Archived: Netherton Practice

Updated 24 September 2015

Netherton Practice is based in the Bootle area of Liverpool. The practice treats patients of all ages and provides a range of medical services. The staff team includes one GP employed by SSP Health Ltd, two bank GPs who are employed by an agency, work solely for SSP Health Ltd and are regularly based at the practice, a practice manager, a practice nurse, a healthcare assistant and reception/administrative staff. There had been changes at the practice and as a result there is a vacancy for a GP/GPs. The vacancy/ies are covered by other bank or locum GPs (GPs employed by an agency who do not work solely for SSP Health Ltd).

The practice is open 8.00am to 6.30pm Monday to Friday. The practice does not offer extended hours opening. This service is offered to patients at a neighbouring practice also provided by SSP Health Ltd. Patients requiring a GP appointment outside of normal working hours are advised to contact an external out of hour’s service provider (Go2Doc). The practice offers pre-bookable appointments up to four weeks in advance, book on the day appointments, telephone consultations and home visits to patients who are housebound or too ill to attend the practice. Patients can book appointments in person, on-line or via the telephone.

The practice is part of NHS South Sefton Clinical Commissioning Group. It is responsible for providing primary care services to approximately 2306 patients. The practice is situated in an economically deprived area. Sixty two per cent of patients have a long standing health condition, 52% of patients have health related problems in daily life and 22% of patients have caring responsibilities which are all slightly higher than average when compared to other practices nationally. The practice has an Alternative Provider Medical Services (APMS) contract.

Updated 24 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Netherton Practice. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring, responsive and well-led services. The practice required improvement for providing safe services.

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

• Staff were aware of procedures for reporting significant events and safeguarding patients from risk of abuse. There were appropriate systems in place to protect patients from the risks associated with equipment, the safety of the premises, recruitment of staff and infection control. Improvements were needed to the processes in place to ensure all safety incidents were analysed, appropriately recorded and lessons learned shared with all relevant staff to mitigate future risk. The security arrangements for managing prescriptions needed improvement. The systems in place for safeguarding adults and children needed to be improved to ensure patient safety was effectively promoted. Greater continuity of GP staffing was needed to ensure effective communication between GPs and ensure effective patient care. Clear information on who locum GPs should contact if there is a clinical issue they need support with was not available.

• Patients care needs were assessed and care and treatment was being considered in line with best practice national guidelines. Referrals were made to other agencies to ensure patients received the treatments they needed. Improvements were needed to the systems for monitoring referrals made. The website for the practice contained no health promotion information for patients to refer to.

• Feedback from patients showed they were overall happy with the care given by all staff. They felt listened to, treated with dignity and respect and involved in decision making around their care and treatment.

• The practice responded to the needs of its population groups. The practice encouraged patients to give their views about the services offered and made changes as a consequence. Information about the types of appointments available should be better publicised.

• There were systems in place to review quality and performance and steps had been taken to make these systems more effective.

The areas where the provider must make improvements are:

• Improvements need to be made to the security of prescriptions.

• Improvements need to be made for the systems for safeguarding adults and children. Robust systems for managing requests for reports for safeguarding meetings from the local authority need to be introduced.

The areas where the provider should make improvement are:

• Improvements should be made to the processes for managing significant events to ensure all events are recorded and to ensure any learning arising from the investigation of an event is consistently shared with all relevant staff and GPs who do not regularly work at the practice.

• Confidential information relating to safeguarding should be held securely

• Make improvements to the continuity of GPs employed at the practice to promote effective communication between clinical staff and continuity of care for patients. Ensure that a contact person for lone working GPs to approach for support around clinical issues or safety incidents is clearly available for staff to refer to.

• Review referrals to ensure all referrals of patients with suspected cancer are seen within two weeks.

• Ensure that patients have suitable access to information about all services available at the practice, such as the different types of appointments and health promotion information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 September 2015

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. Patients who were housebound were visited at home for annual reviews of long term conditions and these were planned alongside immunisations, such as flu, for patient convenience. Patients on multiple disease registers were offered extended appointments of up to 45 minutes so that their annual reviews could look at all their conditions together. Clinical staff kept up to update in specialist areas which helped them ensure best practice guidance was always being considered. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients. They kept a record of patients needing palliative care.

Updated 24 September 2015

The practice is rated as good for the care of families, children and young people. Child health development and immunisation clinics were provided. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns. There was a policy of same day appointments for all children. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding children. Staff put alerts onto the patient’s electronic record when safeguarding concerns were raised. However, we found improvements needed to be made to the systems in place for safeguarding children.

Updated 24 September 2015

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care. The practice ensured each person who was over the age of 75 had a named GP. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice had identified patients at risk of unplanned hospital admissions and a care plan had been developed to support them. The practice carried out home visits and also visited care homes in the area.

Updated 24 September 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice was open 8.00am to 6.30pm Monday to Friday. The practice did not offer extended hours opening. This service was offered to patients at a neighbouring practice also provided by SSP Health Ltd. The practice offered pre-bookable appointments up to four weeks in advance, book on the day appointments and telephone consultations. Patients could book appointments in person, on-line or via the telephone which provided flexibility to working patients and those in full time education. The practice had introduced a system whereby patients could cancel their appointments by text which made it easier for patients to cancel appointments and aimed to increase access by reducing wasted appointments. Health checks were offered to patients who were over 45 years of age to promote patient well-being and prevent any health concerns. In-house services such as phlebotomy and 24 hour blood pressure monitoring provided convenience for working patients.

Updated 24 September 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients an annual appointment for a health check and a medication review. The practice referred patients to appropriate services such as psychiatry and counselling services.

Updated 24 September 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient was partially sighted to enable appropriate support to be provided. Alerts were also available to ensure the length of the appointment was appropriate. For example, if a patient had a learning disability then a double appointment was offered to the patient to ensure there was sufficient time for the consultation. Staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and they had access to the practice’s policy and procedures and had received training in this. However, w e found Improvements needed to be made to the systems for safeguarding vulnerable adults.