York Road Group Practice

Updated 19 November 2015

York Road Group Practice is responsible for providing primary care services to approximately 11669 patients. The practice is based in a more deprived area when compared to other practices nationally.

The staff team includes five partner GPs, one nurse clinician, four practice nurses, two health care assistants, a practice manager and reception and administrative staff. The practice is a training practice and at the time of our visit had one GP registrar working for them as part of their training and development in general practice.

The practice is open from 08:00 to 18:30 Monday to Friday. West Cheshire CCG provides an extended hours GP service 18:30 to 21:30 Monday to Friday and 10:00 to 12:00 on Saturdays.

Patients requiring a GP outside of these hours are advised to contact the Cheshire West Out of Hours Co-operative which is staffed by GPs from practices in Ellesmere Port. This service is based at Ellesmere Port Hospital.

The practice has a General Medical Services (GMS) contract. The practice offers a range of enhanced services including minor surgery, flu and shingles vaccinations and learning disability health checks.

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at York Road Group Practice on 6th October 2015.

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 risk of abuse.
• There were appropriate systems in place to reduce risks to patient safety, for example, infection control procedures and the management of medication. However, the records of some environmental safety checks and the recruitment records needed improvement.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.

• Patients were overall positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful.

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

• Feedback from patients indicated they considered improvements were needed to availability of appointments, length of time waiting to be seen and access to the practice by phone. The practice had made changes to the service to improve access and planned on making further changes.

• The practice sought patient views about improvements that could be made to the service and acted on patient feedback. Information about how to complain was available.

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

There were areas of practice where the provider needs to make improvements:

The provider should:

Introduce a formal system to review significant events to ensure the identified action has been undertaken and that it has been effective.

Ensure that a system is in place to check the on-going registration of GPs with the General Medical Council and the National Performers List.

Ensure that a record of all checks undertaken in relation to staff recruitment are held at the practice.

Ensure that appropriate checks of the water systems are undertaken and that the emergency lighting is regularly serviced and records are held to demonstrate this.

Ensure that actions taken following the investigation of complaints are fully documented to demonstrate that appropriate measures have been taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 November 2015

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. Clinical staff were skilled in dedicated areas and their on-going education meant that they were able to ensure best practice was being maintained. Patients who were housebound were visited at home by the nurse practitioner for annual reviews of long term conditions. The nurse practitioner provided a service for initiating injectable treatments for patients with type 2 diabetes which had reduced secondary care referrals. A GP took the clinical lead for diabetes and had developed diabetes care at the practice which had resulted in improvements to the service provided to patients. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs.

Updated 19 November 2015

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns. There was a policy of same day appointments for all children. Contraceptive and sexual health services were provided. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding children. Staff put alerts onto the patient’s electronic record when safeguarding concerns were raised. The safeguarding lead GP liaised with the health visiting service to discuss any concerns about children and how they could be best supported.

Updated 19 November 2015

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. All patients over 75 had a named GP who was responsible for co-ordinating their care. The practice had identified patients at highest risk, for example, due to multiple medical problems, frailty/falls and recent hospital admissions and a care plan had been developed to support them. The practice worked with other agencies and health providers to provide support and access specialist help when needed. For example, the practice was able to contact a Community Frailty Team led by a Consultant Geriatrician for advice and rapid assessment of patients at high risk. A monthly multi-disciplinary meeting was held to discuss patients with complex needs and how best to support them. The practice was one of four local practices that had worked together with the Clinical Commissioning Group (CCG) and secured funding to develop initiatives to improve patient care. One of the first major projects being undertaken was setting up a joint Early Visiting Service whereby a GP would assess older patients with acute problems during the morning and mobilise any necessary resources such as community support services to optimise patient care. If a hospital admission was required then research had shown that an early assessment could result in a reduced length of stay. Services for carers were publicised and a record was kept of carers to ensure they had access to appropriate services.

Updated 19 November 2015

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 in person, 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. An extended hour’s service was provided by West Cheshire CCG. This service was publicised at the practice and on the practice website. Health checks were offered to patients who were over 45 years of age to promote patient well-being and prevent any health concerns.

Updated 19 November 2015

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 for patients in the waiting areas to inform them of 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 19 November 2015

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. Staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and they had access to the practice’s policy and procedures and had received training in this. The practice referred patients to a Well-being Co-ordinator who provided advice and support to patients around issues such as housing problems and benefit issues and was able to sign post patients to other sources of support.