Garston Family Health Centre

We carried out an announced comprehensive inspection at Garston Family Health Centre on 7 and 8 November 2023.

We have not rated this practice overall. This is because the provider had recently taken over the service and the majority of staff who provided care to patients were new and there was not enough evidence to rate effective, caring and responsive. The practice is rated requires improvement for safe and good for well-led.

The provider, Primary Care 24 (Merseyside) Limited (PC24) has the contract for the practice which was registered with CQC in June 2023. During the inspection process, the practice highlighted efforts they were making to improve outcomes and treatment for their population. These had only recently been implemented so at the time of inspection, and outcomes were still under review.

Why we carried out this inspection.

We carried out this inspection in line with our inspection priorities.

How we carried out the inspection/review

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

• The practice had systems, practices, and processes to keep people safe and safeguarded from abuse. However, a number of the systems had only recently been developed at the time of inspection and were not fully implemented.
• The systems in place for monitoring medicines that require monitoring and clinical review prior to prescribing were not effective to ensure medicines were always prescribed in line with best practice guidance.
• There was a system for recording and acting on safety alerts, however the practice was unable to demonstrate that all relevant safety alerts had been acted upon.
• Patients with long-term conditions were not always receiving appropriate monitoring and reviews.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• During the inspection process, the practice highlighted efforts they were making to improve patient experience and in turn improve the feedback given by patients. An action plan was in place addressing the negative results received in patient surveys. Any changes put into place by the provider had only recently been implemented and the effect of these efforts was not yet reflected in verified outcomes data above.
• Patients could access care and treatment in a timely way.
• The provider had undertaken audits and reviews and identified a number of significant challenges for the practice. Short, medium and longer term actions plans were developed to address these challenges.

We found one breach of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.

The provider should:

• Improve the uptake of cervical screening and children’s immunisation.
• Take action to ensure that all Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) assessments are reviewed annually.
• Continue to develop and monitor safe systems and processors for safeguarding vulnerable patients.
• Take action to ensure records of vaccinations status for relevant staff are maintained.
• Monitor the staff vacancy rates, continue the recruitment processes for vacant positions to ensure there are enough staff to provide appointments and prevent staff from working excessive hours.
• Take action to ensure the workflow arrangements for patient test results are managed safely.
• Improve communication systems to ensure patients who may be digitally excluded have their needs equally met.
• Continue to monitor the governance and risk management processes which at the time of inspection were newly developed.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care