Archived: Dr Manuel Enrique Martin Hierro Also known as Woodchurch Medical Centre

Updated 19 March 2015

Dr Manuel Enrique Martin Hierro is registered with the Care Quality Commission to provide primary care services. It provides GP services for approximately 2100 patients living in and around the Woodchurch area of the Wirral. The practice has one GP who is supported by locum GPs, a practice manager, practice nurse, phlebotomist and administration and reception staff. At the time of the inspection Dr. Martin-Hierro was suspended from the clinical performers list by NHS England. He was managing the practice which had locum GPs and the practice nurse and phlebotomist undertaking clinical duties.

The practice is open Monday to Friday from 8.00am to 6.30pm. Patients can book appointments in person or via the telephone. The practice provides telephone consultations, pre bookable consultations, 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). The practice is situated in a deprived area of the country. The practice population is made up of a higher than national average younger population and a lower than national average of patients aged over 65 years. Sixty three percent of the patient population have a long standing health condition and there is a higher than national average number of unemployed and patients claiming disability allowance.

The practice does not deliver out-of-hours services. These are delivered by Wirral Community NHS Trust who provides a service in the local hospital.

As part of this inspection we followed up areas of concerns identified at a previous inspection carried out in July 2014. The provider had submitted an action plan telling us how they would meet the regulations breached. We followed up these actions and improvements were evident.

The CQC intelligent monitoring placed the practice in band 1. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

Updated 19 March 2015

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Dr. Manuel Enrique Martin Hierro. The practice is registered with the Care Quality Commission to provide primary care services.

We undertook a planned, comprehensive inspection on 13 January 2015 at the practice location Woodchurch Medical Centre. We also followed up concerns that we found at the last inspection of this location in July 2014. We spoke with patients, relatives, staff and the registered provider.

The practice was rated overall as Requires Improvement. They provided care and treatment that addressed the needs of the diverse population it served however aspects of the service needed improvement.

Our key findings were as follows:

• There were aspects of safety which needed improvement to ensure systems were fully embedded to keep patients safe from risks and harm. Incidents and significant events analysis and sharing of information needed improvement. Staff were safely recruited. Infection risks and medicines were generally managed safely.

• Patients spoke highly of the practice. They told us staff were helpful and caring and treated them with dignity and respect.

• The practice provided good care to its population taking into account their health and socio economic needs. Access to suitable, convenient appointments was good and patients had confidence in the practice staff. Complaints were managed appropriately.

• Patients’ needs generally were assessed and care was planned and delivered in line with current legislation and guidance. However the practice needed to improve their recording of care and treatment in relation to patients who experienced poor mental health to ensure patients received appropriate care and treatment.

• There was good team working evident. Staff enjoyed working for the practice and felt well supported and valued. Clinical Governance systems were in place however these were not fully embedded into practice to ensure continuous quality monitoring.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

Have an effective system in place to regularly assess and monitor the quality of services provided. Have an effective system in place for identifying, assessing and managing risks related to the health and safety of service users and others. Have an effective system in place for reporting, analysing, learning from and disseminating significant events.

In addition the provider should:

• Ensure all clinical staff, including practice nurses are trained to a higher level of safeguarding than non- clinical staff and that level should be relevant to their role.
• Ensure the vaccine fridge is situated in a suitable safe location and that the fridge plug is labelled warning people not to inadvertently unplug it.
• Improve recording of care and treatment for patients with poor mental health to ensure they are reviewed and monitored regularly and that information regarding their health is gathered. Ensure any informal patient drop in sessions are fully documented.
• Ensure medical equipment and portable electrical appliances are regularly calibrated, tested and maintained.
• Hold regular documented multi-disciplinary meetings occur to discuss care and support for palliative care patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 March 2015

The practice had a higher than average number of patients with long standing health conditions (63% of its population). Patients with long term conditions were supported by staff that cared for them using good practice guidelines. Patients had health reviews at regular intervals depending on their health needs and condition. Patients spoken with confirmed medication reviews took place regularly. The practice maintained and monitored registers of patients with long term conditions for example asthma, diabetes and chronic obstructive pulmonary disease. The Quality and Outcomes Framework (QOF) information indicated that patients with long term health conditions received care and treatment similar to the national average. This included for example, patients with diabetes having regular screening and monitoring and clinical risk groups (at risk due to long term conditions) having average uptake rates for seasonal flu vaccinations. However it was noted that the practice did not hold regular multi-disciplinary meetings to review palliative care patients and aspects of the service required improvement to ensure patients with long term conditions were safe from risks and harm.

We spoke to patients with long term conditions at the inspection, they all said they received good care and treatment; staff treated them with care, compassion and respect. The practice was accessible to disabled patients.

Updated 19 March 2015

The practice served a higher than average younger population. We received positive feedback from mothers with children that we spoke with at the time of the inspection regarding their care and treatment at the practice. They told us they were confident with the care and treatment provided to them. The practice had a policy of always offering a same day urgent appointment to children who were ill.

Staff demonstrated a good understanding and awareness in safeguarding and protecting children from the risk of harm or abuse. The practice had a clear means of identifying in records those children who were subject to a child protection plan. The practice had appropriate child protection policies in place to support staff. However staff had not all received appropriate training for their role. Aspects of the service required improvement to ensure families, children and young patients were safe from risks and harm.

The practice ran weekly baby clinics with the practice nurse leading on this. They offered a full range of childhood vaccinations.

Updated 19 March 2015

The practice did not have a high population of elderly patients. Care and treatment was delivered in line with current published guidelines and good practice. For example the Quality and Outcomes Framework (QOF) information indicated the percentage of patients aged 65 and older who had received a seasonal flu vaccination was similar to the national average. It offered a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older patients in that it offered home visits and extended appointments for those with enhanced needs. The GPs supported some older patients living in nursing and care homes locally. They visited on a regular basis and undertook reviews of patients’ needs and medicines.

The practice generally safeguarded older vulnerable patients from the risk of harm or abuse. There were policies in place to support staff. However staff had not been appropriately trained in safeguarding vulnerable older people.

Updated 19 March 2015

Aspects of the service required improvement to ensure working age patients (including those recently retired and students) were safe from risks and harm including ensuring that staff were appropriately trained in safeguarding and chaperoning.

The practice had a higher than average working age population. The practice was responsive to this group’s needs. The practice offered evening appointments for patients who worked and had extended hours once a week. Telephone consultations were available and appreciated by working patients. The practice provided a full range of health promotion, such as smoking cessation, and screening that reflected the needs for this age group. The practice scored highly in the latest national GP patient survey in accessibility of appointments.

Repeat prescriptions could be ordered online and the practice website also contained various information regarding long term conditions and health and wellness.

Updated 19 March 2015

The practice maintained a register of patients who experienced poor mental health. QOF data showed that performance of recording certain information for patients with poor mental health was below average. For example the percentage of patients with psychotic disorders who did not have a comprehensive care plan, record of alcohol consumption or smoking status recorded in the preceding 12 months was well below national average. The percentage of patients diagnosed with dementia who did not have a face to face care review in the preceding 12 months was also well below the national average. The practice acknowledged the need to improve their recording of care and treatment in relation to patients who experienced poor mental health and were addressing this.

The practice supported patients with depression, however this was through informal drop in sessions and consultations were not always recorded.

Updated 19 March 2015

The practice was aware of, and identified their vulnerable patients. This was highlighted within patient records. There was evidence of the practice having discussed any concerning patients with community staff, safeguarding policies and protocols were in place. Aspects of the service required improvement to ensure patients whose circumstances may make them vulnerable were safe from risks and harm. Not all staff were appropriately trained in safeguarding and some staff who acted as chaperones had not received relevant training.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. They carried out health checks for people with a learning disability although this was found not to have always been recorded accurately in their records. They offered longer appointments for people whose circumstances may make them vulnerable when needed.