Archived: The Elms Surgery

Updated 14 March 2019

The Elms practice is part of the NHS West Lancashire Clinical Commissioning Group (CCG). Services are provided under a general medical service (GMS) contract with NHS England. The practice had approximately 5,387 patients on its register. The Elms practice provides services from a two-storey building at 16 Derby Street, Ormskirk, Lancashire L39 2BY. The practice provides a full range of services including GP appointments, nurse led health screening clinics and baby clinics.

Information published by Public Health England rates the level of deprivation within the practice population group as nine on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The percentage of the population with a longstanding health condition is lower than the local and national averages at 47.9% as compared with 55.1% and 51.2% respectively. The practice's unemployed patient population is lower, 2.2% compared with the CCG average of 2.7% and the England average of 4.3%. The patient numbers in the younger age groups are higher than both the CCG and England averages. For example, 3.4% of the patient population is aged 0-4 years (CCG and England average 4.4 and 5.6% respectively).

The practice has one lead and one long-term locum GP (both male). The practice employs a practice manager, an advanced nurse practitioner, two nurse practitioners and a healthcare assistant (HCA). In addition, the practice employs a team of secretarial, reception and administrative staff.

The Elms practice is open Monday to Friday 8am to 6.30pm. Patients may also book appointments at other local practices until 8pm on weekdays and at weekends via the GP federation.

Patients are asked to contact NHS 111 for Out of Hours services.

The practice provides the following regulated activities: treatment of disease, disorder or injury, surgical procedures, diagnostic and screening procedures and maternity and midwifery services.

Updated 14 March 2019

We carried out an announced comprehensive inspection at The Elms Surgery on 12 February 2019 as part of our inspection programme.

At the last inspection completed in February 2016 we rated the practice as good overall.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

The practice is rated as requires improvement overall.

We rated the practice as good for providing caring and responsive services.

We rated the practice as requires improvement for providing safe, effective and well-led services because:

• People who used the service were generally protected from avoidable harm and abuse, however legal requirements in relation to recruitment of staff were sometimes not met.
• The practice did not have safe and effective systems and processes to manage medicines and equipment.
• Patient consent was not recorded appropriately.
• There was a lack of audit and quality monitoring of systems.
• Some staff felt unsupported and some clinical staff had not received an appraisal.

This means that:

• Patient safety was not always assured, management of medicines and equipment were not always safe.
• Patients generally had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• Patients’ needs were met by the way in which services were organised and delivered.
• The leadership, governance and culture of the practice did not always promote the delivery of high quality person-centred care and staff were not always supported.

There were areas where the provider must make improvements:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed

There were areas where the provider should make improvements:

• Review internal building security and confidentiality arrangements at the reception desk.
• Update the practice safety alerts records with any results of action taken.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 14 March 2019

Updated 14 March 2019

Updated 14 March 2019

Updated 14 March 2019

Updated 14 March 2019

Updated 14 March 2019