Causeway Medical Centre

Updated 3 September 2016

Causeway Medical Centre is located at 166-170 Wilderspool Causeway, Warrington, Cheshire, WA4 6QA. The practice also has a branch surgery located at: Great Sankey Health Centre, Hood Manor Centre, Great Sankey, Warrington, WA5 1UH.

The practice was providing a service to approximately 7000 patients at the time of our inspection. The practice is situated in an area with average levels of deprivation when compared to other practices nationally. The number of patients with a long standing health conditions is comparable with the national average.

The practice is run by two GP partners. There are two practice nurses, one health care assistant, a practice manager and a team of reception/administration staff. The practice is open at both sites from 8.00am to 6.30pm Monday to Friday. The practice had signed up to providing longer surgery hours as part of the Government agenda to encourage greater patient access to GP services. As a result patients could access a GP at another surgery from 6.30pm until 8.00pm Monday to Friday and between 8.00am to 8.00pm Saturdays and Sundays. Outside of practice hours patients can access the Bridgewater Trust for 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 3 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Causeway Medical Centre on 6 January 2016. The practice has a branch surgery at the address: Great Sankey Health Centre, Hood Manor Centre, Great Sankey, Warrington, WA5 1UH. We visited the branch surgery as part of the inspection. Overall the practice is rated as good.

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

• 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.

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

• Patients felt informed about their health conditions and the treatment options available to them.

• The practice was proactive in identifying and supporting patients to prevent common health conditions.

• There were systems in place to reduce risks to patient safety for example, infection control procedures.

• Patients found it easy to make an appointment and there was good continuity of care.

• The practice provided appropriate facilities for disabled patients and was equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff understood their roles and responsibilities.

• The practice proactively sought feedback from patients and acted upon it.

• Complaints were investigated and responded to appropriately.

• The practice learned from events and complaints and used this learning to improve the service.

• The practice made good use of audits, the results of which were used to improve outcomes for patients.

The areas where the provider should make improvement are:

• Review clinical staffing, in particular nursing, to ensure that this is sufficient to meet patient needs.

We saw one area of outstanding practice:

• The practice worked proactively to identify patients at risk of developing health conditions and referred /signposted patients for advice and support on preventative care. The practice had recently started working with a local primary school to promote health matters such as immunisation, to encourage children to attend drop in sessions at the practice and to provide information and messages about health matters on the school newsletter.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 September 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. The practice nurse had the lead role in chronic (long term) disease management. Patients with long term conditions were invited to attend reviews to check that their health and medication needs were being met. Patients were sent follow up letters to attend for health checks if they failed to attend their original appointment. Data from 2014 to 2015 showed that the practice was comparable with other practices for the care and treatment of people with chronic health conditions such as diabetes. The practice worked proactively to identify patients at risk of developing health conditions and referred /signposted patients for advice and support on preventative care. Longer appointments and home visits were available when needed. The GPs attended regular multi-disciplinary meetings to discuss patients with complex needs. The practice worked to avoid unplanned hospital admissions for patients.

Updated 3 September 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, alerts on medical records identified children at risk. Staff shared information or concerns about patent’s welfare with health visitors or other relevant professionals when required. Appointments were available outside of school hours and children were given appointments at short notice. The premises were suitable for children and babies and baby changing facilities were provided. Immunisation rates were comparable with local CCG benchmarking for standard childhood immunisations. Immunisations could be provided without a pre-booked appointment to encourage uptake. The practice monitored any non-attendance of babies and children at vaccination clinics and reported any concerns identified. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding. A dedicated notice board provided information about child health and signposted people to support agencies offering advice and support to children and families. The practice offered appointments with an advanced paediatric nurse practitioner who had specialist training and experience in the diagnosis, care and treatment of ill children. This was provided as part of a locally agreed pilot with the Clinical Commissioning Group (CCG).  The pilot also included the services of a family nurse practitioner who role was to support families with health needs in the community. Family planning clinics were provided and a community midwife provided a weekly anti-natal clinic at the practice. The practice had recently started working with a local primary school to promote immunisations, to encourage children to attend drop in sessions at the branch practice and to include messages about health related matters on the school newsletter.

Updated 3 September 2016

The practice is rated as good for the care of older people. The practice offered proactive and personalised care and treatment to meet the needs of the older people in its population. Home visits and urgent appointments were provided for those with enhanced needs. The appointments system was responsive to ensure frail patients who were at risk of an unplanned admission to hospital were spoken with and seen quickly. 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. GPs attended multi-disciplinary meetings to review the care and treatment provided to people living in residential care homes and to prevent unplanned hospital admissions. The practice worked in collaboration with other local practices to share resources and meet the needs of patients in care homes across the local area. As part of this one of the GPs remained the named GP for a specific care home but they saw other patients as part of an agreement with a cluster of practices. The practice provided enhanced services for older people. The practice maintained a register of patients over 75 years of age and those patients had a named GP and were offered an annual health check and shingles vaccination.

Updated 3 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students) . The practice offered appointments that were accessible, flexible and offered continuity of care for people in this group. Late appointments and telephone consultations were available. The practice offered an online repeat prescription request service and appointment booking service which provided flexibility to working patients and those in full time education. The use of an electronic prescription service enabled patients to collect medication in the most convenient location. A range of health promotion information and screening that reflected the needs for this age group was available to patients.

Updated 3 September 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Data about how people with mental health needs were supported showed that outcomes for patients using this practice were comparable to other practices locally and nationally. The practice provided an enhanced service for screening patients to identify patients at risk of dementia and to develop care plans with them. The GPs referred patients to a memory clinic if this was appropriate. Data showed that patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. Reception staff had been provided with training to assist them in supporting patients with dementia. Staff were knowledgeable about obtaining consent and supporting patients who lacked capacity. The practice was aware of people who were subject to restrictions under the Mental Health Act. Patients experiencing poor mental health were provided with information about how to access support groups and voluntary organisations and a counselling service was hosted at the practice. Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they took and patients who did not attend were sent follow up reminders.

Updated 3 September 2016

The practice is rated as good for the care of people whose circumstances make them vulnerable. The practice held a register of patients living in vulnerable circumstances. This enabled them to tailor the service to meet patient need. For example, a register of people who had a learning disability was maintained and this ensured patients who were learning disabled had the opportunity of an annual health check and were offered longer appointments if required. Vulnerable patients were provided with advice and support about how to access a range of support groups and voluntary organisations. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies. Staff shared examples with us of how they had responded to concerns about patients’ welfare. Interpreter services were available for patients who required this. The practice had good links with a local drug abuse service, patients were supported with managed withdrawal plans and the practice hosted a regular clinic for people who required support with substance misuse. The practice had named members of staff who were ‘patient champions’. These were designated to provide extra advice and support or to signpost patients to support agencies. There were patient champions for different groups of patients including: military veterans, new parents and carers. The practice also hosted a Citizens Advice Bureau drop in session on a regular basis.