Archived: Maghull Practice

Updated 19 March 2015

Maghull Practice is registered with CQC to provide primary care services, which include access to GPs, family planning, ante and post natal care. The practice is situated within the Maghull ward area of Sefton. The practice has a higher than average population in full or part time employment and over 75 year olds. At 84.6 years, life expectancy in the Maghull area is higher than the national average.

The practice provides GP services for 3500 patients. They have one self-employed doctor working on a regular basis with all other sessions covered by locum GPs. The practice also has a practice nurse, practice manager and a number of administration and reception staff. The practice is part of South Sefton Clinical Commissioning Group (CCG).

GP consultation times are Monday to Friday 08.00 to 18.30. Patients can book appointments in person or via the telephone. Appointments can be booked for up to a week in advance for the doctors and a month in advance for the nursing clinics. The practice treats patients of all ages and provides a range of medical services. The practice does not deliver out-of-hours services. These are delivered by Go To Doc (GTD), a private provider of out of hour’s services commissioned by South Sefton CCG.

Updated 19 March 2015

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Maghull Practice. The practice is registered with the CQC to provide primary care services. We undertook a planned, comprehensive inspection on 20 November 2014 and we spoke with patients, relatives, staff and the practice management team.

The practice was rated as Requires Improvement.

Our key findings were as follows:

• There were aspects of the service that needed improvement. The practice had a good track record for maintaining patient safety. Incidents and significant events were identified, investigated and reported, though improvements were required for the reporting of incidents. Lessons learnt were disseminated to staff. Improvements were required to ensure staff were safely recruited and records were maintained.
• There were some systems in place which supported GPs and other clinical staff to improve clinical outcomes for patients. However, there was a lack of local clinical audits, peer review and support to monitor and improve patient outcomes and experience. The high use of locum GPs caused anxiety and concern for patients. Care and treatment was not always considered in line with recognised best practice standards and guidelines and in line with current legislation.
• The practice was caring, staff treated patients with dignity and compassion.
• The service was responsive. The practice provided good care to its population taking into account their health and socio economic needs. Patients were listened to and feedback was acted upon. Complaints were managed appropriately.
• Whilst there was good open and transparent leadership form the practice manager, improvements were required in terms of clinical leadership and support available to staff. Systems to monitor, evaluate and improve services required improving. Staff enjoyed working for the practice and felt supported and valued.

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

Action the provider MUST take to improve:

• Ensure the practice has suitable arrangements in place for obtaining and acting in accordance with consent of patients in relation to their care and treatment. Some staff did not have sufficient knowledge of the Mental Health Act 2003, the Mental Capacity Act 2005 and the Children’s Act 1989.

Action the provider SHOULD take to improve:

• Ensure full and complete required information relating to workers is obtained and held when recruiting staff. This must include a Disclosure and Barring Service (DBS) check for all staff with chaperoning responsibilities or a risk assessment to support their decision not to undertake this.
• Ensure that full and comprehensive records are made when serious events and incident occur to encourage learning and improvement.
• Staff should undertake chaperone training and records should be made when this is carried out for patients
• Ensure doctors have available emergency drugs for use in a patient’s home or a risk assessment in place supporting their decision not to have this.
• Have available the use of equipment such as pulse oximeters, defibrillators and oxygen for emergency treatments or a risk assessment in place supporting
• Ensure staff have appropriate support from a practice safeguarding lead person.
• Ensure there is a systematic programme of clinical and internal audit and that action is taken when improvements are identified.
• Ensure that all clinical equipment is PAT tested annually.
• They should review the high use of locum GPs at the practice to ensure patients receive consistency and continuity of care when attending appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 March 2015

There were aspects of the practice which required improvement in relation to all population groups. The practice had processes in place for the referral of patients with long term conditions that had a sudden deterioration in health. The GP reviewed all unplanned admissions to hospital. We did not find that registers were kept for this patient group but the practice nurse showed us the work she undertook on a regular basis. Annual reviews of patients were carried out, or more regular if needed including a review of medications. All patients with an unplanned admission to hospital were reviewed by the GP on discharge. We saw health promotional advice, information and referral to support services for example smoking cessation.

Updated 19 March 2015

There were aspects of the practice which required improvement in relation to all population groups. The practice had systems in place for identifying children, young people and families living in disadvantaged and vulnerable circumstances. The practice monitored children and young people with a high number of A&E attendances. The GP had written reports for safeguarding and child protection meetings as required. The practice identified and reviewed newly pregnant women with ante and post natal referrals along with patients who experienced issues with their pregnancy. Regular meetings were held at the practice with midwives, health visitors and district nurses.

If required the GP would liaise with school nurses working locally. Not all staff we spoke with were aware of consent best practice for young people (Gillick competences). The practice nurse undertook children immunisation sessions and the practice and procedures were in place to follow up patients who did not attend their appointment.

We saw health promotional advice, information and signposting to support organisations and services for families, children and young people, including for sexual health clinics and mental health services.

Updated 19 March 2015

There were aspects of the practice which required improvement in relation to all population groups. The practice had a high population of elderly patients. We saw that care was tailored to individual needs and circumstances, including those who resided in local care home setting. We saw that the Quality and Outcomes Framework (QOF) information indicated the percentage of patients aged 65 and older who had received a seasonal flu vaccination was similar to the national average. The practice was responsive to the needs of older people, they offered home visits and extended appointments for those with enhanced needs. The practice participated in the Virtual Ward programme for older vulnerable housebound patients.

The practice safeguarded older vulnerable patients from the risk of harm or abuse. There were policies in place, staff had been trained and were knowledgeable regarding vulnerable older people and how to safeguard them. However the practice did not have a safeguarding lead person. The practice nurse undertook some structured annual assessment of older people, including a review of their medicines. However we saw no evidence that the practice kept a register of all older people to help plan for the regular review of care and treatment. We found that all older patients had been assigned a named GP (as required nationally) but this was the registered provider and not their local GP. This was not practicable as the registered provider did not know the individual patients’ and would have to travel some distance when needed.

Health promotional advice and support was given to patients and their carers if appropriate and leaflets were seen at the practice. These included signposting older patients and their carers to support services across the local community. Older patients were offered vaccines such as the flu vaccine each year

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Updated 19 March 2015

There were aspects of the practice which required improvement in relation to all population groups. There was a lack of evidence to show that services for working age people including recently retired and students were good. There were no late night or weekend services available. There were no on-line arrangements for booking appointments or repeat prescriptions. We were told from patients within this population group that they had experienced delays in getting an appointment to see the GP.

Updated 19 March 2015

There were aspects of the practice which required improvement in relation to all population groups. The practice maintained a register of patients who experienced mental health problems. The register supported clinical staff to offer patients an annual appointment for a health check and a medication review. Clinicians routinely and appropriately referred patients to counselling and talking therapy services, as well as psychiatric provision.

Updated 19 March 2015

There were aspects of the practice which required improvement in relation to all population groups. Systems were in place for sharing information about patients at risk of abuse with other organisations where appropriate. The practice had a system in place for identifying patients living in vulnerable circumstances. Training for staff in children’s and adult safeguarding matters was on offer but some staff required updating. A register was kept of patients with a learning disability to help with the planning of services and reviews. All such patients were offered an annual health check. We heard of the close links with community teams supporting this patient group. We saw health promotional advice and information available for patients.