Ormskirk House Surgery

Updated 17 February 2017

Ormskirk House Surgery is based in a residential area within St Helens close to all local amenities. There are 8062 patients on the practice list. The practice has three partners, all male GPs, two practice nurses, a health care assistant, a practice manager, reception and administration staff.

The practice is open on Monday and Friday from 8.30am to 6.30pm and Tuesday to Thursday 8.30am with extended hours to 7.30pm. Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Outside of this time the practice uses St Helens Rota. The practice opts in to provide out of hours services via a consortium arrangement known locally as St Helens Rota. They provide a service locally in St Helens. This is a conglomerate of GPs who provide out of hours cover.

The practice is part of St Helens Clinical Commissioning Group. The practice has a General Medical Services (GMS) contract. In addition the practice carried out a variety of enhanced services such as: providing shingles vaccinations.

Updated 17 February 2017

We carried out an announced comprehensive inspection at Ormskirk House Surgery on the 22nd October 2015. Overall the practice is rated as good.

Our key findings were as follows:

• Improvements were needed in regard to mitigating safety due to gaps in audits and records for safety checks for temperatures of refrigerators, emergency drugs and equipment, managing fire safety and emergency procedures.
• Clinical staff regularly reviewed significant events although there was no formal system to share learning amongst the whole staff team to identify and learn from events.
• The practice had a safeguard lead and staff had reported patients at risk. However, there were gaps in staff training where some staff had not received safeguard training for vulnerable adults.
• The practice had good facilities in a purpose built building with disabled access and a lift to the second floor consulting rooms. The practice was clean and tidy.
• The clinical staff proactively sought to educate patients to improve their lifestyles by regularly inviting patients for health assessments.
• Patients spoke highly about the practice and the whole staff team. They said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a Patient Participation Group. They made suggestions throughout the year to help improve the service provided by the practice.
• Information about services and how to complain was available on the practice’s website, but not within the reception area. Complaint records had detailed information to show how they had been investigated.
• Staff had delegated duties distributed amongst the team. However, the practice manager’s role was still developing and work was needed to develop a clear leadership structure. Staff felt supported by management and they felt that since the promotion of the practice manager the practice was developing in the right direction.

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

Action the provider MUST take to improve:

• Ensure that health and safety arrangements including risks assessments are reviewed and accessible to all staff and state clearly what actions are in place to maintain people’s safety. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 12 Safe care and treatment 1)2)a)b)c)d)g)

Action the provider SHOULD take to improve:

• To ensure safeguard training is available and provided for all staff in regard to vulnerable adults and children and ensure staff are updated in the level of training needed for their role.

• To share all serious incidents of risk and complaints with all staff to help improve shared learning within the practice.
• To develop risk assessments and guidance regarding the decision to not carry emergency drugs in GP bags and for not storing oxygen within the practice.
• The systems in place for monitoring medicines including their storage and expiry dates of equipment should be improved to ensure continuous safety checks.
• To review training records to ensure that all staff have evidence of updated training relevant to their role and patient needs.
• Review processes for accessing appointments and practice waiting times for appointments.
• To review policies and procedures to ensure necessary written guidance is in place to cover ‘Business continuity plans’ and ‘Governance systems’ within the practice to help mitigate risks of health and safety within the practice.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 December 2015

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment and screening programmes. The practice contacted these patients to attend annual reviews to check that their health and medication needs were being met. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs with their community matron. The practice managed a warfarin clinic to enable patients to attend the clinic which they found convenient.

Updated 3 December 2015

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Immunisation rates were comparable and sometimes exceeded local CCG benchmarking for all standard childhood immunisations. The practice monitored any non-attendance of babies and children at vaccination clinics and reported any concerns they had identified. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding. However, some of the practice staff had not received updates to their safeguarding training. One GP with level 3 training took the lead for safeguarding. Staff put alerts onto a patient’s electronic record when safeguarding concerns were raised. Patient information sign posted young people to sexual health services in the building which was easily accessible to their patients. Urgent access appointments were available for children and appointments after school hours including three late nights a week provided extended hours to more convenient appointments. The staff sent out ‘congratulations cards’ to new parents to help inform them of the services available. The practice had facilities for baby feeding, promoting breast feeding and provided baby changing facilities.

Updated 3 December 2015

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. There was an up to date registers of patients’ health conditions and this information was used to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice staff met with the community matron and multi-disciplinary professionals on a regular basis to provide support and access specialist help when needed. The practice carried out home visits and reviewed patients who lived at home and those people who lived in care homes.

Updated 3 December 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this group 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 offered online prescription ordering and an online appointment services. Patients could book appointments in person, on-line or via the telephone and repeat prescriptions could be ordered on-line which provided flexibility to working patients and those in full time education. The practice offered drop in clinics for services such as flu vaccinations, maternity clinics and smoking cessation. They also held a flu vaccination clinic each Saturday morning. Health checks were offered to patients who were over 40 years of age to promote patient well-being and prevent any health concerns.

Updated 3 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients with mental health problems in order to regularly review their needs and to carry out annual health checks. They had 79 patients on the Mental Health Register with up to 61% of patients having already agreed with their care plan up to October 2015. The practice staff liaised with other healthcare professionals to help engage these patients to ensure they attended reviews. The practice were able to refer patients to the ‘Mental Health Assessment Team’ in accordance with each person’s individual circumstances.

Updated 3 December 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, a register was maintained of patients with a learning disability and annual health care reviews were provided to these patients. The practice had a shared care clinic running with the local ‘Addaction Service’ (drug support organisation). They had 10 patients registered for support with drug related issues and reviewed these patients regularly within the shared care scheme. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. However they had not all received up to date safeguarding training.