Park Medical Centre

Updated 21 October 2016

Park Medical Centre is registered with the Care Quality Commission to provide primary care services. The practice provides GP services for approximately 9,400 patients living in Chester and is situated in an extended and purposely refurbished building. The practice has three female GPs, three male GPs, three nurse practitioners, two healthcare assistants, administration and reception staff and a practice management team. Park Medical Centre holds a General Medical Services (GMS) contract with NHS England.

The practice is open Monday –Friday 8am – 6.30pm.

Appointments start at 8.30am with the last appointments at 5.50pm.

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice is part of West Cheshire Clinical Commissioning Group (CCG) and is situated in a more affluent area in Chester. The practice population is made up of around national average population groups with 19% of the population under 18 years old and 19% of the population aged over 65 years old. Fifty three percent of the patient population has a long standing health condition and there is a higher than the national and CCG average number of unemployed patients. Life expectancy for both males and females is around the CCG and national average.

The practice does not provide out of hours services. When the surgery is closed patients are directed to the local GP out of hour’s service and the local extended hours GP service. Information regarding out of hours services was displayed on the website and in the practice information leaflet.

Updated 21 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Medical Centre on 6 September 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Safety alerts were received and acted upon.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Staff had been trained to deal with medical emergencies and emergency medicines and equipment were available.
• Infection control procedures were in place.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said that sometimes they had difficulty making appointments with a named GP and telephone access was variable. However urgent appointments were available the same day for children and those patients who needed them and national patient survey results did not indicate a concern in accessing appointments.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear approach to working with others to improve care outcomes with a clear strategy and objectives including engaging with other key partners in providing health services.
• There was a clear leadership structure and staff were well supported by the GP partners.
• Staff were supervised, felt involved and worked as a team.
• The provider was aware of and complied with the requirements of the duty of candour.

There were areas of practice where the provider should make improvements, these were:

• Review the monitoring of the cleanliness of the premises to include documenting adherence to the cleaning schedule.

• Review the system for obtaining and acting on patient feedback to include reviewing results and acting on issues raised by any external surveys (such as the national GP patient survey). Review the contribution of internal surveys for obtaining feedback and suggestions.

• Review the access to safeguarding policies and procedures to include having practice specific policies and procedures available for staff.

• Review their governance arrangements to include annual or more frequent review of complaints and significant events to identify themes and trends.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 October 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff and GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Data from the 2014/2015 QOF performance showed the practice achieved 100% of the 86 points available for the performance indicators for diabetes. This was above the CCG and National average. For example:

  The percentage of patients on the diabetes register, in whom the last blood pressure reading (measured in the last 12 months) was 140/80mmHg or less was 91%. The CCG average was 81% and the national average was 78%.

• Patients with diabetes were cared for well and had improved outcomes. For example patients requiring insulin were initiated on their treatment by one of the nurses without the need for them to attend hospital. They had a “capture all” one appointment at which healthchecks, health promotion, lifestyle and disease management were discussed.

• Longer appointments and home visits were available when needed for patients with long term conditions and multiple conditions.

• All these patients were monitored and had a structured annual review to check their health and medicines needs were being met.

• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Medical records for vulnerable patients with long term conditions were highlighted so that all staff knew their needs and arranged appointments and care accordingly.

Updated 21 October 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Immunisation rates were good for all standard childhood immunisations with immunisations uptake for all children aged five and under around 97%.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Unwell children were always offered same day/urgent appointments.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was above average at 87%. (CCG average being 82%, national average being 82%).

• Appointments were available outside of school hours and could be managed online.

• There was raised awareness and good uptake of testing for sexual health diseases. The practice was in the top three high performing practices in the local area for uptake of chlamydia testing for 16-24 year olds.

Updated 21 October 2016

The practice is rated as good for the care of older people.

The practice had an elderly population around the national and local clinical commissioning group (CCG) average number of elderly patients with 19.4% over the age of 65. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in avoiding unplanned hospital admissions, dementia, and end of life care.

• The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments for those with enhanced needs.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were good. For example the percentage of patients with hypertension in whom the last blood pressure reading was 150/90mmHg or less was 84% and around the CCG and national average. Whilst the percentage of patients with atrial fibrillation treated with anticoagulation or anti platelet therapy was 100% and higher than the CCG and national average.

• All the older patients had a named GP who coordinated their care and contacted patients over 75 following discharge from an unplanned hospital admission.

Updated 21 October 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• For example, it offered online bookings of appointments and prescription requests and telephone consultations. Appointments could be pre booked or booked on the day and emergency appointments were also available daily for those in need and children.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group for example NHS health checks for those aged 40 to 75 years old.

Updated 21 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 84% and CCG average of 85%.

• 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months which was above the national average of 88% and CCG average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and could signpost to relevant specialist services.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 21 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with substance or alcohol misuse and those with a learning disability. Alerts on medical records flagged when a patient was vulnerable or was living in vulnerable circumstances.

• The practice had 37 patients with a learning disability registered and offered longer appointments for these. We saw good examples of where care was personalised to the individual needs. For example a practice nurse visited a patient with learning disabilities support worker to plan specific dietary information for the patient and GPs participated in the adult attention deficit hyperactivity disorder (ADHD) local steering group.

• The practice regularly worked with other health and social care professionals in the case management of vulnerable patients.

• The practice worked with and informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.