Jubilee Medical Centre

Updated 8 May 2018

Jubilee Medical Centre is located in the Croxteth area of Liverpool which is one of the most deprived areas of the country. There were approximately 8,700 patients registered at the practice at the time of our inspection.

The practice has four GP partners, four salaried GPs, two advanced nurse practitioners and one trainee advanced nurse practitioner; two practice nurses, a health care assistant, practice manager, assistant practice managers, and reception and administration staff. The practice is a training practice and had a GP registrar and a foundation year two doctor. The practice also had a long term locum GP.

The practice is open 8am to 6.30pm Monday to Friday and offers extended morning and evening opening hours for GP, advanced nurse practitioner, practice nurse and pharmacist appointments. Patients who contact the practice for routine matters before 3pm are offered a same day consultation. Patients who need to speak to a GP urgently are able to consult with a GP invariably within one hour, on the same day, provided they contact the surgery during opening hours.

Patients accessed the Out-of-Hours GP service by calling NHS 111.

Jubilee Medical Centre has a General Medical Services contract (GMS). The practice is part of NHS Liverpool Clinical Commissioning Group (CCG).

Updated 8 May 2018

This practice is rated as Good overall. (Previous inspection 28 October 2014– Good overall)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Jubilee Medical Centre on 23 March 2018 as part of our routine inspection programme.

At this inspection we found:

• The number of patients on the practice list had increased by approximately 1,000 patients since our last inspection in 2014.The practice recognised the challenges they faced from patient needs and were in the process of reviewing and embedding their values and systems to try to meet these demands. The practice had reviewed the staff skill mix to make better use of GP time and had taken on additional staff, including a pharmacy team.
• The practice had increased the remit of the pharmacy team over the past four years to cover all medication reviews, prescription signing and dealing with medication changes identified in secondary care letters. Pharmacists also offered advice on medication optimisation following chronic disease reviews. We saw evidence from 2014-2018 of the effectiveness of this, for example, demonstrating better blood sugar control for diabetic patients

• The practice had also sought innovative ways to improve patient access to services. For example, by the use of e consult. Results from the national GP patient survey from July 2017 showed that patients’ satisfaction with the service and how they could access care and treatment was higher compared to local and national averages. Patients were able to access care and treatment from the practice on the same day that they requested it.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. We saw evidence that the practice learnt from incidents and adapted systems to improve when necessary.
• 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. However, not all staff had received regular formal appraisals of their work, as there had been an increase in new staff employed and existing staff were being trained up for other roles, which took time. Although formal appraisals had not been carried out for all staff, there was evidence of informal reviews with some staff including regular review of development needs and opportunities. The practice recognised this as one of their areas for development and had plans in place.
• Care Quality Commission (CQC) comment cards and GP national patient survey data 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. Improvements were made to the quality of care as a result of complaints and concerns.
• There was a clear leadership structure and staff felt supported and valued by management. 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.

We saw areas of outstanding practice:

• The practice recognised that they had previously had a high rate of dermatology referrals. The practice had purchased a dermatoscope and trained a GP in the use this so that other clinicians could seek timely advice in house. We saw audit results that this had reduced unnecessary dermatology referrals.
• The practice recognised that their practice population had a higher than average depression prevalence (14% compared to a national average of 9%). The practice informed us that they had initiated a local psychiatry collaborative pilot with the community mental health team which had reduced referrals to secondary care by 50%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 March 2015

There were registers of patients with long term conditions which enabled the practice to monitor and arrange appropriate medication reviews. The practice nurses looked after patients with long term conditions such as diabetes and liaised with the GPs to ensure where necessary appropriate reviews of care and risk were carried out.

The practice used the Quality and Outcomes Framework to monitor patient outcomes and worked on local initiatives.

The practice sent the out of hours service a weekly report of priority patients, for example, those that had a serious long term condition or terminal illness that may require help over a weekend or bank holiday.

Updated 26 March 2015

The practice had a community midwife who attended the practice once a week. The practice had a system in place for flagging up those children who had not received their vaccinations and the practice encouraged follow up visits.

The practice had child safeguarding policies and procedures in place and the majority of the staff had received updated training. There were systems in place to ensure that those children at greater risk were monitored appropriately.

Comments from patients demonstrated that the practice had systems in place to ensure that children requiring urgent consultations were seen when necessary. There were appointments made available for children and young people outside of school and college core hours.

Updated 26 March 2015

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice kept a register of those patients 75 and over which was regularly updated and the practice offered a named GP for these patients in line with the new GP regulations. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

The practice held Gold Standard Framework meetings to discuss patients who required palliative care with other health care professionals to ensure patients received ‘joined up’ care appropriate to their needs.

Immunisations such as the flu and shingles vaccinations were offered to older patients and the Quality and Outcomes Framework (QOF) information indicated the percentage of patients aged 65 and older who had received such vaccination was higher than the national average.

Updated 26 March 2015

All patients were offered referrals to hospitals through the choose and book system.

The practice had a variety of extended opening hour times for pre-bookable evening appointments with the GP or practice nurse to accommodate those patients who could not attend the practice during normal working hours.

The practice offered an online booking system for appointments and ordering of repeat prescriptions. The practice had recently introduced on line access to medical records.

The practice also operated NHS health checks for patients between 40-74 years of age.

Updated 26 March 2015

The practice maintained a register of patients who experienced mental health problems. The register was used by clinical staff to offer patients an annual health check and medication review.

The practice kept a separate registers for long term conditions including patients with dementia and depression. The practice liaised with other health and social care services to ensure patients received appropriate care and support.

Updated 26 March 2015

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 housebound patients and those with a learning disability. It had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability to enable more time to discuss treatment options.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It supported patients 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.