Heaton Norris Medical Practice Also known as Dr Marshall & Partners

Updated 21 December 2016

Heaton Norris Health Centre 1 Dr Marshall and partners, Heaton Norris Health Centre

Cheviot Close, Heaton Norris, Stockport, SK4 1JX is part of the NHS Stockport Clinical Commissioning Group (CCG). Services are provided under a general medical services (GMS) contract with NHS England. The practice confirmed they had 6670 patients on their register.

The practice is a registered partnership between three female GPs and one male GP. The practice employs two salaried GPs, a pharmacist, a practice manager, a reception manager, two practice nurses and one health care assistant as well as reception and admin staff. The practice is a training practice for undergraduate medical students.

Information published by Public Health England rates the level of deprivation within the practice population group as three 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 (76 and 81 years respectively) in the practice geographical area is below the England and CCG averages of 79 and 83 years.

The practice’s patient population has a higher rate of long standing health conditions (62% compared to 53% locally and 54% nationally) and there is a significantly higher rate of unemployment at 19% compared to 5% locally and nationally.

The practice is located within a NHS property service health centre. The district nursing and health visitors’ teams, podiatry, physiotherapy and continence service are located within the building. There is also one independent pharmacy. The community midwives team run a weekly antenatal clinic at the practice and a blood anti-coagulation clinic is held at the centre each week. The building provides six consultations rooms all with ground level access, which is suitable for people with mobility issues. Car parking is available across from the practice and local shops are available close by.

The practice reception is open from 8.00am until 8pm on Monday and includes extended access to GP appointments. The reception is open Tuesday to Friday from 8.30am to 6.30pm. The practice opens two Saturday mornings per month (2nd and 3rd Saturday) from between 8am until 1pm and offers both GP and practice nurse appointments. 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 book and cancel appointments and order prescriptions.

Updated 21 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heaton Norris Health Centre 1(Dr Marshall and partners) on 23 November 2016. Overall the practice is rated as good.

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

• The practice had 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 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 implemented suggestions for improvements and made changes to the way it delivered services as a direct response to feedback from patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• Evidence was available that demonstrated the practice complied with the Duty of Candour requirement.

We saw some areas of outstanding practice:

• The practice nurse, working with the health visitors delivered a talk every six to eight weeks to new mums at the local Sure Start children’s centre to emphasise the importance and benefits of baby and young children’s immunisations and vaccinations. The practice uptake was comparable to the CCG.
• The practice had recognised that patients living locally lived in an area of high deprivation and that some patients were unable to buy food. To support their patients the practice had established working relationships with the local food banks to provide patients with food vouchers to use at the food banks. The practice provided this support discreetly, recognising the potential loss of dignity patients might feel.

The areas where the provider should make improvement are:

• Strengthen existing arrangements for the security of prescriptions to fully reflect the NHS Security of prescription forms guidance.
• Establish a rolling programme of regular clinical audit and re-audit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 December 2016

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

• The practice performed similarly to the local and national averages in the diabetes indicators outlined in the Quality and Outcomes Framework (QOF) for 2015/16.
• The practice encouraged patients to self refer to education programmes for the management of diabetes and other long term conditions.
• The practice pharmacist supported the clinical team to ensure medicine reviews were undertaken and monitored the dosage of prescribed medicines to ensure patients received the optimal clinical dosage.
• Longer appointments and home visits were available when needed.
• 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 21 December 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.
• 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. To encourage uptake a practice nurse delivered a talk, every six to eight weeks to new mums at the local Sure Start children’s centre to emphasise the importance and benefits of baby and young children’s immunisations and vaccinations. The practice held children’s flu parties to encourage uptake of the flu vaccine.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Quality and Outcome Framework (QOF) 2015/16 data showed that 73% 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 73%, which was below the CCG and the national average of 81%. The practice had recognised they needed to improve the uptake of this screening and had implemented a plan to target 25 year old women by holding an educational evening to raise awareness of the importance of this screening.

Updated 21 December 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.
• 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 also provided continuity of care to an intermediate care unit four days per week.
• 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.
• Data from the practice showed that the results of their flu campaign for 2015 for over 65 year old reflected the national average of 71%.

Updated 21 December 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 flexible surgery times including later evening appointments until 8pm on Mondays and two Saturday mornings each month. Telephone consultations were also available.
• The practice was proactive in offering online services such as booking and cancelling appointments and ordering prescriptions.
• The practice website also offered information on health promotion and screening.

Updated 21 December 2016

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 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, reflected the Clinical Commissioning Group (CCG) of 85% and the England average of 84%.
• 84% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months, which was lower than the CCG average of 92% and the England average of 89%.
• 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 21 December 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.
• 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.
• The practice had recognised that patients living locally lived in an area of high deprivation and that some patients were unable to buy food. To support their patients the practice had established working relationships with the local food banks to provide patient with food vouchers to use at the food banks. The practice provided this support discreetly, recognising the potential loss of dignity patients might feel. There were four food banks locally.
• 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.