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 2 • 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. 3 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. 4 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. 5 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. 6 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 7 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.