Archived: Market Street Surgery

Updated 4 June 2015

Dr James and Partners (Market Street Surgery) is located in Newton le Willows, St Helens, which is a deprived area of the country. The practice is located in a large semi-detached property in the centre of the town. There were approximately 8000 patients on the practice list.

The practice has four partner GPs and a salaried GP in addition there are nurses, a healthcare assistant, a practice manager, office manager and reception and administration staff. The practice is open 8.30am to 6pm Monday to Friday. The practice has open access clinics at various times throughout the week to accommodate same day appointments. Patients requiring a GP outside of normal working hours are advised to contact an external out of hours service that is provided by local GPs. The number of this service is clearly displayed in the reception area and on the practice website. The practice has a GMS contract and also offers enhanced services for example; various immunisation and learning disabilities health check schemes.

The practice was a designated teaching practice for the training and education of student doctors they had robust systems in place to support student doctors including weekly tutorials.

Updated 4 June 2015

Letter from the Chief Inspector of General Practice

This is the report from our inspection of Dr James and Partners Surgery. The practice is registered with the Care Quality Commission to provide primary care services.

We undertook a planned, comprehensive inspection on the 10 March 2015 at Dr James and Partners Surgery. We reviewed information we held about the services and spoke with patients, GPs, and staff.

Overall the practice is rated as good.

Our key findings were as follows:

• There were systems in place to mitigate safety risks including analysing significant events and safeguarding. The premises were clean and tidy. Systems were in place to ensure medication including vaccines were appropriately stored and in date.

• Patients had their needs assessed in line with current guidance and the practice had a holistic approach to patient care. The practice promoted health education to empower patients to live healthier lives.

• Feedback from patients and observations throughout our inspection highlighted the staff were kind, caring and helpful.

• The practice was responsive and acted on patient complaints and feedback.

• The staff worked well together as a team.

We an area of outstanding practice including:

The practice offered support through shared care agreements for those patients who had addiction issues. The practice also ran joint clinics with a drug advisor to ensure patients received the correct medication, support and advice. Records showed that all patients who had a member of their family with an addiction issue had an alert placed on their record. This was to ensure the practice could offer appropriate support and safeguard against possible abuse or neglect.

However, there was also an area of practice where the provider needs to make improvements.

The provider should:

Ensure there is a system in place whereby audits undertaken are centrally monitored to ensure identified actions are carried out and reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 June 2015

The practice is rated as good for the care of people with long-term conditions. There were systems in place for call and recall of patients for annual reviews with a total of three letters being sent if patients failed to respond. Patients with long term conditions had alerts placed on their records to ensure they were offered a longer appointment with the GP.

The practice offered weekly clinics for patients taking warfarin and other anti –coagulation medicines to have their blood tested to ensure they were taking the right dosage. This service supported patients to be monitored and treated at the practice rather than having to attend the local hospital.

Updated 4 June 2015

The practice is rated as good for the care of families, children and young people. The senior partner was the safeguarding lead for the practice. There were systems in place to identify and follow up children living in disadvantaged circumstances and also cases of domestic violence. Records showed the lead GP liaised and sought advice from other health and social care professionals when necessary.

The practice offered two post natal clinics per week where babies received their six week check carried out by a GP, babies received their immunisations and mothers were supported with breastfeeding. Health visitors attended both these clinics.

There was a system in place to follow up babies who had not been immunised and there was also an escalation procedure to GPs if this remained a concern.

Patients from the local settled traveller community were registered at the practice and were supported to access services including child immunisation programmes.

There was advice available in reception regarding access to community sexual health clinics held locally.

Updated 4 June 2015

The practice is rated as good for the care of 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, the avoidance of unplanned admissions scheme. The practice had a designated named GP for patients who were 75 years of age and over and care plans were in place for these patients. All patients with a plan had a direct line to the practice to speak to a GP should they need it.

The practice had a register of those patients who were housebound and the office manager coordinated with the nursing staff to ensure those patients were visited and offered vaccinations. Drop in clinics for vaccinations were advertised in the reception for all patients but at risk patients were sent specific letters to advise them of the need to have the vaccination.

The practice had access to a health improvement team who would visit patients in their home. There was information available to patients about services offered within the local community including those patients who may be experiencing social isolation.

Updated 4 June 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice currently does not offer extended hours we were told that this issue was to be reviewed following the employment of another GP.

Appointments with GPs and practice nurses were available from 9am until 6pm each day. Patients requiring minimal nursing support were offered appointments with the health care assistant from 8:30am.

All patients over 45 years of age were invited to attend a health check however the practice told us the uptake for this service was poor. There was health promotion information available in the waiting area and on the practice website.

Updated 4 June 2015

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 people experiencing poor mental health and sign posted patients to the appropriate services. The practice participated in enhanced services for dementia and used screening tools to identify those patients at risk.

Those patients who experienced poor mental health received six monthly medication reviews.

Updated 4 June 2015

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. The practice held a register for those patients with a learning disability. Patients annual health checks were carried out by a GP and usually took place in their homes.

The practice had a register of carers that was shared with the carers champion at the CCG. The practice supported patients to access support and services based in the community including respite care.

The practice offered support through shared care agreements for those patients who had addiction issues. The practice also ran joint clinics with a drug advisor to ensure patients received the correct medication, support and advice. Records showed that all patients who had a member of their family with an addiction issue had an alert placed on their record. This was to ensure the practice could offer appropriate support and safeguard against possible abuse or neglect.

The practice had signed up to a CCG led service for patients who were under 18 and attended accident and emergency departments due to intoxication. This information was shared with the practice who invited the young person and their parents or carers to discuss the event.

The practice supported the local settled traveller community to access services including health checks and immunisation programmes.