Archived: The Marshside Surgery

Updated 3 November 2016

The partnership practice of the The Marshside Surgery – Dr Wainwright, is based in the Marshside are of Southport, Merseyside. Generally referred to as The Marshside Surgery, the partnership is made up of one male and one female GP partner. The practice patient list at the time of inspection was approximately 2,650 patients.

The practice partners are supported by a salaried GP, who works regular sessions at the practice. The combined number of GP sessions gives 1.4 full time working equivalent GPs. The practice has a practice nurse who works part time and there is a health care assistant to support the clinicians, working five hours each week. The practice manager works part time and oversees the general day to day running of the practice. The office manager leads a team of administrative and reception staff that support the practice team.

The practice is situated in a purpose built facility, with all patient areas at ground floor level. The practice is fully accessible to those with limited mobility; there is ample parking for patients to the front and side of the building, and there are designated parking spaces for disabled patients, close to the electronic doors of the practice. The practice was inspected in November 2013 under the regulations applicable at that time, and was found to be meeting required standards.

The practice is a member of the Dementia Alliance, and is part of a Dementia Friendly neighbourhood. This was started by the partners, along with a neighbouring practice and is made up of other local businesses such as the local pharmacy and food stores. It’s purpose is to be supportive of people experiencing dementia and their carers, providing a safe environment for them visit and to be part of a dementia friendly community. The practice has higher numbers of over 65’s and 75 year old patients, so numbers of patients with dementia may grow. The practice is also the only research practice in the local clinical commissioning group (CCG), and works with the National Institute for Health Research and with the Royal College of General Practitioners (RCGPs). We saw that the practice was involved in many innovative projects and pilots, which ultimately bring benefits to patients of the practice and across the CCG.

The practice opening times are from 8am to 6.30pm Monday to Wednesday and Friday of each week. The practice provides an extended hours surgery on a Thursday when the practice is open until 7.45pm. Throughout the week the practice delivers 156 GP appointments. This does not include urgent slots, when GPs will see patients that need to be seen at the end of each surgery, but did not have an appointment. Typically, the GPs see three patients as urgent cases at the the end of each clinic. The practice nurse delivers 110 appointments each week, and an extra eight appointments in the extended hours clinic each Thursday evening. Outside of surgery hours, patients are directed by a telephone message to the NHS111 service, who will refer on to an out of hours provider, Go to Doc if required.

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Marshside Surgery –Dr Wainwright (known locally as The Marshside Surgery) on 24 August 2016. Overall the practice is rated as good .

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• The practice used innovative and proactive methods to improve patient outcomes. For example, the practice signed up to a trial of Alivecor devices, which could be used with mobile phones to confirm whether patients have atrial fibrillation. Early diagnosis of the condition allows prompt treatment for patients.

• Feedback from patients about their care was consistently and highly positive.

• The practice worked closely with other organisations and the local community in planning how services were provided to ensure they meet patients’ needsFor example, one of the practice partners worked with hospital paediatric consultants and the community nursing teams to develop the Children’s Community Nursing Outreach Team. This service provided support for children whose condition made them vulnerable to hospital admission. This was piloted by the practice and two other surgeries locally. As a result this service was successful and now accepts GP referrals from any practice across the CCG, helping avoiding admissions of unwell children safely.

• The practice is involved with the CCG “New ways of working group”, looking at all clinical and support roles in the locality to see if there are better ways of delivering services to all patients.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. When satisfaction scores for interactions with reception staff dipped, all staff were given further customer service and conflict resolution training.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority.
• The partners strived to deliver good outcomes for patients; where improvements were required, steps were taken to deliver these, for example in the improvement of care for diabetic patients.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 3 November 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice had acted to improve diagnosis rates of asthma and the effective and safe treatment of these patients. The practice nurse had received further training in spirometry and respiratory management, and worked with a CCG lead nurse to deliver respiratory clinics at the practice.

• The practice had conducted a full audit of all patients with diabetes to ensure that medication and care regimes were in line with latest National Institute for Health and Care Excellence guidance. This was a two cycle audit and improvements in treatment regimes were introduced with some patients being referred for further specialist advice.

• The practice had achieved all diabetic care indicators but noted from audit that more could be done to support these patients. As a result, the practice has been accepted onto the Royal College of General Practitioners Diabetes Quality Improvement programme, which will benefit diabetic patients at the practice.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

Updated 3 November 2016

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

• One of the practice partners worked with hospital paediatric consultants and the community nursing teams to develop the Children’s Community Nursing Outreach Team. This scheme was successful in reducing admissions of unwell children, safely. As a result this service has been extended and all GPs in the CCG can refer to this service.

• There were systems in place 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 A&E attendances.

• One of the practice partners had worked with the CCG safeguarding lead and Multi Agency Safeguarding Hubs (MASH), to agree a form of words and template to be used by practices, to facilitate the better sharing of information between GPs and child safeguarding teams across the CCG. This was adopted by GPs in the area, ensuring relevant information on safeguarding was passed to MASH teams as required.

• The practice GPs had noted there was a delay in receiving details of new child patients who were subject to protection plans. This was raised with the named CCG lead for safeguarding who is addressing the matter. In the meantime, safety measures were in place whereby Health Visitors who received this information, shared it with the practice by phone or at face to face meetings.

• Immunisation rates were high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

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

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 3 November 2016

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

• The practice had responded positively to data around poor rates of diagnosis of dementia in older patients. By increasing screening processes, cross checking records of other healthcare providers, and checking how any previous reports of cognitive impairment had been recorded the rate of dementia diagnosis at the practice has increased by 139% over the past two years.

• The practice had higher numbers of over 75’s and 85 year old patients as a proportion of the patient register than other practices locally. Clinicians offered proactive, personalised care to meet the needs of this population group. The practice screens older patients to determine their risk of frailty; when identified these patients have a personalised care plan in place that all clinicians in the community can access to follow a prescribed path of care.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• We saw evidence of GPs providing pastoral care to older patients, who for various reasons had not been reached by community initiatives.

Updated 3 November 2016

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 achieved its cervical screening target each year: achievement for 2014-15 was 84% compared to CCG average of 81% and national average of 82%.

• The practice had improved the attendance rates of working age patients at bowel and breast cancer screening clinics, by sending out personalised letters to patients who failed to attend these screenings.

• The rate of patients receiving annual flu vaccinations was the fourth highest in the local CCG.

• The recording of patients smoking status was reviewed regularly and was the second highest in the local CCG, with referrals for and attendance at smoking cessation advice clinics at the highest in the CCG.

• The practice scored the second highest rates of patient satisfaction within the CCG.

Updated 3 November 2016

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

• 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the CCG average of 82% and the national average of 84%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record was 100%, compared to the CCG average of 88% and national average of 88%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a record of alcohol consumption their record was 100%, compared to the CCG average of 86% and national average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

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

• We saw that carers of patients with dementia were particularly well supported from the point of referral for diagnosis of the condition through to practical help and support post diagnosis.

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

• We saw evidence from minutes of clinical meetings that the practice worked with community professionals to follow-up patients who move out of the area, taking all steps possible to ensure they register with a GP at their new location, reducing the possibility of patients experiencing a lack of care or mental health crisis.

• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff had undergone dementia awareness training and displayed a good understanding of the confusion experienced by patients experiencing poor mental health.

• The practice is a member of the Dementia Alliance and all staff are Dementia Friends trained. The practice forms part of a Dementia Friendly neighbourhood, which is led by this and a neighbouring practice. Recent fundraising events were held, which included all dementia patients able to attend and their carers. Funds from the event are being used to host a Christmas meal for dementia patients and their carers.

• As a research practice the partners were committed to participating in any dementia research initiatives that would help or benefit patients.

Updated 3 November 2016

The practice is rated as good for the care of people who circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability.

• 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.

• Staff recently identified a patient who had become homeless and referred this person directly to a GP who worked with other clinicians to carry our all health care checks and ensure the patient had access to other support services.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.