Archived: The Delamere Practice

Updated 23 March 2016

Delamere Medical Centre is registered with the Care Quality Commission to provide primary care services. The practice provides GP services for approximately 12,000 patients living in Crewe and the surrounding area. The practice is situated in a purpose built medical centre containing two other GP practices, a dentist, pharmacy and other related medical services. The practice has four GP partners, two female and two male, there are three regular locum GPs (one male and two female), a practice manager, an IT manager, practice nurses, administration and reception staff. Delamere Medical centre hold a General Medical Services (GMS) contract with NHS England.

The hours of practice are:

Monday – Friday 8.00am – 6.00pm with extended hours once a month on Saturday mornings between 8.30 and Midday. The practice operates a reduced service on a Wednesday afternoon accepting walk-in patients only.

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 treats patients of all ages and provides a range of primary medical services.

The practice is part of South Cheshire Clinical Commissioning Group (CCG) and is situated in an area of relatively high deprivation. The practice population is made up of a mostly working age and elderly population with 20% of the population aged over 65 years old. 58% percent of the patient population has a long standing health condition and 26% of the patient list do not have English as a first language, most of these patients are of eastern European origin.

The practice does not provide out of hours services. When the surgery is closed patients are directed to the local out of hour’s service provider (East Cheshire out of hours service) via NHS 111 for help. Information regarding out of hours services was displayed on the website and in the practice.

Updated 23 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Delamere Medical Centre on16 February 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 and untoward incidents.
• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses.

• Risks to patients were assessed and well managed including the risks of infection and medication.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Patients were treated with care, compassion, dignity and respect and they were involved in their care and decisions about their treatment. They had plenty of time at appointments and full explanations of their treatment were given. They valued their practice and felt confident with the skills and abilities of staff.

• We observed a strong patient-centred culture from a personal and family orientated practice.

• The practice proactively sought feedback from staff and patients, which it acted on.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with routine and urgent appointments available the same day.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

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

Importantly the provider Should:

• Improve documentation around learnings from analysis of complaints and significant events

• Improve staff recruitment protocols around risk and medical assessments

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 March 2016

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

The practice maintained and monitored registers of patients with long term conditions for example cardiovascular disease, diabetes, chronic obstructive pulmonary disease and heart failure. These registers enabled the practice to monitor and review patients with long term conditions effectively.

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance indicators for management of diabetes were around or above national average. The percentage of patients with diabetes who had received an influenza injection was 99.3% as opposed to the national average of 94.4%.

• Longer appointments and home visits were available when needed.

• Patients had a named GP and a structured annual review to check that their health and medicines needs were being met.

• Systems ensured patient recalls were highlighted.

• 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.

Updated 23 March 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.

• Immunisation rates were high for all standard childhood immunisations with all of immunisations for five year olds uptake around or above the local and national averages

• 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.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 93.1% withthe national average being 81.8%

• Appointments were available outside of school hours and the practice worked well with midwives and health visitors.

Updated 23 March 2016

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 found in older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in avoiding unplanned admissions, dementia and end of life care.

• It was responsive to the needs of older people, and offered home visits (including to their patients in care homes) and urgent appointments for those with enhanced needs.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 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.

Updated 23 March 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. For example the practice offered morning, extended evening and monthly Saturday appointments face to face or via the telephone.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 23 March 2016

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

• The practice carried out advance care planning for patients with dementia and 86.8% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months compared with the national average of 84%.

• 79.7% of people experiencing poor mental health (above national average of 88.4%) had a comprehensive documented care plan in place.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

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

• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

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

• Patients with poor mental health were given extended appointments.

Updated 23 March 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 and with alcohol or substance misuse.

• It offered longer appointments for people with a learning disability.

• 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 worked with voluntary organisations, one of which was co-located in the building.

• Staff were familiar with patients from this group and knew and understood family dynamics.

• 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.