Archived: P D Medical Centre

Updated 21 May 2015

P D Medical Centre is located in the Huyton – Dovecot area of Liverpool, and sits within Knowsley Clinical Commissioning Group (CCG). The practice is in an area measured as one of the most socio-economic deprived areas in the country. (Measuring 1 on the scale of deprivation, where 1 is the most deprived and 10 is the least deprived.) Two statistics that express the effect of this are the practice Income Deprivation score, which is 55.7 compared to the average practice in England, which is 23.64. (Last available figures from 2012). Life expectancy for males in the area is 76.6 years and 80.7 years for females. Life expectancy at a practice that falls within an area that is the least deprived (with a score of 10 on the deprivation measurement scale) for men is 81.95 years and for women 86 years.

The practice premises is a former domestic property, although we understand it has been used as a GP practice for almost 80 years. The premises has two GP consulting rooms on the ground floor, a nurse treatment room and a patient reception and waiting area. The upper floor of the premises is given over to a staff area and the practice manager’s office. There is a small amount of parking available at the surgery. There are approximately 3,000 patients registered with the practice. Dr Messing is registered with the Care Quality Commission (CQC) as the provider and Registered Manager of the service, and delivers care and treatment under a Primary Medical Services contract.

We saw that availability of GP consultations was good; the practice did not operate a formal appointment system throughout the day. If patients arrived at the practice before 10.45am, they would be seen by a GP. Patients who wished to make an appointment could be seen at the structured clinics which ran between 3.00pm and 6.30pm. For those patients with working commitments, extended hours appointments were available between 7.30am and 8.00am. A practice nurse worked two days each week, delivering disease management clinics, baby vaccinations and immunisations, cytology screening and contraception advice. The lead GP Dr Messing was supported by two, part time GPs. The practice does not provide out of hours services. These are provided by a separate, external provider called Urgent Care 24 (UC24).

Updated 21 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at P D Medical Centre on 19 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for all population groups. Some improvements were required for providing safe services.

• Patient safety was a priority of the practice staff and clinicians. Systems in place supported this and all staff were clear about their responsibilities, however –
• Further work was needed to update risk assessments for staff who may work in isolation and for those staff who may be required to perform chaperone duties. A risk assessment was also required on how medical emergencies could be managed without access to oxygen.
• Care and treatment of patients was effective. We found the ‘sit and wait’ system of seeing patients worked effectively as opposed to an appointment system. This had eliminated any time lost by GPs due to patients’ failure to attend appointments.
• Patients we spoke to on the day of our inspection, and information from CQC comment cards, confirmed that the practice staff and clinicians were caring and compassionate.
• The practice was responsive to patients’ needs. Access to clinicians was good and patient feedback had been considered by the practice in preparing for its merger with a neighbouring practice.
• Staff responded quickly and effectively to any safeguarding concerns in relation to young children and vulnerable adults.

However, there were also areas of practice where the provider must make improvements.

• Ensure all staff who are required to carry out chaperone duties are risk assessed on whether they should have an enhanced Disclosure and Barring Service check (DBS) for their suitability to carry out this work.
• Ensure staff receive annual performance and appraisal review.

Additionally the provider should

• Keep appropriate records in respect of all staff training;
• Carry out risk assessments in respect of lone working and how it would manage any medical emergencies without the availability of oxygen.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 May 2015

The practice is rated as good for the care and treatment of people with long term conditions. The practice nurse worked in partnership with community teams that helped patients manage longer term and chronic conditions, for example by working with the dedicated chronic obstructive pulmonary disease (COPD) team. GPs planned their day so that they could accommodate any home visits to patients who required further support and treatment. Telephone appointments were also available at the end of each surgery. The practice had an electronic prescribing service and patients appreciated that their medicines could be ordered through their nominated pharmacy. Patients would receive further reminders through their pharmacy if any of their medicines needed to be reviewed by their GP.

Updated 21 May 2015

The practice is rated as good for the care and treatment of families, children and young people. The practice nurse worked to ensure that any child who had missed immunisations as a baby, received an invitation letter to attend the practice to take up that immunisation. Other baby vaccinations and immunisations were delivered in structured clinics. The practice nurse we spoke with displayed a good understanding of consent, the Mental Capacity Act 2005 and Gillick competency. This nurse was able to show how they communicated with younger patients in an age appropriate way to ensure they fully understood any treatment delivered. The nurse also delivered cytology screening and worked with the specialist diabetic nurse to support patients with diabetes.

Updated 21 May 2015

The practice is rated as good for the care treatment of older people. From data we reviewed before our inspection we could see that key services to older patients, for example, in health promotion and protection initiatives were being delivered. Those patients with a diagnosis of dementia were having their care reviewed by their GP regularly, patients aged 65 and over who required flu vaccination were contacted and received this service. Older patients we spoke with on the day of our inspection told us the GP they saw always allowed them sufficient time to discuss their health concerns and that staff took time to explain things to them, for example, any changes a GP had made to their medicines.

Updated 21 May 2015

The practice is rated as good for the care and treatment of working age people. The practice had consulted with patients and asked when extended hours surgeries could be planned to best meet their needs. In response to patient feedback, extended hours surgeries had been moved from evenings to first thing in the morning. The practice staff worked to meet the needs of patients requiring repeat prescriptions, ensuring these were ready to send to community pharmacies to enable collection in the evening. Typical turnaround of requests for repeat prescriptions was 24 hours.

Updated 21 May 2015

The practice is rated as good for the care and treatment of people experiencing poor mental health. The practice signposted and referred patients to specialist services within the community who could offer support to patients experiencing low mood to mild depression. For example, referring older patients to a service called Listening Ear, a community based counselling service. The practice was also able to refer any children or younger adults to a community based bereavement service called Butterflies. Here, younger patients could be seen by specially trained counsellors for talking therapies. The practice also had a good working relationship with the community matron, who would provide on-going support for patients who had attended hospital emergency departments on multiple occasions for non-urgent problems. This could include patients recently diagnosed with dementia.

Updated 21 May 2015

The practice is rated as good for the care and treatment of people whose circumstances may make them vulnerable. The practice kept registers of those patients whose circumstances could make them more vulnerable to poor health, such as those patients with learning disabilities and patients who were carers. Annual health checks were offered to these patients to ensure any underlying health conditions were diagnosed and treated in a timely manner. Patients who were also carers could be referred to a community service to access further support. Details of palliative care patients were entered onto a register. Details of those patients’ who may require a visit from out of hour’s services, were sent to the out of hours care provider and updated on a daily basis. The practice GPs worked closely with multi-disciplinary care teams to ensure patients receiving palliative and end of life care, were well supported.