Tattenhall Village Surgery

Updated 20 July 2017

Tattenhall Village Surgery is responsible for providing primary care services to approximately 7,914 patients. The practice is situated in Tattenhall in Cheshire. The practice has a branch practice called Farndon Village Surgery. Both practices share the same staff and patient list. The provider for the practice is Dr Melissa Siddorn and Dr Laura Freeman, however the practice and the branch are referred to as The Village Surgeries Group. Tattenhall Village Surgery was registered with CQC in November 2016.

The practice and the branch are based in an area with lower than average levels of economic deprivation when compared to other practices nationally. The number of patients with a long standing health condition is about average when compared to other practices nationally.

The staff team includes two partner GPs, six salaried GPs, one advanced nurse practitioner, two practice nurses, two health care assistants, practice manager, compliance manager, business manager, administration and reception staff. There are both male and female GPs. The nursing team and health care assistants are female.

Tattenhall Village Surgery and the branch practice at Farndon are 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 practices have a car park for on-site parking.

The practice has a Personal Medical Service (PMS) contract. The practice offers enhanced services such as minor surgery, learning disability health checks and influenza and shingles immunisations.

Updated 20 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Tattenhall Village Surgery on 7 February 2017. The overall rating for the practice was Good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for Tattenhall Village Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused review carried out on 4 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified at our previous inspection on 7 February 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• The provider had improved safety systems in place to ensure that staff recruitment checks, monitoring of medication fridge temperatures and safety checks of the premises promoted the health, safety and welfare of patients.

The following improvements to the service had also been made:

• A system had been put in place to ensure that fire drills occurred at the recommended frequencies.

• A system to monitor the allocation of blank prescriptions was in place.
• A formal structure of supervision had been put in place for the advanced nurse practitioner.

• A record of verbal complaints was being maintained.

• A disability access audit had been undertaken.

• The systems for gathering patient feedback had been improved with the establishment of a patient participation group.

• The disciplinary procedure had been revised.

The areas where the provider should make improvements are:

• Where no references can be obtained during the recruitment process, clearly record the reason for this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 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 no patient missed their regular reviews for long term conditions. The practice aimed to ensure that patients were able to see one nurse for all of their long term conditions to reduce the need for multiple appointments. The clinical team took the lead for different long term conditions. Internal referrals were made to clinicians in accordance with their specialist areas to reduce the need for referrals to secondary care. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. All palliative care patients had a named GP which ensured continuity of care. The practice worked with other agencies and health providers to provide support and access to specialist help when needed.

Updated 22 March 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. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. The practice liaised with the school health team, midwives and health visiting service to discuss any concerns about children and their families and how they could be best supported. Child health promotion information was available on the practice website and in leaflets displayed in the waiting area. Family planning and sexual health services were provided.

Updated 22 March 2017

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date 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 provided services to two local nursing homes. Weekly v isits were carried out by the same clinicians where possible to provide continuity and nursing home staff were able to telephone these GPs with any concerns. The advanced nurse practitioner visited housebound patients, many of whom were over 75. During these visits their needs were assessed, care plans were developed and a review of long term conditions took place. These assessments also considered social care needs and vulnerability of the patient and as a result of the assessment referrals were made to appropriate health and social care services. The practice was involved in the development of a Retirement Village and once this was opened they would be holding regular clinics on the premises. The practice worked closely with Tarporley War Memorial Hospital and referred patients to avoid acute hospital admissions.

Updated 22 March 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. Tattenhall Village Surgery and the branch practice at Farndon were open from 8am to 6.30pm Monday to Friday. Patients could book appointments in person, via the telephone and on-line. Repeat prescriptions could be ordered on-line or by attending the practice. Appointments could be booked up to two weeks in advance. Telephone consultations were also offered. The practice website provided information around self-care and local services available for patients. 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 services such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP). An in-house phlebotomy service and services hosted at the practices such as counselling meant patients could receive these services locally rather than having to travel.

Updated 22 March 2017

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 receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The advanced nurse practitioner identified patients needing an assessment for dementia during home visits. If necessary a GP would visit the patient at home to undertake this assessment. Appointments were offered that met the needs of patients experiencing poor mental health, for example after school appointments were offered to avoid any unnecessary disruption to school attendance. The practice referred patients to appropriate services such as psychiatry and counselling services. The practice hosted a counsellor who had links to local mental health services twice a week. This allowed patients who were unable to travel to Chester to access this service more easily.

Updated 22 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice identified vulnerable patients through multi-disciplinary meetings. A register was kept of patients with a learning disability and there was a system to ensure these patients received an annual health check. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and children and all staff had safeguarding training relevant to their role. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff acted as a carer’s link and they were working to identify carers and promote the support available to them through organisations such as the Carers Trust. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the wellbeing coordinator.