Great Homer Street Medical Centre

Updated 29 June 2017

Great Homer Street Medical Centre is registered with the Care Quality Commission to provide primary care services. It provides GP services for approximately 2,382 patients living in a socially deprived area of Liverpool. The practice is a teaching and training practice managed by an individual GP (male) and has one salaried GP (female). There are two practice nurses. There are administration and reception staff and two practice managers. The practice holds a General Medical Services (GMS) contract with NHS England and is part of Liverpool Clinical Commissioning Group (CCG).

The practice is open during the week; between 8am and 6.30pm and offers extended hours opening from 7.15am on Tuesdays. Patients can book appointments in person, online or via the telephone. 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. Patients accessed the Out-of-Hours GP service by calling NHS 111.

Updated 29 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Great Homer Street Medical Centre on 11 May 2017. Overall the practice is rated as good and outstanding for providing services for vulnerable patients.

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

• Staff worked well together as a team to support patients to access treatment and address their lifestyle needs.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment in particular for patients who were more vulnerable.
• There was a flexible approach to appointments depending on patient need and urgent appointments were available the same day.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Care Quality Commission (CQC) comment cards reviewed indicated that patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Learning from complaints was shared with staff.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of the requirements of the duty of candour.

We saw elements of outstanding practice:

• There was a strong emphasis on promoting well- being for patients. The practice referred patients to support groups to help support healthy living and had sent members of staff to courses provided to ensure the services were suitable for their patients. The practice recognised that uptake for these services for this population was sometimes low. As a result the practice had employed a well- being co-ordinator to encourage the uptake of healthy living services and information about services was accessible.
• The practice is situated in an area of high social deprivation and responded well to those patients who presented with more challenging issues such as asylum seekers, homeless patients and those with drug and alcohol addiction. In these instances, the practice team engaged with other health care professionals and social support groups. Staff demonstrated they knew their patients well and could respond to patient’s individual needs effectively. For example, the practice recognised that patients who had been addicted to heroin often went on to develop chronic obstructive respiratory diseases and early diagnostic testing was included in health care reviews of these patients.

The areas where the provider should make improvement are:

• Review incidents periodically to identify any trends to reduce the risks of reoccurrence.
• Work towards identifying more carers .

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 June 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All these patients had a named GP and there was a system to recall patients for a structured annual review in the month of the patient’s birthday to check their health and medicines needs were being met.
• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• A diabetic specialist nurse attended the practice monthly to help with more complex cases.
• The practice worked with a digital coordinator to provide home based blood pressure monitoring, better use of inhalers and smoking cessation support.

Updated 29 June 2017

The practice is rated as good for the care of families, children and young people.

• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics and provided immunisations.
• The practice had emergency processes for acutely ill children and young people.
• Staff were trained in safeguarding children relevant to their role.

Updated 29 June 2017

The practice is rated as good for the care of older people.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 29 June 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice offered early morning appointments on Tuesdays.
• The practice offered exercise on prescription for all patients over 18 years of age.

Updated 29 June 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. For example, a review of all dementia patients taking antipsychotic medication had been undertaken with a pharmacist and psychiatric liaison officer.
• The practice worked closely with the mental health services in Liverpool.
• The practice recognised that patients living in a socially deprived area often experienced long term depression. The practice was able to signpost these patients to access various support groups and voluntary organisations. For example, the practice employed a well- being coordinator who helped patients who had experienced poor mental health return to work or with general physical and mental well- being.

All staff were dementia friends. 

Updated 29 June 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. This was because during the inspection staff demonstrated they knew their patients well and we observed how patients who had more chaotic lifestyles were managed to ensure their health needs were met. In addition:-

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice supported homeless patients and asylum seekers and worked with a local bail hostel.
• The practice offered longer appointments for patients with a learning disability and tailored appointments for patients who required additional support such as patients with autism. There was a flexible approach for patients who turned up late for their appointments. Elderly patients were given appointments in daylight hours during the winter months.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the practice worked with a drugs misuse service. The practice recognised that patients who had been addicted to heroin often went on to develop chronic obstructive respiratory disease and early diagnostic testing was included in health care reviews of these patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. For example, advice on prescription to help with welfare benefits.
• The practice is a zero tolerance practice helping patients who needed additional support to be provided with health care. Staff were trained in de-escalation techniques to support patients who presented with challenging behaviour.
• The practice monitored patients who were out of reach or had not turned up for appointments or immunisations on a practice risk register to ensure the patients were followed up to attend.
• The practice had carried out an audit to ensure all their patients in nursing homes had the appropriate level of advanced care plans in place to support them in end of life care.
• The practice had worked with other practices in the area and had bid for a social isolation project for patients over 75 years of age.