Dr RI King's Practice Also known as St. Laurence's Medical Centre

Updated 13 April 2016

Dr RI King’s practice is based in a purpose built facility in a residential area of Knowsley close to local amenities. The practice is based in a more deprived area when compared to other practices nationally. The male life expectancy for the area is 75 years compared with the CCG averages of 77 years and the National average of 79 years. The female life expectancy for the area is 79 years compared with the CCG averages of 81 years and the National average of 83 years. There were 6400 patients on the practice list at the time of inspection.

The practice has three GP partners (one female) and one male salaried GP. The practice has two practice nurses, a practice manager, a data manager, reception and administration staff. The practice is a teaching practice that hosts medical students on placement.

The practice is open Monday to Friday from 8am to 6.30pm. Appointments were accessible from 8.40am to 5.40pm. Patients requiring GP services outside of normal working hours are referred on to the local out of hour’s provider for Knowsley, Urgent Care 24 (UC24).

The practice has a Personal Medical Services (PMS) contract. In addition the practice carried out enhanced services such as health assessments for patients with learning disabilities and flu and shingles vaccinations.

Updated 13 April 2016

We carried out an announced comprehensive inspection at Dr RI King's Practice on 9th February 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety. The practice had a system in place to report significant events. However some events had not been recorded and shared with the team which limited learning from all events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.

• Risks to patients were assessed and well managed for example, arrangements to safeguard vulnerable patients, keep medicines safe and managing infection control.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff retention at the practice was good offering stability and continuity of care to patients.
• Patients were positive about the practice and the staff team. They said they were treated with dignity and respect and felt involved in decisions about their treatment.
• Information about services and how to complain was available but not displayed in the patient waiting area.
• Patients were positive about accessing appointments with a named GP and said that there was continuity of care. However some patients said they found difficulties in accessing an appointment after 8am.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.

The areas where the provider should make improvement are:

• Ensure all significant events are reported and recorded and findings shared with staff to promote learning.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Review access and availability of the complaints procedure and review ways of capturing verbal complaints and suggestions.

• Review the management and availability of appointments with patients.
• Ensure updated training is provided for all staff including infection control and the Mental Capacity Act 2005.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice kept up to date registers of patients’ health conditions. They worked closely with additional services such as cardiology, respiratory teams, diabetes and ear nose and throat (ENT) clinics.

• Longer appointments and home visits were available when needed.

• Patients with mental health needs and learning disabilities had structured annual reviews to check their health needs were being met.

• For those patients with the most complex needs, the staff worked with Macmillan nurses and the community matrons to deliver a multidisciplinary review of their care. They had identified nine patients receiving palliative care.

• The practice had identified patients who were at risk of unplanned hospital admissions and supported these patients to stay well at home.

Updated 13 April 2016

The practice is rated as good for the care of 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.

• Patients told us that children and young people were treated in an age-appropriate way. Relatives were pleased with the rapport and welcoming attitudes of the staff towards their children.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test has been performed in the preceding 5 years was comparable with national data.

• The premises were suitable for children and babies and the practice

• The practice had in-house ant- natal, post-natal clinics and flexible children’s immunisation clinics.

• Staff work closely with the domestic violence unit in Kirkby and display contact numbers in discreet patient areas including in the patient toilets.

Updated 13 April 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. All patients over 75 years had a named accountable GP. Dementia assessments were carried out in house.

• Health checks were provided for patients over 75 years and referrals made to any necessary services. The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Older patients were called annually to receive flu vaccinations and some patients were visited at home to provide this service.

• Any patients over 75 years who had attended A and E were contacted by the practice.

Updated 13 April 2016

The practice is rated as good for the 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. The practice had introduced access to telephone consultations each day.

• 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.

• Health checks were offered to patients between 40-74 years of age to promote patient well-being and address any health concerns.

Updated 13 April 2016

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

• 90.01% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is above the national average. They had identified 42 patients with dementia.

• The practice had supported patients experiencing poor mental health offering guidance on how to access various support groups and voluntary organisations. They had in-house counsellors who visited the practice several times a week.

• Staff demonstrated a good understanding of issues around patient consent however not all staff had received updated training in the Mental Capacity Act 2005. 

Updated 13 April 2016

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 circumstances that could make them vulnerable including patients with a learning disability.

• 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 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.

• Staff used translation services to assist patients who did not have English as their first language.