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Profile: Child’s play

25 November 2013

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With a high proportion of very young patients, Bracondale Medical Centre has excellent children’s access and has been shortlisted for this year’s General Practice Awards in two categories

With the slightly unusual patient demographics of mainly either very old or very young patients, Bracondale Medical Centre has housed GPs since 1910, before the NHS was even established.

Practice manager Rosemary Hyde (pictured, with her team) said that the reason for the patient demographics was probably related to the housing stock surrounding the practice.

“There are lots of starter homes in the area. When we lose an old person, they are usually replaced by a nice young couple who fill it up with children.

“In years gone by, these people might have then left for bigger houses just outside the practice area, and when they do, they are replaced by another young couple.”

She added though that financial restrictions these days meant that the couples were now staying for longer and so the age range of the population was slowly beginning to even out.  

Rosemary said that many of the patients had been registered there all their lives with a large handful that were now over 100 years old. 

High in patient satisfaction, the number of patients has grown from 2,500 to 4,700 since Rosemary first joined the practice 21 years ago.

To cater for their patient demographics, as well as adopting a proactive approach to care for the elderly, they also have very good access to children’s services which has led to it being shortlisted for the children’s services category of the annual Cogora General Practice Awards. 

With a lunchtime surgery set aside for children each day from Monday to Friday, the practice sees between 20-60 children each week. Rosemary said that the children’s surgery is not a variable and is never cancelled. 

Furthermore, they try and keep the focus on access for children by not having other appointments during that period, apart from nurses who may see other patients during the surgery.

“We have a fantastic children’s surgery in the afternoon, parents never have to wait. They can bring children in without appointments. We will see them no matter the time. 

“We have a staff changeover at 1pm but our children’s services can still be going on till 2pm. But at least parents know they don’t have to worry or have to ring and negotiate an appointment. If the children aren’t well and are sent home from school, they know they can get an appointment. They can come every day, and so they’re happy to use the service.”

She added that the A&E attendance rates for children were very low, reflecting good access to services.

Young families moving into the starter homes were especially keen to join the surgery as they would hear about the practice’s children’s services by word of mouth. 

“People worry about their children more than anything I think,” Rosemary said. 

Although originally, there had been one doctor that was responsible for the children’s surgery, due to the varying number of children that needed to be seen, access has been improved by putting the appointments on a central screen and sharing them out among all the doctors in the surgery.

 Rosemary said that this worked well as patients could now get more of a choice about who they wanted to see as girls might be particular about seeing a female doctor for whatever reason and vice versa. 

 Furthermore, if children needed to be seen outside of the children’s surgery, their names would still go on to a messaging screen during the evening surgery and doctors would then assess how urgent their problem was.

 She said that because many of the children had been registered with the practice since birth and had established relationships with the GPs that many had the confidence to go to the practice on their own once they were old enough, which helped with problems teenagers have about going to see a doctor.

With a midwife affiliated to the surgery, who provides continuous care up to and beyond the point of delivery, care provisions for expecting mothers are also well recommended. 

Before delivery, the midwife and a healthcare assistant help with antenatal care including performing blood tests at the surgery so that expectant mothers don’t need to go into the hospital. 

They also help with the delivery of the baby as well as providing postnatal care. 

After the baby is born, a welcome pack is sent to new mothers letting them know how they can register their babies and what vaccinations are needed. 

A date is then scheduled for the mothers to come back to the surgery, with an effort to make arrangements so that everything can be sorted out in one visit.

Located centrally, straddling the main road through Stockport (the A6), Bracondale practice works with health visitors from four different medical centres. 

Rather than each mum having to go out to the four centres to receive care, the practice is trialling a project where health visitors from the different areas come to the surgery on a Tuesday to work with the midwife.  

“We fought very hard for midwifery care to be based at the surgery, and we made a case that access to the four centres were difficult for patients,” Rosemary said.

Outside of children’s services, general access for patients is also very good with an early morning surgery on Fridays starting at 7am and a late surgery on Monday where the last appointment is at 7.45pm. 

Sometimes, the surgery goes on till half past eight or quarter to nine in the evening. 

Furthermore, the practice has open access surgeries on Mondays and Thursdays where patients can drop in without making appointments.

Rosemary said that the practice constantly monitors access to make sure that they have the right level of appointments and that if the appointment levels seem to be dropping, locums are put in place. 

“There are four to five on-the-day slots per GP session. Some are released at 6am some at 2pm, so there’s always availability coming up… we also have urgent appointments available if the need arises. Adjustments will be made day-to-day depending on need.”

Patients at the practice also have the choice of accessing healthcare via a telephone messaging system if they so choose. 

When patients call in, the messages go through a central messaging board, which appears on the computer screen of every GP in the practice, allowing GPs to monitor whether a call has been responded to or not. 

The messages are in real time, and if the message is for a particular GP, the GPs initials will be on the message marked for their attention. There is also a section on the board for urgent messages, which all GPs can respond to. Rosemary said that the message board is very useful in allowing GPs to prioritise calls.

“Patient satisfaction with our access since our telephone messaging system was installed two years ago has improved unbelievably. The patients love it,” Rosemary said.

The quality of patient access has been reflected by the results of the latest online national patient survey where 88% of the practice patients said they were able to get an appointment the last time they wanted to speak or see a GP.

This is higher than the national average of 74% and the Stockport average of 77%.

Only 2% of patients responded that they were not able to get an appointment compared to the national average of 10%.  On the same survey, 66% of their patients said that they would definitely recommend the practice to others compared to the national average of 50% and Stockport’s average of 61%.

Furthermore, out of 50 practices in Stockport, they rated the 14th lowest with respect to A and E attendances despite the fact that the practice is only three minutes from the local hospital, Stepping Hill hospital. 

“We feel this is a particular achievement as our practice is very close to the hospital and all the practices in our locality who’re close to the hospital have much higher attendance rates,” said Rebecca Baron, one of the senior partner’s at the surgery.

In addition to a stable patient population, the staff turnover rate is also very low. 

Dr Baron has just celebrated her 25th anniversary at the practice while Rosemary, Rosemary’s deputy and the practice nurse have all worked there for 21 years. Even the newest member of staff has been there six years.

“We’re a very close knit team, our family and our children have grown up together,” Rosemary said. 

A very hands-on practice manager, Rosemary helps to pick up calls if the surgery is busy, meet with patients on a regular basis or take calls with patients if required. 

With the practice being a training practice, Rosemary also spends time training staff in other practices across Stockport, where she emphasises that a decision about when patients should be seen should be initiated by the patient. 

“If you start by asking the question ‘how soon do you need to be seen,’ then the patient leads the conversation and they choose how soon they should be seen. And they guide the receptionists about whether it should be today, tomorrow or next week or if a GP call will deal with it. It shouldn’t be about telling people what you haven’t got and you need to have a positive attitude so patients don’t leave the conversation feeling dissatisfied and feeling they haven’t been given a service.”