Stockbridge Village Medical Centre

Updated 6 June 2017

Dr P Rigby and Partners is registered with the Care Quality Commission to provide primary care services. The practice provides GP services for approximately 8500 patients living in and around Knowsley. It is situated in a purpose built medical centre. The practice has three female GPs, three male GP, three practice nurses, administration and reception staff and a practice manager. It is a training practice and has GP registrars working at the practice. Dr P Rigby and Partners holds a General Medical Services (GMS) contract with NHS England.

The practice surgery hours are: Monday, Tuesday, Wednesday and Friday 7am to 11am and 3pm to 5pm. Thursday they are open 7am to 11am and closed in the afternoon. 7am - 8am appointments are offered as extended hour's access to GPs. Telephone lines are open from 8am to 6.30pm Monday to Friday. Patients can book appointments in person, via the telephone or online. The practice provides 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 Knowsley Clinical Commissioning Group (CCG) and is situated in a deprived area with the population having above averages rates of premature mortality, high chronic disease burden and a low healthy life expectancy. Fifty five per cent of the practice patient population has a long standing health condition. The practice population is made up of around national average population groups with 22% of the population under 18 years old and 16% of the population aged over 65 years old. Life expectancy for both males and females is lower than the CCG and national average.

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

Updated 6 June 2017

We carried out an announced comprehensive inspection at Dr Rigby and Partners on 29 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Dr Rigby and Partners on our website at www.cqc.org.uk.

This inspection was a focused follow up inspection carried out on 3 April 2017 to check if the provider had carried out their plan to meet the legal requirements in relation to the breaches identified for the domains for Safe and Well led. This report covers our findings in relation to that and additional improvements made since our last inspection 29 November 2016. We had issued three requirement notices regarding the breaches of regulations.

Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.

The provider did not assess, monitor, manage and mitigate risks to the health and safety of patients, public and staff. They had failed to identify the associated risks by the lack of health and safety procedures, systems and processes including those associated with infections and fire safety.

Regulation 13 HSCA (RA) Regulations 2014 Safeguarding service users from abuse and improper treatment. The provider did not have full systems and processes in place to prevent abuse in that staff were not suitably trained or updated at a level suitable to their role.

Regulation 17 HSCA (RA) Regulations 2014 Good governance. The provider did not have effective systems in place to assess, monitor, manage and mitigate the risks relating to the health, safety and welfare of patients and others. The provider did not have effective systems in place to ensure their governance systems remained effective.

The findings of this inspection were that the provider had taken a number of actions to meet the requirement notices issued and improvements had been made since our last inspection. Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had addressed the issues identified during the previous inspection.

• Risks had been assessed, monitored and mitigated with updated risk assessments including health and safety, infection control, environmental and fire risk assessments. Fire safety drills were undertaken and there was an identified fire marshall within the staff team.

• Recruitment arrangements had been reviewed and updated and now included all necessary employment checks.

• Staff were trained and updated appropriately in core topics such as health and safety, infection control, safeguarding and fire safety. Staff received safeguarding training at a level relevant to their role.

• Policies and procedures relating to health and safety and other relevant policies had been updated since our last inspection and were specific to the practice.

• Effective governance arrangements were in place and monitored to ensure they remained effective.

• In addition, the practice had made the following improvements:

• Significant events were regularly reviewed in order to identify themes and trends.

• Storage of medical records had been reviewed with updated guidance and procedures for staff to follow to help minimise the risk of loss or damage due to environmental factors.

• The recording/documentation of all meetings including multi-disciplinary meetings had been reviewed to ensure clear records were kept.

• The documentation and recording of staff induction had been reviewed and provided for any new members of staff.

• The system for monitoring clinical staff’s professional registration had been reviewed there was a staff log to support regular monitoring and updates to individual registrations.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 June 2017

At the previous inspection in November 2016 the practice was rated as requires improvement for providing care of people with long term conditions because the issues identified as requires improvement in the safe and well led domain affected all patients including this population group. At this follow up inspection 3 April 2017, the domains for safe and well led were assessed as good. The population group ratings have been updated to reflect this. The practice was rated good for providing care of people with long term conditions.

• Nursing staff and GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance indicators for patients with long term conditions were around or above the CCG and National average. For example:

• The percentage of patients on the diabetes register, in whom the last blood pressure reading (measured in the last 12 months) was 140/80mmHg or less was 82%. The CCG average was 82% and the national average was 78%. The percentage of patients with asthma, on the register, who have had an asthma review in the preceeding12 months that includes an assessment of asthma control using the three RCP questions was 83% (compared to the CCG average of 79% and national average of 75%).

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

• All these patients had 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. Medical records for vulnerable patients with long term conditions were highlighted so that all staff knew their needs and arranged appointments and care accordingly.

Updated 6 June 2017

At the previous inspection in November 2016 the practice was rated as requires improvement for providing care of people with families, children and young people because the issues identified as requires improvement in the safe and well led domain affected all patients including this population group. At this follow up inspection 3 April 2017, the domains for safe and well led were assessed as good. The population group ratings have been updated to reflect this. The practice was rated good for providing care of people with families, children and young people.

• There were systems in place 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 A&E attendances.

• Immunisation rates were good for all standard childhood immunisations with immunisations uptake for all children aged five and under on average around 95%. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Unwell children were always offered same day/urgent appointments.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was comparable to other practices at 77%.

• Appointments were available outside of school hours.

• We saw positive examples of joint working with midwives, health visitors and school nurses

Updated 6 June 2017

At the previous inspection in November 2016 the practice was rated as requires improvement for providing care of older people because the issues identified as requires improvement in the safe and well led domain affected all patients including this population group. At this follow up inspection 3 April 2017, the domains for safe and well led were assessed as good. The population group ratings have been updated to reflect this. The practice was rated good for providing care of older people.

• The practice had an elderly population around the national and local Clinical Commissioning Group (CCG) average of elderly patients with 16% over the age of 65. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments for those with enhanced needs. Nationally reported data showed that outcomes for patients for conditions commonly found in older people were good. For example, the percentage of patients with hypertension in whom the last blood pressure reading was 150/90mmHg or less was 84% and comparable to the CCG and national average. 

• The percentage of patients with atrial fibrillation treated with anticoagulation therapy was 100% and higher than the CCG and national average.

• All the older patients (over the age of 75) had a named GP who coordinated their care. The practice had a GP lead for elderly care who liaised with the local elderly care network in caring for patients.

Updated 6 June 2017

At the previous inspection in November 2016 the practice was rated as requires improvement for providing care of working age people (including those recently retired and students) because the issues identified as requires improvement in the safe and well led domain affected all patients including this population group. At this follow up inspection 3 April 2017, the domains for safe and well led were assessed as good. The population group ratings have been updated to reflect this. The practice was rated good for providing care of working age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students 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, it offered online bookings of appointments and prescription requests and offered early morning appointments. Appointments could be pre booked or booked on the day and emergency appointments were also available daily for those in need and all children.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group for example NHS health checks for those aged 40 to 75 years old.

Updated 6 June 2017

At the previous inspection in November 2016 the practice was rated as requires improvement for providing care of people experiencing poor mental health (including people with dementia) because the issues identified as requires improvement in the safe and well led domain affected all patients including this population group. At this follow up inspection 3 April 2017, the domains for safe and well led were assessed as good. The population group ratings have been updated to reflect this. The practice was rated good for providing care of people experiencing poor mental health (including people with dementia).

• 79% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

• 98% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months which was above the national average of 94% and CCG average of 88%.

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

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

• The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations and could signpost to relevant specialist services.

• The practice had a system in place to follow up patients with poor mental health who did not attend appointments.

• Longer appointments were offered to those patients with poor mental health.

Updated 6 June 2017

At the previous inspection in November 2016 the practice was rated as requires improvement for providing care of people whose circumstances may make them vulnerable because the issues identified as requires improvement in the safe and well led domain affected all patients including this population group. At this follow up inspection 3 April 2017, the domains for safe and well led were assessed as good. The population group ratings have been updated to reflect this. The practice was rated good for providing care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, those with substance or alcohol misuse and those with a learning disability.

• The practice promoted “No Barriers” to accessing GP services and people were able to register without fear of stigma or prejudice.

• 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 informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff had received appropriate training and updates relative to their role.