Guardian Medical Centre Also known as Dr M Kerr & Partners

Updated 14 March 2017

Guardian Medical Centre is located at Guardian Street, Warrington, Cheshire WA5 1UD. The practice was provides a service to approximately 9,775 patients. The practice is situated in an area with average levels of deprivation when compared to other practices nationally. The percentage of patients with a long standing health conditions is lower than the local and national average.

The practice is run by four GP partners and there are an additional four salaried GPs (two male and six female). There are two practice nurses, one health care assistant, a practice manager and a team of reception/administration staff. The practice is open from 8am to 6.30pm Monday to Friday. The practice provided one early morning surgery (from 7am) and one late evening surgery (until 8pm) per week. 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 during evenings and weekends. Outside of practice hours patients can access the Bridgewater Trust for primary medical services. The practice is a training practice for trainee GPs and it hosts final year medical students.

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 14 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Guardian Medical Centre on 16 March 2016. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Guardian Medical Centre on our website at www.cqc.org.uk.

At our previous inspection on 16 March 216 we rated the practice as ‘good’ overall but we identified a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not carried out a health and safety risk assessment to identify risks to peoples’ safety and ensure measures were in place to mitigate these.

This inspection was a desk-based review carried out on 30 January 2017 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breach in regulation identified at our previous inspection. This report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

Our key findings were as follows:

• The provider had taken action to meet the breach of Regulation 17. The provider had carried out a health and safety risk assessment that identified risks to peoples’ safety and this included information on the measures in place to mitigate these.

We also found that the provider had made a number of improvements where we had identified these. These included;

• The introduction of a clear and auditable record of staff training to assist the provider in identifying staff training needs and plan for training requirements.

• The development of a safeguarding procedure.

• A review of recruitment procedures to ensure all relevant recruitment checks are carried for staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 April 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.

• Data from 2014 to 2015 showed that the practice was comparable with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. For example, the percentage of patients with diabetes, on the register, who had had an influenza immunisation was 96.98% compared to a national average of 94.45%.

• Longer appointments and home visits were available for patients with long term conditions when these were required. The practice contacted patients following admission to hospital to check if they required any services from the practice.

• Staff referred patients for advice and support to promote healthy lifestyle choices such as smoking cessation, healthy eating and exercise. The practice hosted a weekly dietician clinic.

• The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

Updated 29 April 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.

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

• Appointments were available outside of school hours. The premises were suitable for children and babies and baby changing facilities were available.

• Family planning services were provided. The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 80.39% which was comparable to the national average of 81.83%.

Updated 29 April 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 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.

• The practice provided a range of enhanced services for older people, for example, the provision of care plans for patients over the age of 75 and screening for dementia. Health checks were also provided to patients over 75 years of age.

• 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. Screening uptake for bowel cancer and breast cancer were higher than local and national averages. For example, 77.8% of females aged 50-70 had been screened for breast cancer compared to a national average of 74%.

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

• 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.

• The practice had hosted coffee mornings for patients over the age of 75 and invited speakers to provide advice on health matters.

Updated 29 April 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered a range of appointments to meet the needs of the working age population, those recently retired and students.

• Later appointments were available one evening per week and early morning appointments were provided one morning per week.

• Patients had the option of telephone consultations and this was advantageous for some people in this group as they did not always have to attend the practice in person.

• The practice was 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 Sundays, through a pre-booked appointment system.

• 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.

• The practice offered NHS health checks for people aged 40-74 years of age.

Updated 29 April 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 average. For example, data showed that 79.31% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This compared to a national average of 84.01%.

• GPs carried out cognitive assessments with patients and referred people to a local memory clinic for support if required. The practice provided an enhanced service for screening patients to identify patients at risk of dementia and to develop care plans with them.

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

• The practice provided primary care to patients living in a local facility for people with enduring mental health needs.

• Patients experiencing poor mental health were informed about how to access a range of support groups and voluntary organisations.

Updated 29 April 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.

• 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.

• The practice was accessible to people who required disabled access and facilities and services such as a translation service were available. The practice had a hearing loop system but this was not in use. The practice manager agreed to address this.

• The practice had a designated lead GP to support patients with issues of substance misuse.

• Information and advice was available about how patients could access a range of support groups and voluntary organisations. The practice hosted a Citizens Advice Bureau session on a weekly basis.