Archived: Lime Grove Surgery

Updated 14 May 2015

Lime Grove Surgery is registered with the Care Quality Commission to provide primary medical services. The practice holds a Primary Medical Service (PMS) contract within the centre of St Helen’s. The practice operates from two locations, a main surgery in St Helens and a branch surgery also in St Helens. Doctors and practice staff work at both locations across the week. This inspection took place at the main location within the Haydock Medical Centre building. The practice has a complete primary health team consisting of four GP partners, two locum GPs, two practice nurses, reception secretarial and administration staff. The practice has a lead GP partner with a total of five GPs working there.

The practice is part of St Helen’s Clinical Commissioning Group (CCG).The practice is situated in an area with high deprivation. The practice population has a higher than national average patient group aged 65 + years and there are higher deprivation scores for older patients compared to national figures. Sixty per cent of the patient population has a long standing health condition, whilst 55% have health related problems in daily life. There is a slightly lower than national average number of unemployed.

The practice is open Monday to Friday from 8.45am to 5.30pm with no extended hours as part of their PMS contract. Patients can book appointments in person, online or via the phone. 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 medical services.

From data we reviewed as part of our inspection we saw that the practice outcomes are in line with those of neighbouring practices within the area. The practice keeps up to date registers of those patients with learning disabilities, mental health conditions and those in need of palliative care. Multi-disciplinary team meetings were in place to support these patient groups.

The Out of Hours service is provided by the St Helens ROTA.

Updated 14 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lime Grove Surgery on 10 March 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered in line with best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should

• Ensure legionella testing is undertaken or a risk assessment is completed.
• Ensure that action plans are developed and monitored when serious events and patient complaints take place. A clear audit trail of the steps taken and the decisions reached and the actions to be taken should be implemented.
• Ensure all staff undertake vulnerable adult safeguarding training

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 May 2015

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 has a robust recall system for patients with long term conditions. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 14 May 2015

The practice is rated as good for the care of families, children and young people. The practice offered same day appointments for all children when ill. There were systems in place to identify 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. This included children and young adults with an alcohol related admission to hospital. Immunisation rates were relatively 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 14 May 2015

The practice is rated as good for the care of older people. They provided annual health checks for all patients over 75 years. The practice had identified a list of older patients who were assessed as having complex needs. The practice had drawn up care plans for these patients and was in the process of reviewing them either opportunistically or by invitation. 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 dementia and end of life care. The practice also undertook health assessments of patients with caring responsibilities. It was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 14 May 2015

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The practice did not offer extended opening hours for working patients but they did offer online repeat prescribing of medicines and they had recently started online booking of GP appointments. The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

Updated 14 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). They had a risk stratification and case finding tool to identify high risk patients who may benefit from dementia screening and referral to memory clinics. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. The practice also worked closely with the local community mental health team.

Updated 14 May 2015

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 learning disabilities patients who lived in residential home nearby. Annual health checks for these patients were carried out. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.