Archived: Great Homer Street Medical Centre

Updated 22 January 2015

Great Homer Street Medical Centre is registered with CQC to provide primary medical care services, which includes access to GPs, minor surgery, family planning, ante and post natal care. The practice provides GP services for 2521 patients living in the Everton area of Liverpool. The practice has two GP partners,  one practice nurse and one healthcare assistant. Great Homer Street Surgery is currently a training practice for medical students and new GPs. The practice is part of NHS Liverpool CCG .

The practice is open 8.30am to 6.15pm Monday to Friday and each Wednesday they close at 5pm.  Patients can book appointments in person, via the telephone and online. 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. When the practice is closed patients can access the out of hour’s provider for Liverpool, Urgent Care 24 (UC24).

The practice is registered with the Care Quality Commission to deliver the regulated activities:

Diagnostic and screening procedures

Family planning

Maternity and midwifery services

Surgical procedures

Treatment of disease, disorder or injury.

Updated 22 January 2015

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Great Homer Street Medical Centre. The practice is registered with the Care Quality Commission to provide primary care services. We undertook a planned, comprehensive inspection on 7 October 2014 and we spoke with patients, relatives, staff and the practice management team.

The practice was rated as Requiring Improvement.

Our key findings were as follows:

• Safety

The practice is rated as requires improvement for safety as there are areas where improvements must be made. There was an open culture when reporting incidents but staff had not been trained. Systems were in place for children's safeguarding but they were not robust for adults. Safe arrangements were in place for medicines management. The GP’s undertook regular minor surgery without policies and procedures to support this. A number of concerns were identified relating to the unfit state of the premises. Appropriate pre-employment checks were not undertaken and completed before employment.

• Effective

The practice is rated as requires improvement for effective as there are areas where improvements should be made. Care and treatment was considered in line with current published guidelines and best practice but written patient consent was not sought for patients undergoing minor surgery. Audits were undertaken but there was a lack of evidence to show what action and learning had taken place. Staff had not received annual appraisals or regular supervision.

• Caring

The practice is rated as good for caring. We saw good compassionate care where patients were given time and support during their appointment. Feedback we received from patients before and during our inspection indicated they felt fully involved in their care.

• Responsive

The practice is rated as good for responsive. The practice reviewed the needs of their local population and engaged with the NHS Local Area Team (LAT) and Clinical Commissioning Group (CCG) to secure service improvements where these were identified. Patients reported good access to the practice. There was an accessible complaints system with evidence demonstrating that the practice responded quickly to issues raised.

• Well-led

The practice is rated as requires improvement for well-led as there are areas where improvements should be made. Staff we spoke with were clear about their working values and ethos and how important these were in working in an area of high deprivation. Staff felt supported, valued and motivated. We saw transparent and open governance arrangements but in parts they were not effective because systems were not in place to effectively manage staff and or identify, monitor and manage risks to patients and staff working at the practice. The practice proactively engaged the general public, patients and staff to gain feedback (PPG).

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

Importantly, the provider must:

• Review the arrangements in place to ensure that people attending the practice are protected against the risks associated with unsafe premises. 

• Review the systems for assessing and monitoring the quality and safety of service provision and take steps to ensure risks are managed appropriately.

• Take action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff.

• Ensure that all staff have the necessary skills and competencies in relation to all aspects of their work and a written record of this is maintained. They must also ensure that all staff have access to a period of induction, supervision and annual appraisal and written records for these must be maintained.

In addition the provider should:

• Ensure alert notifications from national safety bodies are cascaded to all relevant staff and held at the practice.
• Take action to address infection prevention and control to ensure that they comply with the ‘Code of Practice for health and social care on the prevention and control of infection and related guidance’. In particular for the impact the increased infection control risks caused by the unfit premises.

• Review the systems and processes in place for the safeguarding of vulnerable adults.

• Ensure that written consent is sought for all patients undergoing minor surgical procedures in line with DOH guidance.

• Audits and reviews of services were taking place however the provider should ensure that actions and learning taking place following the results should be clearly documented.

• Review the system in place for reviewing all letters relating to blood results and patient discharge letters.

• Electronic patient summaries should be completed for all to ensure that if required by another provider, patients can receive healthcare faster, easier access for instance in an emergency situation or when the practice is closed.

• Review all policies and procedures to ensure they are up to date.

• Ensure minutes are taken for all clinical and practice meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 January 2015

The practice is rated as good for the population group of people with long term conditions.  The practice had processes in place for the referral of patients with long term conditions that have a sudden deterioration in health. Registers of long term conditions were kept and annual reviews of patients were carried out, including a review of medications. All patients with an unplanned admission to hospital were reviewed by the GP on discharge. The practice had summary care records and special patient notes in place to share with other providers. We saw health promotional advice information and referral to support services take place for example smoking cessation.

Updated 22 January 2015

The practice is rated as good for the population group of families, children and young people . The practice had systems in place for identifying children, young people and families living in disadvantaged 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 hearings as required. The practice provided ante and post natal support for patients who experienced issues around pregnancy. Regular meetings were held at the practice with midwives, health visitors and district nurses. If required the GP liaised with school nurses working locally. Staff we spoke with were aware of consent best practice (Gillick competences). The practice nurse undertook children immunisation sessions and the practice followed up patients who did not attend. 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 22 January 2015

The practice is rated as good for the care of older people.  Staff were able to recognise signs of abuse in older people and know how to escalate or refer these concerns if needed. They recognised the complex needs of older people and how best to treat them. The practice kept a register of all older people to help them plan for the regular review of care and treatment. Structured assessment of older people took place annually. The practice was working towards establishing a care co-ordinator for all older people on their practice register. If older patients were admitted to hospital in an unplanned way this was reviewed by the GP and if required changes would be made to their treatment plan for example medications. Health promotional advice and support was given to patients 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.

Updated 22 January 2015

The practice is rated as good for the population group of the working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students, had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. Appointments were available prior to 9am on one day each week. 

Updated 22 January 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). 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 appropriate therapy services. These sessions were held within the practice.

Updated 22 January 2015

The practice is rated as good for the population group of people whose circumstances may make  them vulnerable. Identification of people at risk of abuse and follow up actions were taken. Systems were in place for sharing information about people at risk of abuse with other organisations where appropriate. The practice had a system in place for identifying people living in vulnerable circumstances. 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.