Archived: Townfield Health Centre - Dr Lee

Updated 31 March 2015

Townfield Health Centre- Dr Lee is registered with the Care Quality Commission to provide primary care services. It provides GP services for approximately 6600 patients living in and around the Prenton area of Birkenhead. The practice has one GP partner (male), one salaried GP (female), a vacant GP post covered by locum doctors, a practice manager, practice nurses, healthcare assistant, administration, IT and reception staff. Townfield Health Centre holds an APMS contract with NHS England (Cheshire, Wirral and Warrington area team).

The practice is open Monday to Friday from 8.00am to 7.00pm with an extended surgery on Saturday mornings (9.00am to 11.45am) for pre bookable appointments. 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 an economically mixed area with some areas of affluence and some deprived areas. The practice population is near the national average for most age groups with a slightly higher than national older population aged over 65 years of age. Sixty percent of the patient population has a long standing health condition whilst 73% of patients claim disability allowance (these are higher than the national average). There is a lower than national average number of unemployed.

The practice does not deliver out-of-hours services. These are delivered by Wirral Community NHS Trust.

As part of this inspection we followed up areas of concerns identified at a previous inspection carried out in August 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 31 March 2015

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Townfield Health Centre - Dr Lee which is registered with the Care Quality Commission to provide primary care services.

We undertook a planned, comprehensive inspection on 27 January 2015 at the practice location in Townfield Health Centre. We spoke with patients, relatives, members of the patient participation group, staff and the practice management team.

The practice was rated as good. A safe, caring, effective, responsive and well- led service was provided that met the needs of the population it served.

Our key findings were as follows:

• Systems were in place to ensure patients were safe from risks and harm. Incidents and significant events were identified, investigated and reported. Lessons learnt were disseminated to staff. Improvements were needed to ensure staff were safely recruited, including locum GPs. Infection risks and medicines were overall safely managed.

• Patients care needs were assessed and care and treatment was considered in line with best practice national guidelines. Staff were proactive in promoting good health and referrals were made to other agencies to ensure patients received the treatments they needed.

• Feedback from patients showed overall they were happy with the care given by all staff. They told us staff listened to them, were kind, caring and compassionate and treated them with dignity and respect.

• The practice planned its services in response to the differing needs of patients. The appointment system provided access to the service. Patients were encouraged to give their views about the service and the practice listened to them.

• There was a clear leadership structure in place. Quality and performance were monitored, risks were identified and managed. The practice ensured that staff had access to learning and improvement opportunities.

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

The provider should:

• Ensure that infection control training and update is undertaken by all staff on a regular basis.
• Ensure that full checks are undertaken on independent locum GPs prior to employment.
• Ensure that the environmental risk assessment is specific to the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2015

The practice had a higher than average number of patients with long standing health conditions (60% of its population). Patients with long term conditions were supported by a healthcare team that cared for them using good practice guidelines and were attentive to their changing needs. There was proactive intervention for patients with long term conditions. Patients had health reviews at regular intervals depending on their health needs and condition. The practice maintained and monitored registers of patients with long term conditions for example cardiovascular disease, diabetes, chronic obstructive pulmonary disease and heart failure. These registers enabled the practice to monitor and review patient with long term conditions effectively.

The practice also maintained a register of housebound patients to ensure that they received a home visit from a nurse at the practice to review any long term conditions. Clinical staff kept up to date in specialist areas which helped them ensure best practice guidance was always being considered. The practice had identified all patients at risk of unplanned hospital admissions and a care plan had been developed to support them. The practice had a palliative care register and held regular multidisciplinary meetings to discuss the care and support needs of patients and their families.

We spoke to patients with long term conditions at the inspection, they all said they received very good care and treatment and were reviewed regularly. Staff treated them with care, compassion and respect.

Updated 31 March 2015

Child health surveillance and immunisation clinics were run on a weekly basis. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns. The staff were responsive to parents’ concerns and ensured children and babies had access to urgent and same day appointments as needed.

Staff were knowledgeable about child protection and a GP took the lead for safeguarding. Staff put alerts onto the patient’s electronic record when safeguarding concerns were raised. Regular meetings were held with the health visiting service to discuss any children who were at risk of abuse and to review if all necessary GP services had been provided.

We received positive feedback regarding care and treatment at the practice for this group. Patients we spoke with told us they were confident with the care and treatment provided to them.

Updated 31 March 2015

The practice was knowledgeable about the number and health needs of older patients using the service. They kept registers of patients’ health conditions and information was held to alert staff if a patient was housebound. The practice had a record of carers and used this information to discuss any support needed. The practice actively promoted carers support services and actively identified and supported people to join carer support groups.

The practice offered a range of enhanced services, for example, avoiding unplanned admissions, and seasonal flu vaccinations. It was responsive to the needs of older patients, and offered home visits and extended appointments for those with enhanced needs. The GPs supported older patients living in care and nursing homes locally. The practice had identified all patients at risk of unplanned hospital admissions. The majority of these patients had a completed care plan to support them and the practice was well on their way to complete care plans for all at risk patients by the end of the year.

The practice safeguarded older vulnerable patients from the risk of harm or abuse. There were policies in place, staff had been trained and demonstrated knowledge regarding vulnerable older people and how to safeguard them.

Updated 31 March 2015

The practice is rated as good for the population group of working-age people (including those recently retired and students). We found the practice had a range of appointments available including pre-bookable, on the day and telephone consultations. The practice cared for this population group well within line with national guidelines and legislation. The practice was open 8.00am until 7.00pm Monday to Friday with every Saturday morning 9.00am until 12.00n noon for pre bookable appointments that were convenient to patients who worked. Telephone consultations were available and supported working patients.

Staff told us they would try to accommodate patients who were working to have early or late appointments wherever possible. The practice monitored patient satisfaction with access to the service through patient feedback. Patient feedback indicated patients were satisfied with the range of appointments available. Health checks were being offered to patients who were 40 – 74 years of age to promote patient well-being and prevent any health concerns.

Updated 31 March 2015

The practice maintained a register of patients who experienced poor mental health, including those with dementia. The register supported clinical staff undertake annual reviews and we found that nearly all patients (97%) registered as having had dementia had been reviewed. The practice monitored patients with poor mental health according to clinical quality indicators and in line with good practice guidelines.

The practice had information for patients in the waiting areas to inform them of other services available. For example, for patients who may experience depression or those who would benefit from counselling services for bereavement. The practice referred patients to appropriate services such as psychiatry and counselling services. Members of the practice staff had undertaken additional training in counselling and were able to assist identifying and supporting patients with specific needs.

Updated 31 March 2015

The practice was aware of, and identified their vulnerable patients. This was highlighted within patient records. The practice discussed any concerning patients as a team and with the extended multi-disciplinary teams. Safeguarding policies and protocols were in place and staff were trained in safeguarding vulnerable adults and children. The safeguarding lead was a GP who had received appropriate training.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. They carried out annual health checks for people with a learning disability and offered longer appointments for people with a learning disability when needed