St Werburgh's Medical Practice for the Homeless Also known as Northgate Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Werburgh's Medical Practice for the Homeless on 9th December 2015.

Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• There were appropriate systems in place to reduce risks to patient safety, for example, infection control procedures and the management of medication. However, the recruitment records needed improvement and improvements were needed to the records for building and equipment checks and the management of electronic prescriptions.
• Patients’ needs were assessed and care and treatment was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.

• A caring service was provided. Patients commented that they were treated with respect and dignity and that staff were supportive and helpful.

• Access to the service was monitored to ensure it met the needs of patients. Patients reported satisfaction with opening hours and said they were able to get an appointment when one was needed.

• The practice sought patient views about improvements that could be made to the service and acted on patient feedback.

• There were systems in place to monitor and improve quality and identify risk. However, the registered manager’s involvement with the practice should be more formalised in order to monitor the quality of the service provided. For example, by agreeing with the practice team bench marks to review performance and a formal plan for audits.

We saw that the practice was outstanding in the way it responded to the needs of its patients:

• The practice understood the needs of the patient population. It recognised that a high number of patients that were homeless experienced poor mental health and were alcohol and drug dependent. It also recognised that engaging patients to access primary medical and mental health services could be problematic. The services provided by the practice and in partnership with mental health services and other health services demonstrated the outstanding manner in which the practice had responded to these needs. For example:-

• The practice employed a counsellor and a bereavement counsellor was on secondment from a local hospice to respond to patients’ emotional and mental health needs.

• A mental health practitioner was available to provide advice to patients. They worked on a self-referral and open referral basis which meant that there was quicker access which encouraged patients to engage with this service.

• An optician service came to the practice to encourage patients to have their eyes examined. We were informed that this service had already enabled additional health needs to be identified in some patients.

• The nurse practitioner had organised health events were patients were provided with information and guidance about specific issues. For example, a men’s health day was held which included a presentation from the Fire Service about the Princes Trust.An event was also held for female patients with a focus on relaxation techniques, the importance of sleep and this included a presentation from local police about domestic violence.

• The nurse practitioner had been awarded the Queen’s Nurse Award in 2012 for services to the homeless.

• A flexible appointment system was in operation. Patients where provided with longer appointments as needed. Patients were seen on a drop in basis and patients who frequently missed appointments were never turned away when they presented at the practice. As patients may not visit the practice frequently reviews of long term conditions and vaccinations, such as, influenza vaccinations were carried out opportunistically.

• Staff spoken with were committed to the provision of a responsive service that was provided in a non-judgemental manner.

• Donations were sought to enable patients to be provided with toiletries and clothing when needed, for example, toiletries and pyjamas had been provided to patients going in to hospital. A Christmas sock appeal took place every year so that new socks could be provided to patients.

However there were areas of practice where the provider needs to make improvements:

• The provider must ensure that there is a record of the required recruitment information to confirm the suitability of staff employed.

There were areas where the provider should make improvements.

Importantly the provider should:

• Given the imminent reduction in security at the premises, undertake a risk assessment to ensure that staff and patient safety is promoted at all times.

• Ensure a record is kept of building and equipment checks, the outcome and when they are due to assist in monitoring the safety of the premises and equipment.

• Ensure a record is maintained of the numbers of the electronic prescriptions received and the printers they are distributed to in accordance with guidance from NHS Protect.

• Make the registered manager’s involvement with the practice more formalised in order to monitor the quality of the service provided more systematically.

• Put a plan in place for ensuring audit cycles are undertaken to demonstrate how patient care is assessed and improved upon.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice