Princes Park Health Centre

Updated 19 July 2017

Princes Park Health Centre is a newly registered GP practice, registered with the Care Quality Commission to provide primary medical services and it has a APMS contract with NHS England. The practice has a registered list size of 6323 patients (at the time of inspection). The practice is close to the centre of Liverpool. The practice is owned and managed by the Brownlow Group Practice which has a number of GP practices across the city of Liverpool. The previous provider was placed in Special Measures by CQC in August 2015 and they left the practice in March 2016. Brownlow Group Practice became interim providers in 2016 and was awarded the permanent contract in February 2017.

Updated 19 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Princes Park Health Centre under the new ownership of the provider Brownlow Group Practice on 14 March 2017. The previous provider had been placed in Special Measures by CQC in August 2015 and they left the practice in March 2016. Brownlow Group Practice became interim providers in 2016 and was awarded the three year APMS contract in February 2017. The findings of our inspection carried out on 14 March 2017 was the practice was rated overall as Good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. New systems and processes had been put into place by the new provider. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Significant events were investigated and action had been taken as a result of the learning from such events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. For example, infection control practices were good and there were regular checks on the environment and on equipment used.
• 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.
• Feedback from patients about the care and treatment they received from clinicians was very positive. Patients told us they were treated with dignity and respect and they were involved in decisions about their care and treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said there had been improvements made to the appointment system under the new provider. They now found it easier to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• There was a clear leadership structure and staff felt supported by management since the new provider had taken over the practice. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• External agencies and stakeholders described the quality improvements that had been made by the Brownlow Group Practice as interim and now permanent providers.

There were areas also where the provider should make improvement. The provider should:

• Continue to monitor and improve the cervical screening and childhood immunisations programmes to improve performance in these areas.

• Continue to develop and improve the number of clinical audits that have completed a two cycle process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 July 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. Staff were trained on the effective use of templates to ensure accurate data gathering.

• The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients with long term conditions. On the day of inspection data shown to us demonstrated quality improvements, but there were still areas where the performance was below local and national targets and it was too early to assess the impact of the new systems that had been put in place.

• 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.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for a structured annual review 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. Robust call and recall systems were put in place with processes to avoid duplication of recall in patients with multiple long term conditions. Administration staff were trained to take on a lead role in the organisation of this.

• Close working arrangements were in place with community and hospital specialist nurses. For example the nurse met regularly with the community specialist diabetes nurse consultant to produce diabetic plans for poorly controlled diabetics and to discuss any other challenges for this patient group.

• The practice employed a Pharmacist to manage prescribing issues within the practice and to review patients’ medicines effectiveness and cost.

• Protected time was given for nurses to undertake home visits to housebound patients with long terms conditions.

Updated 19 July 2017

The practice is rated as good for the care of families, children and young people. From the sample of documented examples we reviewed we found:

• There were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.

• Previous poor immunisation and vaccination figures led the practice to review their systems. This led to the development of a more personalised role for administration staff (care navigator) that had designated responsibilities for childhood immunisation and vaccinations.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications. We found that potentially sick babies presenting at reception or on phone lines were prioritised to avoid missing significant illness and to manage parental anxiety.

• The practice was developing arrangements for communicating with young people through social media and at the time of inspection had set up a new web site for the practice. Their aim was to develop this further.

• All staff had received training from a local organisation supporting the needs of young people, Young Persons Advisory Service (YPAS). Staff told us this had been a very positive session which had encouraged them to consider the needs of younger patients and those who were disengaged in terms of their access to services.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice’s uptake for the cervical screening programme was below local and national targets when Brownlow Group Practice took over the practice. They were aware of the results and an action plan was put in place to improve this. At the time of inspection these actions had not yet been fully evaluated but was closely being monitored.

Updated 19 July 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• 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. This 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.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. The practice introduced two dementia screening questions for all patients attending an over 75 year’s health check. Patients who were over 75 years, who were not on a long term conditions register or had not been seen for over two years, were contacted for a health check and to see if support was needed. These patients have now been added to a database so that they can be monitored in the future.

• In response to a perceived need the practice initiated monthly ward rounds at a local care home for older and vulnerable people.

Updated 19 July 2017

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

• The needs of these populations 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 introduced telephone consultations to improve access and to better facilitate patients seeing the right clinician. The practice undertook email consultations at the request of patients. Same day access appointments and pre bookable appointment’s for clinicians were in place.

• We were told that patient registration could be done on-line to support people who were working.

• The practice had a full range of contraceptive services on site.

• The practice had recently introduced text messaging test results to patients with their consent.

Updated 19 July 2017

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

• The practice had a dementia lead GP. Annual reviews of patients with dementia and mild cognitive impairment were implemented. The lead GP developed a dementia strategy outlining for the practice how to detect new cases and to manage existing patients.

• The practice carried out advance care planning for patients living with dementia.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. The practice developed closer links with the local psychiatry services and they had a practice based community psychiatric nurse working with them to offer advice and support to staff and patients.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Staff interviewed had a good understanding of how to support patients with mental health

• needs and dementia. Practice staff have received recent training on their own wellbeing to enable them to better support patients with mental health problems. The practice had arranged suicide prevention training for staff.

• The practice had a lead GP partner who specialised in eating disorders and who worked for the local NHS service. They were offering one to one advice for patients with significant eating disorders.

Updated 19 July 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 including homeless people, travellers and those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.