Castlefields Health Centre

Updated 14 November 2016

Castlefields Health Centre is located in a modern, purpose built facility, which was opened in May 2012, in the Castlefields area of Runcorn, Merseyside. The building is shared by other community health professionals such as midwives, health visitors, community matrons and other ancilliary health professionals.

The practice is run by a partnership of GPs. There are five GP partners, two male, three female, supported by four salaried GPs, three female and one male. The practice also has two advanced nurse prescribers, (both female), five practice nurses, (all female), four health care assistants (female) and two practice pharmacists who work as part of the NHS England clinical pharmacists pilot. The practice is a teaching practice, hosting GP registrars, medical students and student nurses. The practice also employs its own counsellor. The combined working hours of the GPs, including the Registrar GP gives 6.33 working time equivalent GPs, delivering 57 clinical sessions each week.

The practice administrative team is overseen by a practice manager who is supported by 12 reception, administrative and secretarial staff. This includes an apprentice administrator.

The practice is open between 8am and 6.30pm each week day. Each week, the practice provided:

• 625 pre-bookable face to face appointmentswith a GP, and 91 with an Advanced Nurse Prescriber (ANP).

• 122 pre-bookable telephone consultations with a GP and 20 with an ANP

• 768 pre-bookable nurse appointments each week

• 238 GP call back (triage) calls each week which helped allocate urgent, on the day GP appointments.

The practice does not offer any extended hours opening for patients. Patients ringing the practice in the out of hours period (when the surgery is closed) are diverted to the NHS 111 service. If patients are found to be in need of a GP, they are directed to the local out of hours service provider, Runcorn Out of Hours

The practice has approximately 12,000 patients and falls within an area of high socio-economic deprivation. Average life expectancy for males is three years lower than the England average, at 77 years, and for females is 80 years of age compared to the England average of 83 years of age.

The practice has not been inspected previously.

Updated 14 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Castlefields Health Centre on 22 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.
• Risks to patients were assessed and managed.
• Some areas of safety required review, including access to blank prescription pads left in printers overnight, and processing information in relation to planned safeguarding meetings. GPs did not always provide safeguarding reports for use at safeguarding meetings.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Work with diabetic patients was proactive and nurses were seen to be delivering improved results in the care and management of diabetic patients.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice worked with a number of community providers to deliver services to patients that met their needs, for example, Admiral Nurses who supported dementia patients and their carers.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said there was continuity of care, with urgent appointments available the same day.
• The practice was responsive and had developed triaging systems to ensure that those patients needing to be seen by a GP on the day, were seen.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The were areas where the provider should make improvements. The provider should:

• Improve access to the practice by telephone.

• Review the current arrangements for security of blank prescription pads;

• Ensure relevant staff understand procedures for production of safeguarding reports for safeguarding boards.

• Review all significant events annually to check for any trends or re-occurence of events and to promote learning.

• Minute practice clinical meetings to circulate content to those unable to attend.

• Share the findings of audits with the full clinical team and more widely to promote learning.

• Review patient specific directions to ensure these are up to date.

• Collate staff training records to ensure staff are up to date with training required for their role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 November 2016

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

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

• Key performance indicators for the management and monitoring of treatment for patients with diabetes, were in line with or above local and national averages. Nurses demonstrated that they were pro-active in managing long term conditions and testing of patients early to spot potential onset of diabetes.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

Updated 14 November 2016

The practice is rated as requires improvement 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.

• The practice were not able to demonstrate that they submitted reports for use at safeguarding review meetings, as required, when GPs were unable to attend these meetings. We were shown a system that had recently been introduced to manage this process more effectively in future.

• The practice had a specialist paediatric Advanced Nurse Prescriber, who would see all children under 11 years of age on the day, as required.

• Immunisation rates were relatively high for all standard childhood immunisations.

• 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.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors, school nurses, well being officers and SCIP (social care in practice) officers.

Updated 14 November 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

• The practice was a member of the Dementia Action Alliance, which promoted initiatives aimed at ensuring that those who had contact with dementia patients had a good understanding of the challenges faced by people with dementia, and their carers.

• The practice arranged for and paid for taxis for those patients that would struggle to use public transport at peak times of the day, for example, more frail, older patients attending the practice without a carer.

• The practice had an Advance Nurse Prescriber whose primary role was the care of patients over 75 years of age. This nurse visited patients in their home setting including on discharge from hospital. We received positive feedback on the work of this nurse from patients and carers.

Updated 14 November 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.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Rates of cervical screening for women were in line with those achieved locally and nationally.

• The practice had ceased to deliver extended hours surgeries in 2015 due to cost implications. Work was on-going to find an alternative way of providing extended hours surgeries for patients, that was more effective and sustainable.

Updated 14 November 2016

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

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  Care for patients experiencing poor mental health was good; 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their records, within the past 12 months.

• 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.

• We saw evidence of the practice utilizing the services of partner organisations to help meet the day to day needs of dementia patients and their carers, for example, by referring to Admiral Nurses who specialised in the care of dementia patients and who could offer practical advice and support to carers of relatives with dementia.

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

Updated 14 November 2016

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

• The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

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

• The practice 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.

• The practice were unable to evidence that they met requests from local authority  safeguarding teams, for reports for use in these meetings, when GPs were unable to attend. A new system to better manage requests for these reports had been introduced recently.