Boughton Medical Group

Updated 20 December 2016

Boughton Medical Group is responsible for providing primary care services to approximately 12,362 patients. The practice is situated in Hoole Lane, Boughton in Chester. The practice is 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 practice has a large working age population.

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

The practice is open 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 on the ground floor. The practice has a car park for on-site parking.

The practice has a General Medical Service (GMS) contract. The practice offers a range of enhanced services such as spirometry, nurse led diabetes insulin initiation, flu and shingles vaccinations, minor surgery and timely diagnosis of dementia.

Updated 20 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Boughton Medical Group on 18th October 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 report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• There were systems in place to reduce risks to patient safety, for example, premises and equipment checks, medication management and the management of staffing levels.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt well supported. They had access to training and development opportunities and had received training appropriate to their roles.

• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. 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.

• Information about how to complain was available. There was a system in place to manage complaints.

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

We saw areas of outstanding practice:

• The practice had been identified as a beacon practice for on-line patient access by NHS England and had made a video for use throughout English GP practices to encourage patients to register for this service. The practice had worked together with their Patient Participation Group (PPG) to develop this service and promotional material for on-line access. The practice had approximately 26% of their patient population registered for on-line access. The practice and the PPG had also linked up with local services to provide computer training and set up email accounts to enable patients to use on-line access.

• The practice had developed and recently implemented its own autism protocol. This acted as an aide memoire to staff when booking appointments for patients with suspected or diagnosed autism and suggested reasonable adjustments to be made when attending the practice. It also stressed the importance of good communication with patients and their families or carers.

• The practice website and newsletter had sections specifically for young people which included information on common health questions, abuse prevention, sexual health and smoking and links to health and social care support organisations.

• The practice had been involved in a number of community engagement projects in the last two years. For example, members of the clinical and management team collaborated with a local supermarket to deliver lifestyle advice and carry out patient health checks in a specially adapted vehicle owned by the supermarket and located in its car park. The practice team visited a local pre-school to explain to children about what to expect when visiting their GP. The practice also promoted student health by providing information about the practice and the services offered at the Fresher's Fayre.  

• Two nurses from the practice had undertaken a study between 2012 and 2014 with the aim of assessing the effectiveness of early diagnosis of dementia and how this impacts on individuals and carers. The conclusions and recommendations included reducing waiting times for diagnosis and that the benefits of earlier diagnosis should continue to be promoted. As a consequence of the findings the practice had been involved in and developed services. Opportunistic screening for dementia took place. Following on from this the practice also offered an in-house dementia care assessment led by a nurse. This involved a 30 minute assessment of the patient and symptoms, followed by a memory assessment. If further investigations were needed the patient was referred on to specialist services. The practice had been part of the nurse led Vulnerable Housebound Adult Service pilot. The aim of this pilot was to improve the experience and outcomes for housebound, vulnerable, frail and elderly patients by advanced care planning and management. Dementia screening and review was included within this service provision. This included a full holistic assessment, an assessment of the patient’s carer to ensure they were receiving sufficient support and sign posting for support service services and referrals to health and social care services as necessary.

The areas where the provider should make improvements are:

• Ensure there is a daily record of the minimum and maximum thermometer readings for vaccine fridges.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 December 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. Patients with long term conditions had management plans in place which empowered them to manage their 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 practice offered patient access to their care records and they were promoting this to patients with a long term condition. This encouraged patients to manage their conditions and improved patients’ health by providing self-care tools. The practice offered annual reviews to patients who have had a splenectomy and to patients who had been diagnosed with coeliac disease. These reviews were in addition to the contractual requirements of the practice as the importance of these reviews had been identified for promoting patients' wellbeing. These patients were offered a review with the nursing team and immunisations in accordance with current guidelines. 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 to specialist help when needed. The practice referred patients with a long term condition to Self-Management UK who provided a free six week course for patients to help them manage the day to day impact of living with a long term condition.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.

Updated 20 December 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. Minor illness clinics with the nurse practitioner were also provided. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had access to a system that allowed direct access to paediatricians at The Countess of Chester Hospital which enabled speedier diagnosis and treatment as well as reducing further primary care appointments and unnecessary referrals to hospital. The staff we spoke with had appropriate knowledge about child protection and all staff had safeguarding training relevant to their role. The safeguarding lead staff liaised with school health, midwives and health visiting colleagues to discuss any concerns about children and how they could be best supported. The health visiting and school nursing service were based in the same building as the practice which assisted with good communication. Contraception and sexual health services were provided. There was a section on the practice website and in the practice newsletter specifically for young people. The Patient Participation Group (PPG) were working with a local college to encourage students to be part of the PPG which would enable the views of younger patients to be considered.

Updated 20 December 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. Each patient has a named GP to ensure continuity of care. The practice provided services to a local nursing home. Visits were carried out by the advanced nurse practitioner twice a week to respond to acute symptoms, minor illness and injury. The advanced nurse practitioner was also available for daily telephone consultations with the nursing home staff and this included issues/concerns that required urgent action prior to the twice weekly visit. The practice nurse visited the nursing home to monitor long term conditions and GPs visited if a patients’ condition deteriorated and to carry out six monthly reviews of patient care. This service had led to better co-ordination of patient care and had assisted with avoiding unplanned admissions to hospital. The practice worked with other agencies and health providers to provide support and access specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients.

Updated 20 December 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 order repeat prescriptions and book appointments on-line which provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday allowing early morning and evening appointments to be offered to working patients. An extended hour’s service for routine appointments and an out of hour’s service were commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. 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, NHS health checks, smoking cessation advice and family planning services. The practice used eConsult a platform that enabled patients to self-manage and consult online with their own GP through their practice website. The benefits of this system included improved access and improved health outcomes through earlier detection of significant symptoms and earlier intervention. An express clinic was run twice a day by a nurse practitioner who was able to assist with many illnesses such as sore throats, chest and ear infections, prescribe medication and allocate a GP appointment if necessary. Reception staff sign-posted patients who do 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) and the Physio First service (this provided physiotherapy appointments for patients without the need to see a GP for a referral).

Updated 20 December 2016

The practice is rated outstanding for the care of people experiencing poor mental health (including people with dementia). Two nurses from the practice had undertaken a study between 2012 and 2014 with the aim of assessing the effectiveness of early diagnosis of dementia and how this impacts on individuals and carers. The conclusions and recommendations included reducing waiting times for diagnosis and that the benefits of earlier diagnosis should continue to be promoted. As a consequence of the findings the practice had been involved in and developed services. Opportunistic screening for dementia took place. Following on from this the practice also offered an in-house dementia care assessment led by a nurse. This involved a 30 minute assessment of the patient and symptoms, followed by a memory assessment. If further investigations were needed the patient was referred on to specialist services.  The practice had been part of the nurse led Vulnerable Housebound Adult Service pilot. The aim of this pilot was to improve the experience and outcomes for housebound, vulnerable, frail and elderly patients by advanced care planning and management. Dementia screening and review was included within this service provision. This included a full holistic assessment, an assessment of the patient’s carer to ensure they were receiving sufficient support and sign posting for support service services and referrals to health and social care services as necessary.

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 20 December 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. The practice had developed and recently implemented its own autism protocol. This acted as an aide memoire to staff when booking appointments for patients with suspected or diagnosed autism and suggested reasonable adjustments to be made when attending the practice. It also stressed the importance of good communication with patients and their families or carers. The practice prioritised patients who may be at risk of poor health due to frailty. Following a medical event such as 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 staff we spoke with had appropriate knowledge about safeguarding vulnerable adults 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. Two members of staff acted as carer’s links 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.