The Elms Medical Centre

Updated 25 February 2016

The Elms Medical Centre is registered with CQC to provide primary care services, which include access to GPs, family planning, ante and post natal care. The practice is a long established GP practice which had recently moved to a new purpose built building ‘Fountains Health’ in May 2015. The building also has three other GP practices within it and all practices share the management of the premises and work together as a cluster at times to offer primary care services to the population of Chester. The practice also has a branch surgery named Blacon Clinic in a neighbouring area of Chester.

The practice has a General Medical Services (GMS) contract with a registered list size of 9,978 patients (at the time of inspection). The practice has four GP partners, three practice nurses, health care assistant, practice manager and a number of administration and reception staff.

The main practice is open between 8am to 6.30pm Monday to Friday with appointments bookable in a variety of ways. Home visits and telephone consultations were available for patients who required them, including housebound patients and older patients. There were also arrangements to ensure patients received urgent medical assistance out of hours when the practice was closed.

Updated 25 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Elms Medical Centre on 12 January 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 readily available in document form for 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.

There were areas where the provider could make improvements as follows:

• The GPs should ensure that minutes are kept for safeguarding meetings attended by the GPs with other agencies.

• Undertake a risk assessment for the need to have a defibrillator at Blacon Clinic for use in an emergency. According to current external guidance and national standards, practices should be encouraged to have defibrillators.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 February 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 CCG and national average. We saw that the diabetes service provided was part of ‘The West Cheshire Way’ - a £5 million initiative between GPs, hospitals, social care and mental health and well-being services to ensure services felt more joined up and were patient-friendly. The diabetic reviews provided at the surgery were in line with the West Cheshire CCG guidance and gave patients more time during their nurse appointment or check-up. Patients received a 20 minute appointment with the diabetic Lead Nurses following a previous 20 minute appointment with a healthcare assistant or junior practice nurse. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed.

Updated 25 February 2016

The practice is rated as good for the care of families, children and young people. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. 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 relatively high for all standard childhood immunisations.

The practice had dedicated weekly ‘Baby Clinics’ led by a Child Development Lead GP who liaised with the Health Visitors for any new issues that had arrived. With involvement of the PPG, the practice has developed a ‘Younger Generation Newsletter’ published bi-monthly on the practice website. The newsletter promoted a health and wellbeing awareness among the young adults within the practice population. The practice also engaged with young adults via social media (Facebook and Twitter).

Updated 25 February 2016

The practice is rated as good for the care of older people. All patients aged over 75 years had a named GP contact. Support for carers was available signposting patients to support agencies and services in the local area. The practice offered proactive, personalised care to meet the needs of the older people in its population. This included weekly visits to a local older persons care home. The practice worked together with the integrated care team and other health and social care professionals to ensure that care plans were actively managed.

The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Annual reviews of care plans took place with the patient and their carer, ensuring that unmet needs were identified. Annual flu clinics took place and this included stalls and information from care agencies and voluntary groups in attendance. Safeguarding policies and procedures were in place. All older patients received an annual medications review.

The practice works in cluster partnership with four other surgeries to provide a nurse led discharge assessment and an active care planning service to elderly patients following hospital discharge. This was also extended to elderly patients with one or more long term conditions and also housebound patients. This new service provided an assessment and review of those who had been recently discharged from hospital with the aim of proactively managing a group if patients that were at risk of readmission to hospital.

Updated 25 February 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 for this age group.

With the recent move to a city centre location and in close proximity to University of Chester, the practice had worked collaboratively with the three surgeries at Fountains to develop a close working relationship with the local Student Union group and the University registration team. This enabled the practice to have an active presence during the registration time for new students providing them with health campaigns and ensuring that the students were registered with primary medical services early on in their university year. The aim was to ensure that the students had accessible GP services from the start hence avoiding unnecessary and avoidable A&E attendances.

Updated 25 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice was pro-active in screening patients for dementia by offering an opportunistic screen during consultations with doctors and nurses. In the event of a diagnosis, they provided care planning during annual dementia reviews in line with the patient’s wishes. Ninety eight per cent of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months compared to 84% nationally. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had a Mental Health GP Lead who reviewed the mental health register with the nurse practitioner to ensure that the patients on this register who don’t frequently attend the surgery were invited proactively for annual reviews. This has enabled the GP lead to establish a trusting relationship with this cohort to enable them to receive appropriate health care. The GP mental health lead also attended quarterly mental health meetings with the CCG to help evolve and improve mental health services in the area.

Updated 25 February 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 and alerts were added to their medical records. They offered longer appointments for people with a learning disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. They told vulnerable patients about how to access various support groups and voluntary organisations. 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 proactive in its support for carers and had a register of carers that was maintained by a named Care-Link Coordinator. The clinical system had alerts to flag up whether a patient was a carer. The carers were contacted annually for health checks and flu vaccinations. The practice ensured that the carers were provided with the support and information from Cheshire Carers Trust. On the day of the inspection the practice had invited the Cheshire Carer Link to hold an awareness session at the practice to opportunistically identify carers who may not be registered with the practice but who had accompanied the patients to their appointments. The practice was also working in collaboration with the cluster practices to offer a nurse led service to ensure that vulnerable house bound patients were reviewed regularly and the frail and elderly were assessed pro-actively and support was put in place to reduce avoidable admissions.

The Practice Child Safeguarding Lead GP regular reviews the register with the Health Visitor to ensure that the families that are vulnerable because of their circumstances have adequate support in place. The learning disability patients were invited annually for an extended appointment for a health review. The practice offers a 20 minute appointment with the practice nurse and an immediate follow up 10 minute appointment with the learning disability lead GP.