Maghull Family Surgery

Updated 7 September 2018

Maghull Family Surgery is located in Maghull, Merseyside and falls within South Sefton Clinical Commissioning Group. The practice has two contracts in place, a Personal Medical Services (PMS) and a GMS (General Medical Services) contract. Under both contracts the practice serves a local population of approximately 4800 patients.

The practice clinical team consists of two GP partners (male) and one none clinical partner, supported by two long term locum GPs, (one male and one female). A further (male) locum GP is available on an ad hoc basis for additional cover as and when required. The service has a practice nurse who works four days per week. The clinical team is supported by a practice manager, a practice administrator and seven administrative and reception staff.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 9am to 11.30am every morning and from 3.30pm to 6pm daily. Extended surgery hours are offered at the practice on Tuesday of each week, from 6.30pm to 8pm.

The practice is in a facility shared with Maghull Community Health Centre. Community midwives, health visitors and nurses are based in the building. The practice has a slightly higher than average population of older patients, with 22.6% of patients being aged 65 and over, compared to the England average of 16.7%, and the practice had 10.6% of patients over age 75 years, compared to the England average of 7.6%.

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).

Why we carried out this inspection

We undertook a comprehensive inspection of Maghull Family Surgery on 29 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as good overall but as requires improvement for providing safe services. The full comprehensive report following the inspection on June 2017 can be found by selecting the ‘all reports’ link for Maghull Family Surgery on our website at www.cqc.org.uk.

We undertook this follow up focused inspection of Maghull Family Surgery on 31 July 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Updated 7 September 2018

We carried out an announced comprehensive inspection at Maghull Family Surgery on 27 June 2017. The overall rating for the practice was good but we rated the practice as requires improvement for providing safe services. This was because the practice did not have robust arrangements in place for monitoring patients on high risk medicines. We issued a requirement notice for the provider to address this issue.

The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Maghull Family Surgery on our website at www.cqc.org.uk.

This inspection was carried out on 31 July 2018 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breach in regulations identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found that the provider had taken appropriate action to ensure an effective system was in place for monitoring patients on high risk medicines.

Our key findings were as follows:

• The provider had reviewed and updated their systems and processes to ensure that risks associated with high risk medicines were closely monitored to protect patient safety. A spreadsheet had been introduced to ensure a regular overview of patients requiring regular tests linked to the medicines they were prescribed.

We had also made a number of recommendations following our June 2017 inspection. We therefore also looked at the providers progress in addressing these. Our findings were as follows:

• The provider had reviewed the processes in place for the management of test results to ensure there are no delays dealing with results.
• A system had been put in place to monitor patient referrals to hospital under the two week wait rule.
• The system for managing patient safety alerts had been reviewed to ensure all relevant alerts were acted upon and that information on the actions taken were documented.
• Blank prescription forms were stored securely and removed from surgery/consulting rooms when not in use.
• A risk assessment has been carried out to identify a list of medicines, in line with best practice, that should be in place for use in an emergency situation.

• An action plan had been implemented to improve the service, in response to results of the national GP patient survey.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice.

Updated 21 August 2017

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

• 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 immunisations received these.

• Practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health.

• Patients with several long term conditions were offered a single, longer appointment to avoid multiple visits to the surgery.

• All these patients had a named GP and 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 21 August 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.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• 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.

• The practice engaged with the younger people and teenage population and had worked to improve outcomes in areas such as teenage sexual health, smoking cessation for young people and increase vaccination and immunisation uptake.

Updated 21 August 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. Older patients were involved 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.

Updated 21 August 2017

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

• 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, extended opening hours and Saturday appointments.

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

Updated 21 August 2017

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

• The practice carried out advance care planning for patients living with dementia.

• 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.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 21 August 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 homeless people, travellers and 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 regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.