Townfield Health Centre

Updated 23 October 2017

Townfield Health Centre is registered with the Care Quality Commission to provide primary care services. The practice provides GP services for approximately 6070 patients living in Wirral and is situated in a purpose built medical centre. The practice has two female and three male GPs, one advanced nurse practitioner, two practice nurses, a healthcare assistant, administration and reception staff and a practice management team. Townfield Health Centre holds an Alternative Primary Medical Services (APMS) contract with NHS England.

The practice is open Monday - Friday 8am - 6.30pm, with extended hours for pre bookable appointments on Saturday and Sunday 9am – 11am. Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, on the day appointments, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice is part of Wirral Clinical Commissioning Group (CCG) and is situated in a more deprived area. The practice population is made up of higher than average patients aged over 65 years 19% compared with 14.5% locally (CCG) and 16.5% (nationally), and lower than average numbers of patients aged under 14 years 18% compared with 20.8% locally (CCG) and 17.3% nationally.

There are a very small number of patients who require interpreter services and the practice cares for some patients who live in a care home.

The practice does not provide out of hours services. When the surgery is closed patients are directed to the GP out of hour’s service provider (NHS 111). Information regarding out of hours services was displayed on the website and in the practice information leaflet.

Updated 23 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Townfield Health Centre on 19 September 2017. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There were systems in place to mitigate safety risks including reviewing significant events and dealing with safeguarding.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Patients’ needs were assessed and care was planned and delivered in line with current legislation.

• Patients said they were treated with care, compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and feedback.
• Appointments were accessible, with extended hours opening for pre bookable appointments at the weekend.
• Patients said they had seen an improvement in access to the service since October 2016.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice had arrangements to respond to emergencies and major incidents.

• There was a clear leadership structure and staff felt supported by management. The practice sought patient views about improvements that could be made to the service; including having an active patient participation group (PPG) and acted, where possible, on feedback.

• Staff worked well together as a team, knew their patients well and all felt supported to carry out their roles.

• The provider was aware of the requirements of the duty of candour.

We saw an area of outstanding practice:

• The practice had implemented a unique, innovative performance management dashboard, in part, as a response to patient feedback to improve access and also to monitor and respond rapidly to staffing, safety and clinical issues. This dashboard provides live information across the Wirral hub for the provider. As well as addressing concerns regarding access, monitoring of staff scheduling and QOF performance, it serves as information to staff as to how well each practice is performing and acts to incentivise performance. We saw that improvements had been made to access as a direct result. Improvements in staffing resources and clinical performance was also seen.

There was an area of practice where the provider needs to make improvements and the provider should:

• Review the system for reviewing significant events and complaints on a regular basis in order to identify themes and trends and learn from these.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 October 2017

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

• The practice nurse specialised in long-term/chronic disease management and patients at risk of hospital admission were identified as a priority. As part of this they provided regular, structured reviews of patients’ health.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required regular checks received these.

• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

• Longer appointments and home visits were available for patients with long term conditions when these were required.

• Patients with multiple long term conditions could be offered a single appointment to avoid multiple visits to the surgery.

Updated 23 October 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances and ensuring the welfare of children in single parent families if a parent became unwell.

• Appointments were available outside of school hours and the premises were suitable for children and babies, for example there was a private room where mothers could breast feed.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Updated 23 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, carrying out over 75’s health checks, fall prevention assessments and Flu vaccinations for the elderly. An increase in uptake of flu vaccinations had been noted since this provider had taken over provision of GP services at this practice.

Updated 23 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

The practice had a high proportion of working age (63%) of their patient population.

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, telephone consultations, extended opening hours with pre bookable appointments available at the weekends.

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

• The practice had improved its uptake of cervical smear testing from 75% (2014/2015) to 79% for 2016/2017, this latest result being unverified and not yet published.

Updated 23 October 2017

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

• The practice held a register of patients experiencing poor mental health.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 23 October 2017

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

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

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

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

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. They provided evidence of meeting these responsibilities.