Enter and View Report

Weaverham Surgery

Weaverham Surgery Northwich Road Weaverham NORTHWICH CW8 3EU

Date of Visit: 17th January 2019 Time of Visit: 10am – 12.30pm

Healthwatch Cheshire Authorised Representatives (ARs): Sue Masterman and Susan Farragher

What is Enter and View?

Healthwatch Cheshire (HWC) is part of a network of over 150 local Healthwatch across England established under the Health and Social Care Act 2012. HWC represents the consumer voice of those using local health and social services and trades as both Healthwatch Cheshire East and Healthwatch Cheshire West.

The statutory requirements of all local Healthwatch include an ‘Enter and View’ responsibility to visit any publicly funded adult health and social care services. Enter and View visits may be conducted if providers invite this, if HWC receive information of concern about a service and/or equally when consistently positive feedback about services is presented. In this way we can learn about and share examples of the limitations and strengths of services visited from the perspective of people who experience the services first hand.

Visits conducted are followed by the publication of formal reports where findings of good practice and recommendations to improves the service are made.

Contact Details: Healthwatch Cheshire, Sension House, Denton Drive, Northwich, Cheshire, CW9 7LU. Tel: 0300 323 0006.

1. Description & Nature of Service

An established practice providing GP-based personal primary care for around 7500 patients in rural Weaverham and the surrounding area close to Northwich, including Hartford, Cuddington, Crowton, Acton Bridge and Sandiway. There are 3 full-time and 2 part-time GPs. The practice is a member of the Vale Royal Clinical Commissioning Group.

2. Acknowledgements

Healthwatch Cheshire would like to thank Practice Manager Paul Deeley, visitors and staff for their contributions to this Enter and View visit.

3. Disclaimer

This report relates to findings gathered on a specific date of visiting the service as set out above. Consequently, the report is not suggested to be a fully representative portrayal of the experiences of all the patients and/or staff and/or family members/friends but does provide an account of what was observed and presented to HWC ARs at the time of the visit.

4. Purpose of the visit

• To enable Healthwatch Cheshire ARs to see for themselves how the service is being provided in terms of quality of life and quality of care principles • To capture the views and experiences of patients, family members/friends and staff • To consider the practical experience of patients/family and friends when visiting the service in terms of access, parking and other visitor facilities

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• To identify areas of patient satisfaction, good practice within the service and any areas felt to be in need of improvement • To enable Healthwatch Cheshire ARs to observe how the service delivers on the statements it advertises on its website.

5. Introduction/Orientation to Service

• A long interview with the Practice Manager, Paul Deeley, who has been with the practice for 8 years and was generous with his time • There has just been a CCG inspection. The results have not yet been published. The previous CCG report ranked the practice as Good • The most recent NHS GP patient survey, however, shows some poor results with patients not happy with appointment times or getting to see the GP they wanted. 62% of patients described their overall experience as “good” compared to 83% average locally and 84% average nationally [Reference: (https://www.gp- patient.co.uk/compare?practices=N81031,N81051&s=0&w=1&g=0&a=0&e =0&h=0)] • Family and Friends reports for the past 3 months, however, reflected that over 80 per cent of patients would be “extremely likely” or “likely” to recommend the practice to family and friends • The website is clear and mainly up to date • The practice does not have a functioning Patient Participation Group at the moment although former members are contacted on an ad hoc basis.

6. Methodology

ARs were equipped with various tools to aid the gathering of information. The following techniques were used by the ARs:

• Observing the quality and adequacy of access, parking and other facilities for visitors • Assessing the suitability of the environment in which the service operates in supporting the needs of the patients. • Direct observation of interactions between staff and patients • Talking to patients, visitors and staff (where appropriate and available) about their thoughts and feelings regarding the service provided.

7. Summary of Key Findings

• A well-run practice • Meticulous cleanliness • Room for improvement in communications ( ARs understand steps are being taken to resolve this) and waiting room experience • “Sit and wait” welcomed by patients unhappy with appointment delays.

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8. Detailed Findings

8.1. Location, external appearance, ease of access, signage, parking

Weaverham Surgery underwent considerable refurbishment/building works a few years ago. It is well signposted off the main Northwich Road and is near a variety of shops. There is a direct bus route along the main road. Separate off-road parking for both staff and patients appeared adequate for a quiet surgery period although we heard there are occasional problems with shoppers taking up the spaces. The building itself is very well cared for both outside and in.

Access for disabilities: Very good – wide corridors. The entrance was clean and fresh with automatic doors and a shallow ramp approach. ARs observed wheelchair users visiting with no obstacles.

8.2. Initial impressions (from a visitor’s perspective on entering the practice)

The initial impression is of a bright, clean large waiting area. The double automatic doors mainly stop cold air and drafts entering the waiting area. They also form a discreet security check.

8.3. Internal physical environment

The waiting room is large but loud with no plants, curtains or other decoration to soften its appearence or acoustics. Back office staff can personalise their rooms. There is CCTV, however we were unable to take photographs due to attendance by patients.

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8.3.1 Décor, Lighting, heating, furnishing & floor coverings

The decor is kept white or very light throughout, radiators are clean, all floor coverings are synthetic and practical with no carpeting or rugs. Lighting is bright, aided by large windows throughout most of the building. Chairs in the waiting room are plain and rigid with just a couple with arm rests. Considering the older demographic this practice serves, these might not be enough for patients who find it hard to get up from sitting.

8.3.2. Freshness, cleanliness/hygiene & cross infection measures

The hand sanitiser in the reception area was not immediately visible, being located near the door through to the consultation rooms. All other rooms were equipped with hand sanitisers. Information leaflets and information were well organised and displayed, though not immediately in the line of sight of patients who are seated in regimented rows facing a TV screen. This displays an ongoing NHS information package and the call-up for patients to go through to the doctor. All parts of the building ARs visited, including toilets and a staff room, were scrupulously clean. There were no unpleasant smells.

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8.3.3. Suitability of design to meet needs of patients

With the exception of the waiting room, the design appeared most suitable for the patients. Considering that this surgery, which looks custom built, was converted from industrial use, this is remarkable. Everything is on one floor with no stairs in the patient area. However, the waiting area, though highly functional, did not please the patients we spoke to. “I just hate it,” said one older patient who remembered the cosier waiting area in the old premises. “I really don’t like it,” said another.

Patients have to stand in a cordoned line to reach reception and once there conduct their business very publicly in a room which echoes their voices. There is a notice saying that a private room is available, but this is not directly in view of someone at the receptionist’s desk. There is an electronic check-in facility which is not located near the reception queue.

8.3.4. Staff support skills & interaction

There is a large reception staff (8 in total). All staff have regular training including Cardio Pulmonary Resuscitation every 3 years. There are also 9 Protected Learning Time (PLT) sessions per year. The office beyond the reception desk is open-plan, light and airy. The atmosphere is professional but impersonal.

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8.3.5. Affording dignity and respect

The ARs were unable to obtain a picture of the waiting room at the time of the visit as it was in use.

Dignity and respect appeared afforded except in the very public aspect of reception desk interviews.

8.3.6. Calm, empathic approach to Patients

Receptionists showed patience and empathy when dealing with more complex issues while we were there.

8.3.7 Effective communications – alternative systems and accessible information

There is an informative and well-maintained notice board providing details on sepsis, flu and other health concerns. Healthwatch Cheshire information was also on display.

Many of the problems in the GP survey report appeared to involve appointment-making and accessibility. The practice is having a new phone

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system installed. Currently only 4 callers can queue but this will be upgraded. The practice appears to have made considerable progress in getting patients to register for the electronic (EMIS) system which enables them to book appointments, reorder prescriptions and access their medical records electronically. They are well ahead of NHS targets on this. Google Translate is available, though we saw no demand for it. It was confirmed to us that the patients are overwhelmingly white British. The practice now also provides a “sit and wait” service. Patients who want to see a GP and cannot get an appointment on the day can come into the surgery every day and wait to be seen, first come first served, during a morning or an afternoon session. Appointments are scheduled to last 5 minutes in order to assess the further need. Normal appointments are scheduled for 10 minutes.

The practice does not offer physiotherapy or nutritionist advice. No blood tests are carried out on the premises and there are no district nurses based there. They do renew dressings although this is not part of their duties. Restraints appear to be due to lack of designated space and financial constraints.

The practice is part of a cluster of 7 Vale Royal practices working in the Northwich area, some of whom can provide the facilities not available at Weaverham. This initiative for practices to work together to provide a broader range of facilities is part of current NHS policy.

8.4. Ensuring comfort

See above.

8.5 Maximising Mobility

There is a ramp and hand rails to assist and the waiting room held sufficient space to move around.

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Access for disabilities: Very good – wide corridors. Entrance was clean and fresh with automatic doors and a shallow ramp approach. ARs observed wheelchair users visiting with no obstacles.

8.6 Feeling safe and able to raise concerns and complaints

There are three conspicuous files on the desk at reception which deal with the right to privacy and patient information including how to make a complaint.

The files were also next to the feedback container highlighting the opportunity to have your say.

The practice also has a very clear web page indicating its services and also makes use of social media having a well-attended Facebook page allowing/providing the opportunity to feed back and pass comments.

9. Additional areas of observation See above.

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9.1 Comparisons of observation against provider’s website

The website appears to adequately reflect what we saw. It is strictly factual.

9.2. Comparisons with previous Healthwatch visits(s) where applicable

Not subject to previous Healthwatch Cheshire Enter and View.

9.3. Comparisons with the most recent CQC report

Waiting for most recent report to be published.

9.4. Other observations/findings of note -see points contained below.

10. Elements of Observed/Reported Good Practice

Upgrading of communications and successful EMIS recruitment Responsiveness to patient requests Meticulous cleanliness Good disability access Practice Manager and staff approachable and amenable.

Recommendations

• Redesign the waiting room • Re-introduce the Patient Participation Group • More comfortable and disability-friendly seating in waiting room • Reduce receptionist turnover • More hand sanitsers to be available in the patient area

11. Service Provider Response

Feedback from Provider of Service We did not have any prior notification other than a letter circulated in December that unannounced visits by Healthwatch would be happening in the new year. The visit was a good opportunity to show what goes on behind the scenes and the visit was viewed in this way by the staff. It is good the get a third-party view on how they see things and the comments in the report are welcome and will be reviewed by the Partners and Staff. The Practice welcomes the report and the will consider fully the recommendations made to enhance the service further.

In respect of the recommendations

- More Hand sanitisers to be available in the patient area this can be easily. Currently we have two dispensers and will consider where we can put more.

- The Patient Participation Group is currently being reintroduced and patients have

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already agreed to participate as Ambassadors for the Surgery.

- More comfortable and disability-friendly seating in the waiting room is being considered by the partners. Purchasing some chairs that are more disability friendly will be looked at immediately. In respect of more comfortable seats we will have to balance this consideration with our infection control responsibilities and we will look further into what we can do about this.

- Whilst reception turnover has been high in the past the reasons for this are multi- faceted in a pressured environment. The appointment of a dedicated senior receptionist has proved to be successful in training and retaining staff.

- A redesign of the waiting room is a significant recommendation. We would welcome any ideas that Healthwatch may have in this area and are happy to meet you to discuss this further. We are happy to consider what can be done to improve on what we have given the constraints of the building and finances for this purpose.

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