Enter and View Report Helsby & Elton Practice

GP Contact Details: Helsby Health Centre Lower Robin Hood Lane Helsby Cheshire WA6 0BW

Date of Visit: 31st January 2019

Time of Visit: 10.15 am

Healthwatch Cheshire Authorised Representatives (ARs): Jenny Young, Andrew Pleass

Health Centre Staff Dr Branwen Martin –Senior GP Partner Brian Yorke – Practice Manager Sue Dodds – Office Manager

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 (taken from practice website)

Our practice philosophy encompasses a strong commitment towards patient and family centred care. The practice provides family medicine with excellent clinical care in a happy working environment where there is a strong ethos of team working.

The practice premises at Helsby are well situated in a recently extended purpose-built health centre. There is a branch surgery at Elton which is 3 miles from the Helsby surgery. We are members of the West Cheshire Clinical Commissioning Group (WCCCG).

2. Acknowledgements

Healthwatch Cheshire would like to thank the service provider, manager, 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 residents 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.

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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

• To identify areas of resident 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

The Helsby practice occupies a purpose-built, single story building located in a side road off the main A56 just before Helsby town centre. Together with a branch surgery in Elton, the practice covers a geographic area including Mickle Trafford, Kingsley and part of Frodsham, and currently serves 9,500 registered patients. The Helsby surgery operates from 8.00am to 6.30pm weekdays but is also one of 6 locations in West Cheshire offering the General Practice Extended Hours service – on Mondays and Tuesdays until 8.00pm and 9.45pm respectively and at weekends between 8.00am and 5.00pm. Elton Surgery is open weekdays from 8.00am to 12.30pm. All staff cover shifts at both Helsby and Elton.

6. Methodology

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

• 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

• Reception staff were very polite and professional in checking our identity and obtaining management clearance before authorising our visit • A busy, but well-staffed practice • Reception desk dealt efficiently and politely with patients arriving for appointments 3

• Practice is part of Primary Care Network, Cheshire. Senior members of staff have positions on local boards.

8.0 Detailed Findings

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

The practice is signposted off the main Chester- Frodsham road, sharing a site with a community centre and library. Although this site is clearly signposted from the road, the community centre and library are visible on entry, yet, to a first-time visitor, the location of the health centre is not immediately evident, as it is situated to the rear left of these buildings. There is a reasonably-sized car park and the health centre entrance itself is accessed via a ramp. On the day of our visit the car park surface was very icy, which could have presented difficulties for patients, but the ramp and health centre entrance were well gritted.

A board to the left of the entrance lists 6 resident doctors and the surgery telephone number

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

The reception area is light, airy and welcoming. Many notices and leaflets are displayed; there is seating to the left of the reception desk and a children’s table, chairs and play area. Check-in for appointments is either via the manned reception desk or a touch screen on a wall to the left.

On announcing our visit, the receptionist asked to see our Healthwatch identification badges, advised us that the Practice Manager was currently in a meeting off-site and announced us to the Office Manager, Sue Dodds, who in turn introduced us to the Senior GP Partner, Dr Martin. All staff met were very polite, welcoming and aware of the role of Healthwatch.

A steady flow of patients were arriving for appointments; the atmosphere throughout was calm and efficient.

8.3 Internal physical environment

8.3.1 Décor, Lighting, heating, furnishing & floor coverings in the building.

The reception area is clean, free of clutter and is carpeted. Décor throughout the building appeared in good order. The meeting room in which we met the practice manager and office manager was until recently used as a baby clinic until relocation of the latter to Frodsham, and is awaiting decoration.

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Clear well- presented reception desk with clear signage respecting patient privacy for appointments.

The practice manager stated that he felt the building ‘could do with a good overhaul’ but recent maintenance work has included a new fire alarm system, replacement double glazing and conversion of one room to a minor surgery consultation room.

8.3.2 Freshness, cleanliness/hygiene & cross infection measures

The building was odour-free and at a pleasant temperature despite the icy conditions outside. A hand sanitiser was located in the entrance next to the appointment check-in screen. A further hand sanitiser was visible on the wall behind the reception desk.

Hand sanitiser in reception area next to check-in screen.

8.4 Suitability of design to meet needs of patients

The practice is on one level, with plenty of space for access by users in wheelchairs or using other mobility aids. Two waiting areas are to the right of the reception desk with plenty of seating, display boards with health

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care advice and leaflets. The main waiting area lists the doctors on duty and has a television screen.

A display board in waiting area lists doctors on duty with relevant room number. Minutes of patient participation group meetings are also displayed.

Health care advice displayed in waiting area.

8.5 Staff support skills & interaction

8.5.1 Affording dignity and respect

The practice is well-staffed with full and part-time employees and also avails of the services of visiting clinicians, physicians and district nurses. Seven GP partners own the business. There is one salaried GP and currently two trainees in the practice- a trainee registrar and a student GP. There are 10 part-time receptionists in total and a further six admin staff in addition to the practice manager and office manager.

Patients met were generally happy with the service and treatment provided by the practice. One gentleman who lives within walking distance

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from the practice makes his appointments in person and stated ‘It’s excellent. I’ve never had any problems. I can’t fault it’.

Another:

‘I can ring at 8.00 am or come into the practice for an appointment. I’m happy with the service’.

A lady with a toddler had rung in for an appointment for her child that morning ‘I’ve never had a problem in 3 years with the practice’.

One dissenting note was sounded by a gentleman who had rung at 8.00am for an 11.00 am appointment with a nurse practitioner as ‘I didn’t need to see a GP’ but had been waiting 20 minutes for his appointment. He quoted a previous instance, which he admitted had been an exception, when he had waited 1 hour and 20 minutes for his booked-in appointment, but was annoyed that during the delay there were no updates to him in the waiting room. ‘They didn’t have enough spare capacity for things that day’. He stated that he had been with the practice for 25 years and was generally happy. ‘I always ask to see one of two doctors. I’m the same with my cars. I only trust one or two mechanics when something goes wrong’. When asked, he did state that he’d never had any problems with administration of repeat prescriptions. ‘Perfect. No problems’.

8.5.3 Effective communications – alternative systems and accessible information

Appointments can be booked by phone, on-line or in person for up to two weeks in advance. The practice also keeps a number of time slots free for urgent ‘on the day’ appointments. The practice manager stated that they are able to predict daily demand for appointments fairly accurately and quoted a 92% success rate in matching appointment capacity to demand. He also quoted a missed appointment ration of only 2.3% ‘primarily for baby immunisation clinics’.

The practice sends text reminders of appointments to patients’ mobile phones 24 hours in advance. They also ring or send letters to some patients who they know are likely to forget. The office manager stated: ‘We know the housebound or frail patients who have difficulty attending. If they are not able to visit, we put them down for a home visit by the on-duty GP’.

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Extended Hours appointment information display in reception

The practice has no non-English speaking patients although some have ‘broken English’. One receptionist is able to use sign language for deaf patients.

8.6 Feeling safe and able to raise concerns and complaints.

The practice has an active Patient Participation Group, attended by 8 patients, 1 GP and the practice manager, which meets every two months. Meeting minutes are displayed in the waiting area. The patient participation on the group was said to be skewed towards a retiree age population.

The practice was said to conduct surveys with a virtual group of 35/40 patients and also has a Facebook page. The last published Annual survey on the practice website however is dated 2014.

9 Additional areas of observation

9.1 Comparisons of observation against provider’s website

The practice website is clear and comprehensive, listing all staff and services available. It does appear however that results of patient surveys and newsletters need to be updated on the website, if indeed available.

9.2 Comparisons with previous Healthwatch visits(s) where applicable

No previous Healthwatch visits have been reported.

9.3 Comparisons with the most recent CQC report

The last reported CQC inspection was in February 2017 (report dated 27 March 2017) when the practice received a GOOD rating.

9.4 Other observations/findings of note see points contained below

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New patients wishing to register with the practice have their address and postcode checked, are asked to bring two forms of identification including photo ID. After 24 hours they can book appointments; their first appointment being a general administration appointment to check and record any repeat prescription requirements etc.

10. Elements of observed/Reported Good Practice

• Prediction and planning of appointment demand to capacity • Low missed appointment ratio and proactive contact with potential absentees • Receptionist ability with sign-language • All staff serve both Helsby and Elton surgeries.

Recommendations

• Consider a further direction sign to Health Centre to indicate to first-time visitors its location relative to community centre and library • Ensure gritting of car park when need arises • Update annual patient survey reports and newsletters on website if available • Re: patient comments on updates to waiting room when appointments are delayed. Consider action as necessary.

11. Service Provider Response

Feedback from Provider of Service To be completed prior to publication from comments received from feedback form.

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