Archived: Frodsham Princeway

Updated 16 October 2017

Frodsham Priceway is responsible for providing primary care services to approximately 5,666 patients. The practice is situated in Princeway Health Centre in Frodsham, Cheshire. The practice is based in an area with lower levels of economic deprivation when compared to other practices nationally.

The practice is operated by six partners (5 GPs and the practice manager) who also operate another practice within the same building. The partnership took over responsibility for operating Frodsham Princeway in January 2016 and a five year contract was agreed with NHS England in April 2017. The practice has three salaried GPs, an advanced nurse practitioner, a health care assistant and administration and reception staff. The clinicians are both male and female.

Frodsham Priceway is open from 8am to 6.30pm Monday to Friday. An extended hour’s service for routine appointments and an out of hour’s service are commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. Patient facilities are located on the ground floor. The practice has a car park for on-site parking. The practice shares a building with a number of community services such as physiotherapy, district nursing and occupational health.

The practice has an Alternative Provider Medical Services (APMS) contract. The practice offers a range of enhanced services including anticoagulation, spirometry, near patient testing and minor injury.

Updated 16 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Frodsham Princeway on 29 August 2017.

Overall the practice is rated as good.

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

• There were systems in place to reduce risks to patient safety, for example, there were systems to protect patients from the risks associated with insufficient staffing levels and to prevent the spread of infection. Improvements were needed to the staff recruitment systems.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff had access to training and development opportunities and they told us that they felt well supported.

• Patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.

• Services were planned and delivered to take into account the needs of different patient groups.

• Access to the service was monitored to ensure it met the needs of patients.

• There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

The areas where the provider must make improvements are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Cleaning protocols should be implemented to provide guidance for staff on the arrangements for maintaining the cleanliness of clinical areas and equipment.

• The system for ensuring medication is reviewed when patients do not attend for an appointment should be improved.

• A copy of the report to confirm the electrical wiring at the branch practice is satisfactory should be forwarded to CQC.

• Weekly in-house checks of the fire alarm and monthly checks of the emergency lighting should be carried out and documented.

• Introduce a system to ensure that any locums employed via an agency have received all the necessary pre-employment checks.

• The salaried GPs should have an in-house appraisal in addition to the external appraisal process.
• Put in place a more structured approach to the investigation of complaints to ensure that a clear and accurate record is maintained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 October 2017

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 such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure patients were invited to attend reviews for long term conditions. 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 to specialist help when needed. The practice provided information to patients to encourage them to manage their long term conditions and patients were also referred to educational courses on how to manage their conditions.

Updated 16 October 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Priority was given to young children who needed to see the GP and appointments were available outside of school hours. Telephone consultations for parents worried about their child’s health were offered were this was sooner than an appointment. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. Child health promotion information was available at the practice. Family planning and sexual health services were provided.

Updated 16 October 2017

The practice is rated as good for the care of older people. T he practice kept registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice prioritised patients who may be at risk of poor health due to frailty. Following a medical event such as an unplanned hospital attendance the medical needs of these patients were reviewed to identify what could be put in place to prevent future ill-health or hospital admission. The practice had introduced the “Grey Flag” system which was used to alert clinicians to patients requiring a review or follow-up following such an event. This system was being introduced across Cheshire following the success of its introduction at the practice. The practice had worked with neighbourhood practices and the Clinical Commissioning Group (CCG) to support the needs of older patients and avoid hospital admissions where possible. They had been involved in an early visiting service. This improved patient access to GP services and to the resources needed to support patients at home with the aim of reducing emergency admissions to hospital and use of emergency services. The involvement of the practice with this service had now reduced and this was mainly being managed by the community matron. They were currently involved in offering “step up” care beds at a local nursing home. This enabled the practice to admit patients to the nursing home for up to four days where a patient was not suitable for hospital admission but required more care and support than they were receiving.

Updated 16 October 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice appointment system and opening times provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday. Patients could book routine appointments in person, via the telephone and on-line. Repeat prescriptions could be ordered on-line or by attending the practice. Telephone consultations were also offered. An extended hour’s service for routine appointments was commissioned by West Cheshire CCG. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, contraceptive services, smoking cessation advice and family planning services. Reception staff sign-posted patients who did not necessarily need to see a GP, for example to the Physio First service (this provided physiotherapy appointments for patients without the need to see a GP for a referral).  

Updated 16 October 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). GPs worked with specialist services to review care and to ensure patients received the support they needed. The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services. The practice had information in the waiting areas about services available for patients with poor mental health. For example, services for patients who may experience depression.

Updated 16 October 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. A register was kept of patients with a learning disability and there was a system to ensure these patients were invited for an annual health check. Alerts were placed on the records of vulnerable patients and longer appointments were offered. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the wellbeing coordinator.