Miriam Medical Centre

Updated 16 March 2016

Miriam Medical Centre is registered with CQC to provide primary care services, which include access to GPs, family planning, ante and post-natal care. The practice is based in Birkenhead, Wirral. The practice is situated in an area of high deprivation.

The practice has a Primary Medical Services (GMS) contract with a registered list size of 5459 patients (at the time of inspection). The practice has two GP partners, a nurse practitioner partner and four salaried GPs. They are a training practice for trainee GPs. The practice also has five nurse practitioners, four practice nurses, two healthcare assistants, a practice manager and a number of administration and reception staff.

The practice is open between 8am to 6.30pm Monday to Friday with appointments bookable in a variety of ways. Extended access is available Monday and Wednesday from 6.20pm to 8pm. The practice has a minor injury and illness drop in clinic which is open seven days a week including bank holidays from 10am. Home visits and telephone consultations are available for patients who required them, including housebound patients and older patients. There are also arrangements to ensure patients received urgent medical assistance when the practice was closed. Out of hours patients are asked to contact the NHS 111 service to obtain healthcare advice or treatment.

We discussed with the practice the need to ensure an application to register the new GP partner is submitted to the Commission as a matter of urgency.

Updated 16 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Miriam Medical Centre on 21 January 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 and an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand.

• 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 practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of the requirements of the Duty of Candour (this means providers must be open and transparent with service users about their care and treatment, including when it goes wrong.

We saw areas of outstanding practice including:

• The practice operated a minor injury and illness drop in clinic. This clinic was a nurse practitioner led clinic that operated Monday to Sunday and was open on bank holidays. This service was available to patients from the practice and the wider community and offered patients a viable alternative to attending the local A&E department.

• The practice had an effective audit system in place and shared audits with other practices within the CCG area to promote improvement in services to patients.

• The practice had detailed protocols and support networks in place to support nursing staff working in the minor injury and illness drop in clinic. These protocols promoted safe care and treatment.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 16 March 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 percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 90% compared to the national average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

Updated 16 March 2016

The practice is rated as good for the care of families, children and young people.

• There were effective systems in place to identify, monitor 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 high for all standard childhood immunisations.

• 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.

• The CQC data pack showed that screening rates of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 81.04% compared to the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice operated a minor injuries and illness drop in clinic which was available to their patients and the wider community. The clinic operated seven days per week and was open on bank holidays.

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

• The practice hosted a number of health and social support agencies such as employment support, counselling and citizens’ advice to offer support and advice to patients.

Updated 16 March 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.

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

Updated 16 March 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 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.

• The practice operated a minor injuries and illness drop in clinic which was available to their patients and the wider community. The clinic operated seven days per week and was open on bank holidays.

Updated 16 March 2016

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

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, compared with the national average of 88%.

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

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 16 March 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 homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.