The Care Quality Commission
  • Doctor
  • Independent doctor

Primary Care 24 (Merseyside) Asylum Practice

Overall: Good read more about inspection ratings

Birley Court, 21 Percy Street, Liverpool, Merseyside, L8 7LT (0151) 230 5550

Provided and run by:
Primary Care 24 (Merseyside) Limited

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Primary Care 24 (Merseyside) Asylum Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Primary Care 24 (Merseyside) Asylum Practice, you can give feedback on this service.

4 May 2019

During an annual regulatory review

We reviewed the information available to us about Primary Care 24 (Merseyside) Asylum Practice on 4 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

17 July 2018

During a routine inspection

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.

11 July 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Urgent Care 24 Asylum Practice on 11 July 2017. Overall the practice is rated as requires improvement.

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

  • There was a system for reporting and recording significant events.

  • The systems in place for patient safety required improvement.

  • Arrangements were in place to safeguard children and vulnerable adults from abuse. All doctors were trained to child protection or child safeguarding level 3 and the nurses who had a key role in the assessment of vulnerable patients and families were trained to level 2.

  • We observed the premises to be clean and tidy. The practice did not have an infection prevention and control (IPC) lead.

  • Regular medicines audits were not carried out.

  • There were arrangements for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs. However, the practice had operated for a long period of time with high usage of agency nurses due to a number of nurse vacancies.

  • Clinicians we spoke with were aware of relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines. However, this happened on an individual basis and there was no organisational wide system in place to ensure these were cascaded to staff and monitored.

  • The practice had Key Performance Indicators (KPIs) which were submitted on a quarterly basis to NHS England (NHSE).

  • The practice had not completed any clinical audits or other quality monitoring work.

  • The practice had on going mandatory training for all staff including an induction programme for all newly appointed staff. However, specific training to meet the often challenging needs of this vulnerable patient group was not provided.

  • The provider told us that the clinical IT system and the patient record system in place were considered a challenge and risk for the practice and the organisation. The practice did not have a commonly used web based system and this caused problems with how they and other healthcare professionals/organisations could record and share important patient health information.

  • Staff worked together and with other health and social care professionals to understand and meet the range and complexity of patients’ needs and to assess and plan ongoing care and treatment.

  • During our inspection we observed that members of staff were courteous and very helpful to patients and treated them with dignity and respect. All of the three patient Care Quality Commission comment cards we received were positive about the service experienced.

  • Thirty minute appointments were provided for each patient health assessment. We found that staff were flexible and relaxed about appointment times when patients were often turning up late.

  • To support newly arrived asylum seekers the practice provided information and guidance on how the NHS works, such as appointment systems and prescriptions. Photographs of buildings were used to signpost patients to shops and pharmacies when medicines were prescribed.

  • The practice did not provide information in different languages for specific patient health conditions. The practice provided translation services on a daily basis and we saw interpreters and language line would be used regularly to support patients.

  • The practice had a system for handling complaints and concerns. Its complaints policy and procedures were in line with recognised guidance and contractual obligations for GPs in England.

  • The practice worked with partner agencies and the local community to attend a fun day in a local church to celebrate Refugee week. As well as attending alongside other health and social care agencies they donated food and provided gifts for the refugees attending.

The areas where the provider must make improvement are as follows.

The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

  • Ensure persons employed in the provision of the regulated activity receive the appropriate training, professional development, clinical leadership and supervision necessary to enable them to carry out the duties.

The areas where the provider should make improvement are as follows.

  • Review the arrangements in place for safeguarding vulnerable adults and children. Consider the support that would be gained in having a practice clinical lead for safeguarding.

  • Develop an infection prevention and control (IPC) lead.

  • Ensure that oxygen masks and defibrillator pads for children are available for use in an emergency situation.

  • Review the care pathway for children and how they might access the service.

  • Review the clinical IT system and the patient record system in place.

  • Provide complaints information for patients in alternate languages. Provide translated materials and resources for families about support they can access locally and what they can expect from it. Review the information leaflets available to patients to ensure they are providing health and disability information in other languages.

  • Review the ways in which patients views are collected and analyse the results of this on an annual basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice