West Wirral Group Practice - AR Johnston

Updated 31 May 2017

West Wirral Group Practice - AR Johnston is registered with the Care Quality Commission to provide primary care services. The practice provides GP services for approximately 13,600 patients living in Wirral and is situated in a purpose built medical centre. The practice has five female GPs, six male GPs, an advanced nurse practitioner, three practice nurses, four healthcare assistants, administration and reception staff and a practice management team. It is a teaching/training practice and occasionally has medical students and trainee GPs working at the practice. West Wirral Group Practice – AR Johnston holds a General Medical Services (GMS) contract with NHS England and is part of the NHS Wirral Clinical Commissioning Group (CCG).

The hours of practice are:

Monday 7am – 5.45pm

Tuesday 8am – 5.45pm

Wednesday 7am – 5.45pm

Thursday 8am – 5.45pm

Friday 8am – 5.45pm (normal core hours for GMS contract are 8am – 6.30pm)

Patients can book appointments in person, via the telephone or online. 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) and is situated in an affluent area. The practice population is made up of a mostly working age and elderly population with 48% of the population aged over 65 years old. Sixty one percent of the patient population has a long standing health condition and there is a lower than national average number of unemployed patients.

The practice does not provide out of hours services. When the surgery is closed patients are directed to the local out of hours service provider via the NHS111 service. Information regarding out of hours services was displayed on the website and in the practice information leaflet.

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West Wirral Group Practice - AR Johnston on 19 April 2016. The overall rating for the practice was good, however we found improvements were needed under the key question is the service well led. The full comprehensive report for the April 2016 inspection can be found by selecting the ‘all reports’ link for West Wirral Group Practice - AR Johnston on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were that the provider had met the legal requirements and had made the following improvements:-

• An effective clinical audit programme had been implemented to assess, monitor and improve the quality and safety of services.

• An effective system was in place to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• An effective system had been implemented by which patient views were analysed, acted on and feedback was used to help improve services.

• All staff were trained to an appropriate level for their role in safeguarding of children and protection of vulnerable adults.

• Records relating to staff now included information relevant to their employment in the role including information relating to the requirements under Regulations 4 to 7 and Regulation19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in particular Disclosure and Barring Service checks relevant to the role.

• Records relating to staff were stored safely and securely in accordance with current legislation and guidance.

In addition the practice had made the following recommended improvements:

• Practice policies and procedures had been reviewed and revised to reflect current guidance and legislation.

• The process for learning from significant events and complaints included regular reviews to learn from themes and trends and to monitor completion of action plans.

• Arrangements for receiving and recording the response to patient safety alerts, recalls and medication safety alerts.

• The format of staff meetings had been reviewed to include documented dissemination of lessons learnt from significant incidents, events and complaints and sharing improvements from audits and patient feedback.

• Infection control audits were undertaken six monthly and action plans were documented and complete.

• The cleaning schedule had been reviewed and was now displayed. Cleaning equipment was found to be stored appropriately.

• Training, learning and development needs of staff members was reviewed at appropriate intervals (annual appraisal) and a process was in place for the on-going assessment and supervision of all staff employed which included ensuring staff are up to date with mandatory training including safeguarding, infection control.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 May 2016

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

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 patients with long term conditions effectively.

• GPs, supported by practice nurses, had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Annual reviews for all patients with long term conditions such as diabetes and asthma were offered.

• Performance indicators for the management of long term conditions such as diabetes were around or above national average.

• Longer appointments and home visits were available when needed.

• All patients had a named GP and a structured annual review to check that their health and medicines needs were being met. Systems in place ensured patient recalls were highlighted.

• The GPs and nurses 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 25 May 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 vulnerable, for example, children and young people who had a high number of A&E attendances and those who did not attend for appointments.

• Immunisation rates were high for all standard childhood immunisations with immunisations uptake for all children aged five and under around 97%.

• 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 around the national average at 81%.

• We saw positive examples of joint working with midwives and health visitors. The practice worked with a local primary school to deliver health education to children.

Updated 25 May 2016

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

The practice had a higher than national and local clinical commissioning group (CCG) average number of elderly patients with 48% 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 avoiding unplanned admissions, dementia, nursing and residential care home support and end of life care.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

The practice carried out fall risk assessments to help identify patients at risk of falls and injury.

Updated 25 May 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. For example, it offered a text messaging service to remind patients about their appointments and to cancel appointments more easily.

• It offered early morning (from 7am) appointments and telephone consultations.

• The 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 for example NHS health checks for those aged 40 to 75 years old.

Updated 25 May 2016

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

• The practice carried out advanced care planning for patients with dementia and 85% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (around the national average of 84%).

• 92% of people experiencing poor mental health (higher national average of 88%) had a comprehensive documented care plan in place.

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

• It had a system in place to follow up patients where they may have been experiencing poor mental health. Systems were also in place to recall patients with dementia and poor mental health when they did not attend for appointments.

Updated 25 May 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 vulnerable circumstances including those at risk of hospital admissions, those at the end of their life, those with a learning disability and children at risk.

• It offered longer appointments for people with a learning disability.

• The practice, together with the PPG, had implemented a directory and was able to inform vulnerable patients about how to access various support groups and voluntary organisations.

• Staff were familiar with patients from this group and knew and understood family dynamics.

• Staff knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities regarding information sharing and sharing concerns.