Letter from the Chief Inspector of General Practice
This is the report of findings from our inspection of Vauxhall Primary Health Care.
We undertook a comprehensive inspection on 28th April 2015. We spoke with patients, staff and the practice management team.
Overall, the practice was rated as Good. A caring, effective, responsive and well- led service was provided that met the needs of the population it served. We found elements of outstanding practice in relation to providing effective and responsive services. However, improvements were needed to demonstrate the practice was recruiting staff safely.
Our key findings were as follows:
- There were systems in place to protect patients from avoidable harm, such as from the risks associated with medicines and infection control. However, improvements were needed to the recruitment of staff as the recruitment records did not demonstrate that all necessary checks were undertaken to demonstrate suitability for their roles.
- Patients care needs were assessed and care and treatment was being considered in line with best practice national guidelines. Staff were proactive in promoting good health and referrals were made to other agencies to ensure patients received the treatments they needed.
- Feedback from patients showed they were very happy with the care given by all staff. They felt listened to, treated with dignity and respect and involved in decision making around their care and treatment.
- The practice planned its services to meet the differing needs of patients. The practice encouraged patients to give their views about the services offered and made changes as a consequence.
- Quality and performance were monitored, risks were identified and managed. Staff told us they could raise concerns, felt they were listened to, felt valued and well supported.
We saw areas of outstanding practice:-
- The practice carried out a range of clinical audits to evaluate the operation of the service. The findings from some audits had been shared outside the practice. For example, an audit of bariatric patients had led to changes in the practice protocols for monitoring the healthcare needs of these patients. This audit was presented to the Royal College of General Practitioners to disseminate the findings more widely and led to the GP who carried out the audit being invited to attend a nutritional panel that makes recommendations nationally.
- The practice looked after the health needs of the majority of Liverpool’s travelling community. The practice worked closely with a multi-disciplinary team of health and social care professionals to ensure the health needs of the travelling community were met. For example, if follow up services were needed the traveller support workers (qualified nurses) hand delivered letters from the GPs and read them to the travellers as a number were illiterate. The GPs continued to monitor and prescribe medication when they moved to a site in another area in order to promote patient safety and continuity of care.
- A specialist service was provided to focus on the needs of patients with complex needs, those who were housebound (including those who lived in care homes), on polypharmacy (the use of four or more medications by a patient) and with multiple conditions. Home visits were undertaken by GPs and a comprehensive review of the patients’ health care needs was undertaken. The patients identified were also discussed in multi-disciplinary meetings to ensure their needs were being effectively met. A review was carried out in May 2014 and found there had been changes to patient medication, including a reduction in the amount of prescribed medication compared to results of a review of this service in 2010.
- The practice was involved in a social work pilot. A social work team for adults was based at the practice. This pilot had been developed to encourage better communication and closer working relationships between health and social care services. This pilot had been in operation since February 2015 and although it had not been evaluated we spoke to staff from the practice, a social worker and the social work team leader who gave us many good examples of how admissions to hospital had been avoided and earlier hospital discharges facilitated due to better communication and faster reaction time from the practice and social services.
- We spoke to three members of the Patient Forum who had worked with the practice for over 20 years. They told us that many projects had been run at the practice to make patients’ wait more enjoyable. For example, music was played, a patients’ library had been established and a reading project was tried out. The most successful project had been “Nancy’s Kitchen” where volunteers from the Patient Forum provided tea and toast. This continued to be provided at the practice every morning. Members of the Patient Forum told us how socially isolated patients benefitted from this service and how they were able to direct patients to sources of support if requested.
There were areas of practice where the provider needs to make improvements
Importantly, the provider must:
- Take action to ensure its recruitment policy, procedures and arrangements are improved to ensure necessary employment checks are in place for all staff and the required information in respect of workers is held.
The provider should:
- Ensure the serial numbers of all prescription pads and the clinical staff they are issued to are recorded.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice