Archived: Culcheth Medical Centre

Updated 16 July 2015

Culcheth Medical Centre is registered with the Care Quality Commission to provide primary care services. It provides GP services for approximately 6969 patients living in the Warrington area. The practice has five GPs both male and female, a practice manager with supportive management team, two practice nurses, a phlebotomist, administration and reception staff. Culcheth Medical Centre holds a Personal Medical Services (GMS) contract with NHS England.

The practice opening hours are Monday to Friday from 08.00 to 6.00 most days. Early morning and late evening sessions are also available on set days, these are reserved and pre bookable. The practice treats patients of all ages and provides a range of primary medical services. Outside of these hours the practice will divert patients that phone the practice to the out of hour’s service commissioned by Warrington CCG.

The practice is part of NHS Warrington Clinical Commissioning Group (CCG) and is situated in an area with lowerdeprivation. The practice population has a higher than national average patient group aged 65 years and over. There are lower deprivation scores for patients in this area compared to national figures.

Updated 16 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Culcheth Medical Centre on 20 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for all the population groups it serves.

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

• Systems were in place to ensure incidents and significant events were identified, investigated and reported. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered in line with best practice guidance. Staff had received training appropriate for their roles and any further training needs had been identified and planned.
• Patients spoke highly about the practice and its staff. They 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available on the same day.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw several areas of outstanding practice including:

• The practice ensured patient experience played an important role in improving quality service delivery. The practices Patient Participation Group were an important part of this. The group undertook regular patient surveys and developed actions plans with the practice where negative comments were made. They held annual community events to raise the profile of the practice amongst the local community. They engaged local schools by inviting the young adults to their PPG meetings to gain their views on how services could be developed. Working with the practice the PPG had planned a local community event for this summer to specifically target those patients who are social isolated. The aim of this was to bring together older and more socially isolated patients to ensure they know the full range of services provided by the practice and to gain their views on how services could be improved.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should;

• Improve the current system for clinical audit to ensure full and completed audits are undertaken.
• Ensure doctors have emergency drugs available for use or have in place a risk assessment to support their decision not to have these available for use in a patient’s home.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 July 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice monitors unplanned admissions to hospital for patients with long term conditions. Any patients admitted to hospital were contacted within one week to assess if they require additional primary care support services. The practice had achieved full Quality results for the Outcomes Framework (QOF) relating to their management of Diabetes, Asthma, Coronary Obstructive Pulmonary Disease (COPD), Heart Disease, Heart Failure and Rheumatoid Arthritis in the last QOF year.

Updated 16 July 2015

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 just below the CCG average for most of the standard childhood immunisations. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. The practice undertakes a joint six week child assessment including the administration of childhood vaccines. Patient information sign posted young people to sexual health services in the area.

Updated 16 July 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly experienced by older people. All patients over 75 had a named, accountable GP. The practice was participating in the Warrington Health Plus Nursing Home project, which included two GPs spending one day per week focussing on the needs of nursing home patients. The aim of this was to prevent unplanned hospital admissions and to reduce daily GP visits to the homes. Community events were organised by the practice and their Patient Participation Group. Working with the practice the PPG had planned a local community event for this summer to specifically target those patients who are social isolated.

The practice had undertaken electronic searches of this population group, including identifying those patients who lived alone, who had caring responsibilities and who had been seen in the last 12 months. Older patients with chronic, complex medical conditions and social needs had their own community matron assigned to them, undertaking home visits as required. 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, offering flu vaccination and home visits if needed.

Updated 16 July 2015

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 offers a range of appointment times for working people, from 8am on a Monday, and up to 7.30pm on a Tuesday and Wednesday. The practice was proactive in offering online and telephone services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 16 July 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Systems were in place to ensure people experiencing poor mental health had received an annual physical health check. This included identifying those patients on the practice register that may benefit from a dementia needs review. The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

The practice offered a full mental health support service for patients in partnership with neighbouring mental health trusts. Patients can self-refer for counselling for anxiety, stress and depression.

A number of patient information leaflets and posters were seen in the waiting area, sign posting patients to agencies that could provide support to the patient or their families.

Updated 16 July 2015

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 and annual health checks were carried out for this population group. Staff were knowledgeable about how to support patients with alcohol and drug addiction problems sign posting them to support services locally.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. 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.

The practice offered annual reviews to all patients who have a learning disability. Those patients who were in a nursing homes or were housebound were offered a home visit for full review.