Primary Care 24 (Merseyside) Asylum Practice

Updated 7 September 2018

Urgent Care 24 (UC24) Asylum Practice is a service located in the centre of Liverpool and is within the Liverpool Clinical Commissioning (CCG) Group. The practice is part of a large social enterprise healthcare organisation named Urgent Care 24 (UC24).

The practice has been set up with a Service Level Agreement with NHS England to provide health screening and assessment to newly arrived asylum seekers located in an Initial Accommodation Centre (IAC) in Liverpool. The Home Office has offered support known as Section 98 support (defined in Section 98 of the Immigration and Asylum Act 1999). The support is short term, with people being housed in initial accommodation which covers essential living needs. The practice, which is in one of the IACs in Liverpool, provides assessment and health screening as part of the services provided to this vulnerable patient group.

The practice clinical team consists of a number of practice nurses and associate GP sessional clinicians. A GP works on site for two hours, three days each week, a prescribing nurse works three days and a practice nurse works five days. The clinical lead works an additional 2 hours per week. The clinical team is supported by a practice manager, a practice administrator and several administrative and reception staff. The practice works closely with the health visiting, school nurses and counselling services in the locality.

The practice is open between 8am and 6.30pm Monday to Friday. An out of hours services is provided by UC24.

Updated 7 September 2018

This practice is rated as Good overall. (Previous rating July 2017 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Urgent Care 24 Asylum Practice in July 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Urgent Care 24 Asylum Practice on our website at www.cqc.org.uk.

This inspection was undertaken as an announced comprehensive inspection on 17 July 2018. Overall the practice is now rated as Good.

At this inspection we found:

• The practice had clearer systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had appropriate systems to safeguard children and vulnerable adults from abuse.
• There were adequate systems to assess, monitor and manage risks to patient safety.
• The practice had systems for appropriate and safe handling of medicines.
• The practice had improved systems to keep clinicians up to date with current evidence-based practice. New policies had been put into place to alert clinicians that new guidance had been produced and regular team meetings ensured all staff were informed of this.
• The practice had developed new systems to monitor the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. However, audit systems required further development and implementation.
• Since the last inspection the provider had taken steps to develop the practice IT system. However, at the time of inspection this was in the early stages of implementation and it required further development as problems with communications with other services, GPs and hospital referrals were on-going.
• Staff responded in a compassionate, timely and appropriate way when patients had experienced physical pain, discomfort or emotional distress. A number of these patients may have been through traumatic and distressing experiences and staff were sensitive to this.
• People seeking asylum and refugees may experience a range of mental health problems. Good referral systems were in place with local counselling services to ensure patients who had experienced trauma, for example, received prompt psychological interventions.
• At our last inspection we identified that improvements were needed to the day to day clinical leadership and support available to the practice. Appropriate actions had been taken by the provider to strengthen the leadership support.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Further develop the practice patient survey to ensure questions will gather accurate information about patient views and experiences.

• Improve the range of clinical audit activities ensuring two stage clinical audits are completed.

• Complete a safety impact assessment for the availability of a clinician each day the practice is open. This should assess the risk to patients of timely access to treatment in urgent cases or when patient test results require urgent attention.

• Take action to set up a practice level or provider level system in place to monitor when essential health and safety checks are due for their premises. Ensure a practice premises and security risk assessment is completed.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.