Padgate Medical Centre

Updated 27 July 2016

Dr Reynolds & Partners Padgate Medical Centre is located in Padgate, Warrington, Cheshire WA2 0RX. The practice was providing a service to approximately 6,900 patients at the time of our inspection.

The practice is situated in an area with below average levels of deprivation when compared to other practices nationally. Fifty seven per cent of the patient population has a long standing health condition and this is slightly higher than the national average.

The practice is run by three GP partners. There is an additional salaried GP (two male and two female). There are three practice nurses one of whom is a nurse clinician, a practice manager and a team of reception/administration staff.

The practice is open from 8am to 8.15pm on Mondays and 8am to 6.30pm Tuesday to Friday. The practice also provided a branch surgery at Woolston Branch Surgery, Woolston Neighbourhood Hub Hall, Woolston, Warrington WA1 4PN. We visited the branch surgery as part of our inspection. The branch surgery is open 8.30am-5pm on Mondays, 8.30am-5.30pm Wednesdays and Fridays and 8.30am - 1pm on Tuesdays and Thursdays.

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 a Health and Wellbeing Centre in the centre of Warrington from 6.30pm until 8pm Monday to Friday, 8am to 8pm Saturday and Sunday mornings. This was by pre-booked appointment. Outside of practice hours patients can access the Bridgewater Trust for primary medical services.

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits.

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, and avoiding unplanned hospital admissions. The practice is a training practice for trainee GPs.

Updated 27 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Reynolds & Partners Padgate Medical Centre on 8 June 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Significant events had been investigated and action had been taken as a result of the learning from events.

• Systems were in place to deal with medical emergencies and all staff were trained in basic life support.

• There were systems in place to reduce risks to patient safety. For example, infection control practices were good and there were regular checks on the environment and on equipment used.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Feedback from patients about the care and treatment they received from clinicians was positive.

• Data showed that outcomes for patients at this practice were similar to outcomes for patients locally and nationally.

• Staff felt well supported and they were kept up to date with appropriate training. Staff we spoke with told us they had the skills, knowledge and experience to fulfil their roles and responsibilities.

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

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

• The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

• Information about services and how to complain was available. Complaints had been investigated and responded to in a timely manner and the practice made improvements to the service in response to complaints and other feedback.

• The practice had a clear vision to provide a safe and high quality service.

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

• The practice provided a range of enhanced services to meet the needs of the local population.

• The practice sought patient views about improvements that could be made to the service. This included the practice having and consulting with a patient participation group (PPG).

Areas where the provider should make improvements;

• Produce an action plan as to how outstanding recommendations from the most recent infection control audit will be addressed and how any risks associated with this will be mitigated in the meantime.

• Review and update the complaints information provided to patients.

• Improve checks on emergency medicines and medical equipment to ensure they include all items for use outside of the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 July 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.

• Patients were provided with advice and guidance about prevention and management of their health and were signposted to support services.

• GPs had lead roles in some chronic diseases and practice nurses were also responsible for chronic disease management. As part of this they provided regular, structured reviews of patients’ health. Patients with several long term conditions were offered a single, longer appointment to avoid multiple visits to the surgery.

• Data from 2014 to 2015 showed that the practice was generally performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes.

• The practice provided a phlebotomy service for patients.

• The practice provided an enhanced service to prevent high risk patients from unplanned hospital admissions. This included these patients having care plans and regular review of their medicines.

Updated 27 July 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 those who were at risk, for example, children and young people who had a high number of A&E attendances. A GP was the designated lead for child protection.

• Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.

• Child surveillance clinics were provided for 6-8 week olds and immunisation rates were comparable to the national average for all standard childhood immunisations. Opportunistic immunisations were given to encourage uptake. The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report any concerns they had identified to relevant professionals.

• The practice hosted a community midwife and regular postnatal clinics.

• Comprehensive family planning services were provided at a weekly clinic.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed was 76% which was comparable to the national average of 74%.

• Babies and young children were offered an appointment as priority and appointments were available outside of school hours.

• The premises were suitable for children and babies and baby changing facilities were available.

• The practice worked within a federation of practices to provide a ‘Paediatric acute response nurse’. They also worked alongside the ‘Community Respiratory Team’ which is a nurse led service providing support and treatment for children with asthma or other respiratory conditions.

Updated 27 July 2016

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

• The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population. The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

• Patients over the age of 75 had a named GP and they had been informed of who this was.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or better than local and national averages. For example, the percentage of patients with chronic obstructive pulmonary disease (COPD) who had a review undertaken including an assessment of breathlessness was 91% compared to a national average of 89%.

• GPs carried out regular visits to local care homes to assess and review patients’ needs and to prevent unplanned hospital admissions. Home visits and urgent appointments were provided for patients with enhanced needs.

• Care planning was carried out to prevent the highest risk patients from an unplanned hospital admission.

• The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and care of patients nearing the end of their life) to ensure patients received appropriate care.

Updated 27 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.

• Telephone consultations were provided and patients therefore did not always have to attend the practice in person.

• The practice provided extended hours appointments one evening per week until 8.15pm. The practice was also part of a cluster of practices whose patients could access appointments at a local Health and Wellbeing Centre up until 8pm in the evenings Monday to Friday, and from 8am to 8pm Saturdays and Sunday mornings, through a pre-booked appointment system.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group. Screening uptake for people in this age range was comparable to or above national averages. For example 72% of females aged 50-70 had been screened for breast cancer in the last three years compared to a national average of 72%.

• The practice was proactive in offering online services including the booking of appointments and request for repeat prescriptions. Electronic prescribing was also provided.

Updated 27 July 2016

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

• The practice maintained a register of patients who experienced poor mental health.

• There was a designated lead for mental health.

• Annual health checks were provided for patients with mental health concerns including dementia.

• The practice referred patients to appropriate services such as psychiatry and counselling services and patients experiencing poor mental health were informed about how to access support groups and voluntary organisations.

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were comparable to local and national averages. For example, data showed that 87% patients diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This compared to a national average of 84%.

• A system was in place to follow up patients who had attended accident and emergency and this included where people had been experiencing poor mental health.

• Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they were prescribed.

Updated 27 July 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 in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these.

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

• Staff were aware of their responsibilities regarding adult protection including; information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available.

• Information and advice was available about how patients could access a range of support groups and voluntary organisations.

• The practice hosted the Citizens Advice Bureau (CAB) to provide patients with advice on social and financial matters.