City Walls and Saughall Medical Centres Also known as City Walls Medical Centre

Updated 25 August 2017

City Walls and Saughall Medical Centres are responsible for providing primary care services to approximately 16,900 patients. City Walls Medical Centre is based in Chester and the branch practice is based in the village of Saughall approximately three miles from Chester. The practice is based in areas with average levels of economic deprivation when compared to other practices nationally.

The staff team includes eight GP partners and one nurse partner, four salaried GPs, three nurse practitioners, five practice nurses, three health care assistants, including a phlebotomist, practice manager and administration and reception staff. The practice is a training practice and has GP registrars, medical students and nurses working for them as part of their training and development.

The practice is open 8:00am 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.

The practice has a General Medical Service (GMS) contract. The practice offers a range of enhanced services including flu and shingles vaccinations, timely diagnosis of dementia and minor surgery.

Updated 25 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of City Walls and Saughall Medical Centres on 19 April 2016. The overall rating for the practice was good, however the practice was rated as requires improvement for providing safe services. We carried out a desk-based review on 01 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 April 2016. The practice had met the legal requirements and continued to be rated as good, however we identified a further safety issue that needed to be addressed. The full comprehensive report on the April 2016 inspection and the desk based review in February 2017 can be found by selecting the ‘all reports’ link for City Walls and Saughall Medical Centres on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 12 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 1 February 2017. This report covers our findings in relation to those requirements.

Overall the practice is rated as Good.

Our key findings were as follows:

•  An up to date fire risk assessment had been put in place for both the main and the branch practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 June 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 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 clinical staff took the lead for different long term conditions and kept up to date in their specialist areas. 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 17 June 2016

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Appointments for young children were prioritised. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding children. The safeguarding lead staff liaised with and met regularly with the health visitor, school nurse and midwife to discuss any concerns about children and how they could be best supported. Chlamydia screening was offered to young people. Family planning services such as coil and implant fitting were provided.

Updated 17 June 2016

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 worked with other agencies and health providers to provide support and access specialist help when needed. The practice was working with neighbourhood practices and the CCG to provide services to meet the needs of older people. For example, the group of neighbourhood practices had employed a GP to offer a frailty service. The GP worked with the community care team to identify patients over 75 at risk of unplanned hospital admission. The GP visited these patients and drew up a care plan on how best to manage their condition and prevent a re-admission. Clinicians visited a local nursing home once a week to review patient health and respond to any concerns identified.

Updated 17 June 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments, book on the day appointments and telephone consultations. Patients could book appointments on-line or via the telephone and repeat prescriptions could be ordered on-line which provided flexibility to working patients and those in full time education. The practice was open from 08:00 to 18:30 Monday to Friday allowing early morning and late evening appointments to be offered to this group of patients. An extended hour’s service for routine appointments was commissioned by West Cheshire CCG. The practice website provided information around self-care and local services available for patients. The practice offered a “Health Yourself Hub” where patients could drop in to access blood pressure, height and weight monitoring equipment as well as information on self-care. A health care assistant was available between 2pm and 4pm to assist patients. Reception staff were able to sign post patients to local resources such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP) and the Physio First service (this provided physiotherapy appointments for patients without the need to see a GP for a referral). The practice offered health checks to patients aged 40 – 74. A drop in contraceptive clinic was provided every week.

Updated 17 June 2016

The practice is rated 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 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. Clinical and non-clinical staff had undertaken training in dementia to ensure all were able to appropriately support patients.

Updated 17 June 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient had a learning disability to enable appropriate support to be provided. There was a recall system to ensure patients with a learning disability received an annual health check. Staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and they had access to the practice’s policy and procedures. 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 was the carer’s link. The practice referred patients who were over 18 and with long term health conditions to a well-being co-ordinator for support with social issues that were having a detrimental impact upon their lives. The practice referred patients to local health and social care services for support, such as drug and alcohol services.