Peelhouse Medical Plaza

Updated 19 November 2015

Peelhouse Medical Plaza is based in a residential area of Widnes close to all local amenities. The practice is based in a more deprived area when compared to other practices nationally. The number of patients claiming disability living allowance and with health related problems in daily life is higher than average when compared to other practices nationally. There were 14150 patients on the practice list at the time of inspection. The practice has seven partners, six who are male GPs and one female GP, an advanced nurse practitioner, three practice nurses, a health care assistant, an assistant practitioner, a practice manager, reception and administration staff. The practice also houses other services such as: an NHS pharmacy, NHS optician, private physiotherapy, CAD (citizen advice bureau) bureau, community trust services such as district nurses and the practices also has its own lecture theatres with various meeting rooms. Peelhouse Plaza is a Community Wellbeing Practice, which means that it is connected with community support and services that can help patients to stay well throughout life.

The practice is open Tuesday to Friday from 8am to 6.30pm with extended hours each Monday open from 8am to 8pm. Patients requiring a GP outside of normal working hours are advised to contact the surgery and they will be directed to contact the local out of hour’s service. The out of hour’s provider is UC24.

The practice has a Personal Medical Services (PMS) contract. In addition the practice carried out a variety of enhanced services such as: avoiding unplanned admissions to hospital.

Updated 19 November 2015

We carried out an announced comprehensive inspection at Peelhouse Medical Plaza on the 8th September 2015. Overall the practice is rated as good.

Our key findings were as follows:

• There were systems in place to mitigate safety risks including analysing significant events and safeguarding. Staff understood and fulfilled their responsibilities to raise concerns and report incidents.
• The practice was clean and tidy. The practice had good facilities in a large adapted building with disabled access and a lift to staff offices on the first floor.
• The clinical staff proactively sought to educate patients to improve their lifestyles by regularly inviting patients for health assessments. The practice used innovative and proactive methods to improve patient outcomes.
• There was an effective system in place to undertake audits of the operation of the practice and improve patient care.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.
• Patients spoke highly about the practice and the whole staff team. They said they were treated with dignity and respect and they were involved in their care and decisions about their treatment.
• The practice sought patient views about improvements that could be made to the service, including having a patient participation group (PPG).
• Information about services and how to complain was available and easy to understand. The practice proactively sought feedback from staff and patients, which it acted on.
• There was a clear leadership structure with delegated duties distributed amongst the team and staff felt supported by management. The staff worked well together as a team.
• Quality and performance were monitored

We saw areas of outstanding practice including:

• The practice had strategies in place to identify long term conditions early and therefore improve patient care, for example, to identify patients at risk of chronic obstructive pulmonary disease (COPD). This strategy had gained recognition with external accreditation and within the CCG whereby one GP acted as a lead for Respiratory health within Halton CCG and had a special interest in respiratory conditions. They had developed initiatives for better patient outcomes in regard to patients conditions associated with their respiratory health by developing an assessment tool. This tool covered not only clinical features but also a patient’s home situation, their mobilising needs, diet and all other aspects of care to help encompass a more holistic approach and to identify triggers and understanding of each patient’s needs. COPD audits in 2014 and 2015 showed implemented changes to the assessment tools and quality improvements to helping patients with needs such as using their inhaler and teaching appropriate techniques to patients. This work had led to a respiratory strategy for Halton CCG offering a holistic assessment and approach for patients and sharing their initiatives and best practice in assessing high risk patients to other practices within the CCG.
• The practice ran an effective warfarin clinic managed by the advanced nurse practitioner who was able to see a broad range of patients. The practice carried out monitoring of patient satisfaction surveys each year for the service provided by the warfarin clinic which showed a high satisfaction rate 94.3% amongst patients. Re audits showed the effectiveness of their in-house warfarin clinic with results seen for 2013 and 2015 showing monitoring arrangements and assessments carried out. The results helped to show improvements to patients diagnosis, helped stabilise therapeutic medication levels and offered at least annual reviews with all patients recalled. Data produced by the practice comparing figures for 2010 compared to 2015 showed a steady rise of time in range in spite of a steady rise in the number of patients recruited and tested as the service was developed. This indicated that better control was achieved for a far greater number of patients managed. For example in 2010, 218 patients achieved a therapeutic range compared to an increase in 2015 of 246 patients.
• The nurse practitioner managed the overall monitoring and review of unplanned admissions strategy of patients identified at risk of hospital admission. They provided monthly audits of all patient admissions and details of follow up visits to patients to help monitor and reduce admissions and to help support patients with any identified care and unmet needs. Monthly audits helped evidence improvements and positive outcomes for patients which were presented to the clinical team each month to provide good governance of at ‘risk patients.’ Data showed the number of non-elective admissions per 1000 of the practice population aged 75 years + from 2014 to May 2015 showed a sharp decrease. For example in 2014, 385 patients had unplanned admissions compared to 314.4 up to May 2015. Collated data from April 2013 to May 2015 showed an overall decrease in the number of unplanned admissions to hospital showing effective management of their unplanned admissions strategy.

However there were areas of practice where the provider should make improvements:

Review current storage and potential risks to the security of prescription pads when stored in office cabinets when left open for staff access to other equipment and records.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 November 2015

The practice is rated as outstanding 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 such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions, treatment and screening programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. For example, home visits were undertaken to housebound patients or those residing in residential care or nursing homes. One GP was lead for COPD and acts as a lead for respiratory health within Halton CCG. They had developed initiatives for better patient outcomes in regard to their health and associated with respiratory conditions. This strategy had been in place for a number of years and this work had gained recognition with national awards, external accreditation and recognition as good practice within the CCG.

Updated 19 November 2015

The practice is rated as good for the care of families, children and young people. Staff were knowledgeable about child protection and a GP took the lead for safeguarding. Staff put alerts onto a patient’s electronic record when safeguarding concerns were raised. The practice were in the process of formalising meetings with the health visitor to discuss any children who were identified as being at risk of abuse. The practice offered family planning advice. Immunisation rates were comparable and sometimes exceeded local CCG benchmarking for all standard childhood immunisations. Urgent access appointments were available for children.

Updated 19 November 2015

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. They kept up to date registers of patients’ health conditions. Home visits were made to housebound patients to carry out reviews of their health. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice had identified older patients who were at risk of unplanned hospital admissions and developed a care plan to support them. The practice worked with the Carers Centre to support patients who had caring responsibilities.

Updated 19 November 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this group 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 the practice offered extended hours each Monday from 18:30-2000. practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. H ealth checks were offered to patients who were over 40 years of age to promote patient well-being and prevent any health concerns.

Updated 19 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice referred patients to the appropriate services. The practice maintained a register of patients with mental health problems in order to regularly review their needs. The practice staff liaised with other healthcare professionals to help engage these patients to ensure they attended reviews and various specialists. Mental Capacity Act training was available to all staff and most staff had received this training. Staff had received training on how to care for people with mental health needs.

Updated 19 November 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, a register was maintained of patients with a learning disability and annual health care reviews were provided to these patients. All staff were trained and knowledgeable about safeguarding vulnerable patients and had access to the practice’s policy and procedures and had received guidance in this. The practice had signed up for the Safe in Town scheme and provided a safe haven for vulnerable people (vulnerable people were able to come to the practice and the person’s carers would be contacted). The practice also referred patients to Wellbeing Enterprise Services, a social enterprise to support people to achieve happier, healthier and longer lives[CB1] . Patients could be referred for support with a number of issues, including, debt management and social isolation.