Chelford Surgery

Updated 28 July 2016

Chelford Surgery is located in a rural setting in East Cheshire. Transport links are limited, with an hourly bus service to Knutsford 4.5 miles away, during the day. The practice occupies a purpose built two-storey building first opened in 1993, but has since been extended to cope with the increase in patient numbers and to better meet their needs. Limited parking is available on site; however on-road parking is available nearby. Disabled facilities are provided. There are five GPs working at the practice, one male and four female. Two GPs are partners, and the other GPs are salaried. There are two practice nurses, who are nurse prescribers and two health care assistants, all of whom are part-time. There is a full-time practice manager and a team of administrative staff including pharmacy dispensers.

The practice opening times are Monday to Friday 8am to 6.30pm. The practice appointment times are:

Monday 9am to 11.30am and 3.30pm to 5.30pm

Tuesday 8.30am to 11.30am and 3.30pm to 5pm

Wednesday 9.30am to 11.30am and 3.30pm to 5pm

Thursday 8.30am to 11.30am and 3pm to 5.30pm

Friday 9am to 11.30am and 4pm to 5.30pm

Patients requiring a GP outside of normal working hours are advised to call 111 and thereby access the Out of Hours service.

The practice is a GP teaching practice which means GP trainees and First Year doctors are able to undertake part of their training there.

There are 3,685 patients on the practice list. The majority of patients are white British with a high number of patients in the 65 and over range (47%) and the practice has the highest proportion of elderly patients within the CCG.

The practice also provides primary care services to the David Lewis Centre, which is a residential centre located close by, for people with epilepsy, a learning disability and behavioural problems.

Updated 28 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chelford Surgery on 31 May 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 although the storage of oxygen cylinders was considered to be a risk.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice worked well with its Patient Representative Group to better understand the needs of its patients
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review, and describe more clearly, the system in place to make sure all drugs taken on home visits are in date.

• Arrange for the safe storage (prevent them falling) of oxygen cylinders in the dispensary and for records to be kept of those cylinders being checked along with the defibrillator.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 July 2016

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.

• Performance for diabetes related indicators was better than the national average.

• Longer appointments and home visits were available when needed.

• All these 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.

• The practice employed staff who were trained in dispensing medication on-site, thereby enabling patients to have ease of access to their medication.

• There was an emphasis on educating and informing patients about how to look after themselves in order to maintain good health.

• Regular palliative care meetings were held to discuss patients with cancer and long term chronic conditions.

Updated 28 July 2016

The practice is rated as good for the care of families, children and young people.

• Immunisation rates were high for all standard childhood immunisations.

• 82% of patients with asthma, on the practice register, had had an asthma review in the preceding 12 months that included an assessment of asthma control using the 3 routine clinical practice (RCP) questions. This compared to a national average of 75%.

• 82% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compares to a national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• There was a dedicated child and adult safeguarding lead. Safeguarding training had been provided for practice staff.

• Childhood immunisations were undertaken and strongly encouraged by GP’s when carrying out six-week checks on babies.

Updated 28 July 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.

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

• Care plans and health checks were in place, with regular medicine reviews carried out.

• The building was accessible for patients who may have mobility problems.

• Patients with complex needs were discussed at multi-disciplinary team meetings to ensure their needs were met.

• Referrals to other services were regularly made, for example the dietetic service.

• The practice identified carers a nd offered services such as health checks and annual flu vaccinations and together with the PRG was aiming to improve the services to carers further.

Updated 28 July 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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs of this age group.

• Practice nurse and health care assistant appointments were available from 8am.

• Routine GP appointments were available to pre-book from 8.30am.

• NHS health checks were routinely encouraged.

• The practice was open from 8am to 6.30pm, which meant patients could collect prescriptions or book appointments during their lunch hour.

Updated 28 July 2016

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

• 100% of patients with schizophrenia, bipolar effective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This compares to a national average of 88%.

• 100% of patients diagnosed with dementia had had their care reviewed in a face-to-face review in the preceding 12 months. This compares to a national average of 84%.

• 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

Updated 28 July 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients 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.