Archived: Hightown Surgery

Updated 18 February 2016

Hightown Surgery is located in a residential area of Merseyside and serves a patient list of 1,988 patients. The practice falls with NHS South Sefton Clinical Commissioning Group (CCG). The practice is managed by a large provider, SSP Health Ltd. All services are delivered under a Primary Medical Services (PMS) contract.

The provider retains a core group of locum GPs who deliver the services. The combined hours of the GPs equate to just over one full time working GP each week. There are two practice nurses whose combined part time hours provide 28 hours of nursing care each week. The practice also has a health care assistant who supports the work of the nurses.

Services are delivered from a former domestic property which as been developed over time to provide further consultation facilities. The practice has a consultation room on the ground floor, wheelchair and step-free access. A hearing loop is available for people with hearing difficulties. The practice does not provide its own out of hours care. In the out of hours period, patients are directed to the NHS 111 service who will triage calls and refer on the locally appointed provider, Urgent Care 24 (UC24).

The practice is open between and 8am and 6.30pm Monday to Friday. The practice appointments cover a two and a half hour window in the mornings and afternoons. Due to different GPs, the start times of the surgeries can vary. For example, from 9.30am to 12.40pm and from 2.40pm to 5.40pm each week day, Extended hours surgeries are offered on Friday of each week, from 6pm – 7pm. Patients are made aware of the different start times of surgeries.

The practice was inspected in November 2014, rated as inadequate overall and placed into Special Measures. The provider was required to make significant improvements; specifically we found the domins of safety of care and leadership were inadequate. The practice was rated as requiring improvement in the domains of effective and responsive care and treatment, and for the domain of caring.

At this inspection we discussed the lack of a Registered Manager for the practice. The CQC had written to the practice in July of 2014, outlining the breach in conditions of registration this presented. The provider had given a commitment to address this. However, we understand from the Medical Director that further work is in place, between the provider and the CQC Registrations department, which will address this matter.  

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced follow-up inspection of Hightown Surgery on 22 October 2015. This inspection was a follow-up to our inspection of 6 November 2014 when the practice was rated as ‘Inadequate’. The practice was placed into Special Measures in April 2015 and required to make significant improvements. The practice submitted an action plan detailing how they would make improvements and when they would be compliant with the regulations governing providers of health and social care.

At our follow-up inspection, we found the practice had made improvements across all five domains of safe, effective, caring, responsive and well led. Some improvement was still required in recruitment checks undertaken on locum GPs. Overall the practice is rated as Good

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

• The practice had made improvements that promoted the safe treatment of patients. We saw that arrangements were in place for an appointed GP to lead multi-disciplinary team meetings at the practice to manage the care of palliative patients. A named GP was appointed as the safeguarding lead for the practice.

• GPs delivering services were given sufficient time and support to familiarise themselves with systems in place at the practice, which resulted in the safer care and onward referral of patients to secondary care providers (hospitals and specialist clinics).

• Recruitment checks for staff were in place. However, all checks as required by Schedule 3 of the Health and Social Care Act (Regulated Activities) Regulations 2014 were not complete for locum GPs and several checks had not been carried out before the locum GPs started working for the provider.

• The practice had made improvements that increased the effectiveness of care for patients. The practice had a core group of locum GPs delivering services, which contributed to the effectiveness of treatment of patients by the practice and provided a degree of continuity of care.

• The Patient Participation Group (PPG) for the practice told us things had improved since the CQC inspection of 2014. Patients reported that they had seen improvements in the continuity of care and that GPs were caring and inclusive towards them.

• The provider had responded to the concerns of patients, communicating positively with the PPG.

• The provider leadership team had responded positively to the feedback from Inspectors following the inspection of November 2014. The retention of locum GPs to deliver services was more robust, and patients were familiar with these GPs. Strong clinical leadership was provided by a Clinical Director, appointed by the provider within the last 12 months.

There are areas where the provider MUST make improvements. The provider must:

• Ensure that all recruitment checks as required by Schedule 3 of the Health and Social Care Act 2008, are in place for all staff, including locum GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 2016

The practice is rated as good for the care of people with long term conditions. We found that:

• Nurses at the practice ran effective clinics for treatment of patients with multiple long term conditions.

• Patients at risk of hospital admission were identified as a priority, and received health care that reduced their risk of unplanned admission to hospital.

• Performance indicators for the treatment and management of patients with diabetes showed the practice was performing at or above the national average in this area of health care.

• Longer appointments and home visits were available when needed, for example, when delivering the flu vaccination to housbound patients.

• Patients had a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, a GP liaised with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 18 February 2016

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

• Data collected by NHS England between 1 April2014 – 31 March 2015 showed the practice performed well in the delivery of childhood vaccinations, with the lowest score being 94.1% of children aged up to 12 months receiving all required vaccinations.

• Other than one score of 95.2%, for children aged 5 years receiving a pre-school booster vaccination, the practice achieved a 100% success rate in the delivery of childhood vaccinations for children aged 0 – 5 years.

• Cervical screening had been delivered to 80.86% of female patients at the practice, which is in line with national results.

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

We saw good examples of joint working with health visitors.

Updated 18 February 2016

The practice is rated as good for the care of older people. We saw that:

• The practice offered care to meet the needs of the older people in its population. Longer appointments were offered to people with multiple health condtions.

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

• Patients we spoke to from this population group said there was now some continuity of care offered by the core GPs working at the practice, and that this was important to them.

Updated 18 February 2016

The practice is rated as good for the care of working age people including those recently retired and students.

• The practice offered appointments with a male or female GP were required.

• The delivery of the extended hours clinic had been decided in consultation with patients and was on a Friday evening each week.

• Patients commented that they found it easy to book an appointment when they needed one.

Access to on-line prescription ordering and appointment booking was limited.

Updated 18 February 2016

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

• < >

  88% of patients diagnosed with a mental health condtion had a comprehensive agreed care plan documented within their patient record.

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

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

Updated 18 February 2016

The practice is rated as good for the provision of care for people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability, and those patients who were also carers.

• It offered longer appointments for people with a learning disability and for carers who requested this.

• It had information for 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.