergency drugs cupboard and the procedure for checking medicines and equipment contained within it.

• Review the recruitment policy/procedure to ensure medical fitness declarations are included when recruiting new staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 January 2017

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

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

• Data from the 2014/2015 QOF performance showed the practice achieved 98% of the total points available for all performance indicators. This was above the CCG and national average. For example:

  The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less (01/04/2014 to 31/03/2015) Comparable to other practices 87.71% was above the CCG average of 82% and the national average of 81%.

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

• All these patients were monitored and had a structured annual review to check their health and medicines needs were being met.

• Medical records for vulnerable patients with long term conditions were highlighted so that all staff knew their needs and arranged appointments and care accordingly.

Updated 4 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.

• Immunisation rates were good for all standard childhood immunisations with immunisations uptake for all children aged five and under at 98%.

• 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.

• Unwell children were always offered same day/urgent appointments.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in target period was 77% (CCG average being 75%, national average being 74%).

• Appointments were available outside of school hours and could be managed online and via app. There was also a practice Facebook page providing information via social media.

Updated 4 January 2017

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

The practice had an elderly population above the national and local clinical commissioning group (CCG) average number of elderly patients with 21% over the age of 65 (national average 17%). Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in avoiding unplanned hospital admissions, dementia, and end of life care.

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

• The practice made scheduled weekly rounds in local nursing homes, providing dedicated GP time and mentoring to staff to each home.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were good. For example the percentage of patients with hypertension in whom the last blood pressure reading was 150/90mmHg or less was 85% and above the CCG and national average. Whilst the percentage of patients with atrial fibrillation treated with anticoagulation or anti platelet therapy was 100% and higher than the CCG and national average.

• All the older patients had a named GP who coordinated their care and contacted patients over 75 following discharge from an unplanned hospital admission.

Updated 4 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 online bookings of appointments and prescription requests and telephone consultations. Appointments could be pre booked or booked on the day and emergency appointments were also available daily for those in need and children. There were daily “open” surgeries which had proved popular with the patients.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group for example NHS health checks for those aged 40 to 75 years old.

Updated 4 January 2017

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

• Staff at the practice had undertaken dementia friend training and the practice had installed signage which were dementia friendly.

• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months which was  comparable to the national average of 88% and CCG average of 92%.

• 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 told patients experiencing poor mental health about how to access various support groups and voluntary organisations and could signpost to relevant specialist services.

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

Updated 4 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 substance or alcohol misuse and those with a learning disability. Alerts on medical records identified when a patient was vulnerable or was living in vulnerable circumstances.

• The practice had 15 patients with a learning disability registered and offered longer appointments for these. We saw good examples of where care was personalised to the individual needs.

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

• The practice worked with and 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.