Atlas Medical Practice

Updated 19 January 2017

Park House Surgery is responsible for providing primary care services to approximately 7295 patients. The practice has a General Medical Services (GMS) contract and offers a range of enhanced services such as flu and shingles vaccinations and timely diagnosis of dementia. The number of patients with a long standing health condition is higher at 65.2% when compared to other practices locally and nationally. The practice has one GP partner at the time of inspection, a number two practice nurse, health care assistant, administration and reception staff and a practice manager. At the time of inspection the practice had applied to CQC to register a number of other GP partners as part of a merger with a neighbouring practice.

The practice is open from 8am to 6.30pm Monday to Friday. Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services. Home visits and telephone consultations are available for patients who require them, including housebound patients and older patients.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. Other appointments are available for maternity care, mental health and travel vaccinations.

The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service is available on the practice’s website and in the patient practice leaflet.

The practice is part of the St Helens Clinical Commissioning Group. The practice is located in a very deprived area of the borough area where people experience high levels of unemployment (12.% compared to 5.4% nationally) and a high number of the population (65% compared to 54% nationally) who are living with a long-standing health condition.

Updated 19 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park House Surgery on 30 November 2016. Overall the practice is rated as good.

• A system was in place for reporting and recording significant events, keeping these under review and sharing learning where this occurred.

• Risks to patients were assessed and well managed.

• Systems were in place to deal with medical emergencies and all staff were trained in basic life support.

• There were arrangements in place to safeguard adults and children from abuse that reflect relevant legislation and local requirements. Staff understood their responsibilities and adhered to safeguarding policies and procedures. However safeguarding meetings with other health professionals was not taking place.

• The standard of cleanliness and hygiene was good. Reliable systems were in place to prevent and protect people from a healthcare associated infection. These systems were monitored with regular infection control audits.

• The arrangements for managing medicines, including obtaining, prescribing, recording, handling was safe but the storage of prescription pads required improving.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Feedback from patients about their care was consistently positive. We saw good communication with patients from staff so that they understood their care, treatment and condition.

• Information about services and how to complain was available and easy to understand. We found openness and transparency about how complaints and concerns were dealt with. Lessons were learned from concerns and complaints, and appropriate action taken as a result to improve the quality of care. These lessons were shared with all staff.

• Patient’s feedback for the new triage appointment system was mixed. Some reported concerns that this system was not always convenient and others stated they were happy to consult with the GP via telephone rather than a face to face appointment.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a programme of clinical and internal audit, which was used to monitor quality and systems to identify where action should be taken.

• While the practice had experienced a shortage of GPs the review of management systems had not been undertaken regularly. At the time of the inspection the practice was in the process of developing and implementing an assurance system and service performance measures, which we were informed, would be reported and monitored to improve performance.

There were also areas of practice where the provider should make improvements. The provider should:

• Improve the care plans in place for patients with complex health needs, who are at high risk of avoidable unplanned hospital admissions.

• The security of prescriptions should be reviewed as some were left in printers in rooms which were not locked.

• Encourage an interagency approach to safeguarding patients including regular communications and safeguarding meetings.

• Review the records made of the monthly multi-disciplinary meetings to ensure sufficient detail is made.

• Review the GP patient survey results that showed 43% of patients found it easy to get through to this practice by phone compared to the CCG average of 65% and the national average of 72%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 January 2017

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. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required regular checks received these. Practice nurses held dedicated lead roles for chronic disease management. The practice employed a full time pharmacist also. As part of this they provided regular, structured reviews of patients’ health. Data from 2014 to 2015 showed that the practice was performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care. Longer appointments and home visits were available for patients with long term conditions when these were required. Patients with multiple long term conditions were offered a single appointment to avoid multiple visits to the surgery.

Updated 19 January 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. The practice had a reminder system for parents who did not bring children and babies for immunisation, sending these letters out whenever possible. Appointments for young children were prioritised. Staff were aware of safeguarding matters related to children but the practice did We found the practice did not have regular safeguarding meetings with all professionals to discuss patients at risks and any developments to this. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. The practice provided a comprehensive and confidential sexual health and contraceptive service delivering the full range of contraceptive services.

Updated 19 January 2017

The practice is rated as good for the care of older people. The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population. The practice had a higher than average number of older people in its population. Up to date registers of patients with a range of health conditions (including conditions common in older people) were maintained and these were used to plan reviews of health care and to offer services such as vaccinations for flu. Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or in some cases better than local and national averages. General Practitioners and practice nurses carried out regular visits to local care homes to assess and review patients’ needs and to prevent unplanned hospital admissions. Monthly multi-disciplinary meetings were held to discuss the care and treatment for patients with complex needs.

Updated 19 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students 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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. The practice had an active website as well as noticeboards in reception advertising services to patients.

Updated 19 January 2017

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. These patients were mostly known by reception staff and we saw they would call patients to remind them an appointment had been booked for them. Patients experiencing poor mental health were offered an annual review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services. The practice had information in the waiting areas about services available for patients with poor mental health. For example, services for patients who may experience depression.

Updated 19 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these. The practice worked with relevant health and social care professionals in the case management of vulnerable people. The practice referred patients to local health and social care services for support, such as drug and alcohol services. Staff knew how to recognise signs of abuse in vulnerable adults and children. 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. Information and advice was available about how patients could access a range of support groups and voluntary organisations.