Central Surgery

Updated 21 March 2017

Central Surgery is registered with the Care Quality Commission to provide primary medical services. The practice provides GP services for approximately 6000 patients living in St Helens and is situated within a purpose built health and resource centre in the centre of St Helens.

The practice has two female GPs, one male GP, a practice nurse and healthcare assistants, administration and reception staff and a practice manager. It is a training practice and has GP trainees and nursing students working at the practice.

Central Surgery holds a General Medical Services (GMS) contract with NHS England.

The practice is open Monday to Friday 8am – 6.30pm. Doctors appointment times are as follows:

Each mornings, 8am to 11.15am. Monday afternoons 2pm to 6pm, Tuesday, Wednesday and Thursday 3pm to 6pm and Friday 2.30pm to 5.30pm. Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services. The practice does not provide out of hours services. When the surgery is closed patients are directed to the local out of hour’s service (St Helens Rota) and NHS 111. Information regarding out of hours services was displayed on the website and in the practice information leaflet.

The practice is part of St Helens Clinical Commissioning Group (CCG) and is situated in a more deprived area. The practice population is made up of a more elderly population with 25% of the population aged over 65 years old and 18% of the population under 18 years old. Seventy two per cent of the patient population have a long standing health condition and life expectancy for both males and females is around the national average.

Updated 21 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Central Surgery, St Helens on 1 November 2016. Overall the practice is rated as good.

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

• There was an effective system in place for reporting and recording significant events. Safety alerts were received and acted upon.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Staff had been trained to deal with medical emergencies and emergency medicines and equipment were available.

• Infection control procedures were in place.

• Improvements were needed to ensure the safe storage of temperature sensitive medicines and to ensure medicine storage fridges were adequately serviced and maintained.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they could make appointments easily and urgent appointments were available the same day for all children and those patients who needed them.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must improve are:

• The provider must ensure correct procedures are followed if fridge temperatures fall outside of the required range for safe storage of temperature sensitive medicines.

• The provider must ensure equipment, in particular the medicines storage fridges are serviced, calibrated and maintained to ensure they remain effective.

The areas where the provider should make improvement are:

• Review the use of cleaning schedules to include displaying them in all clinical areas and to include cleaning of medical equipment.

• Review policies and procedures to ensure they are localised and specific to the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 November 2016

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

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

• Some performance indicators for patients with long term conditions were lower than the CCG and National average. For example:

  The percentage of patients on the diabetes register, in whom the last blood pressure reading (measured in the last 12 months) was 140/80mmHg or less was 66%. The CCG average was 80% and the national average was 78% (recently published data from the QOF period 20015/2016).

  The percentage of patients with COPD who had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months was 82%. The CCG average was 92% and national average was 89% (recently published data from the QOF period 20015/2016).

• Longer appointments and home visits were available when needed for patients with long term conditions and multiple conditions.

• All these patients had 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 22 November 2016

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

• 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.

• Immunisation rates were good for all standard childhood immunisations with immunisations uptake for all children aged five and under averaging 91%.

• 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.

• Unwell children were offered same day/urgent appointments.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was comparable to other practices at 81%. (CCG average was 83%, national average was 82%).

• Appointments were available outside of school hours.

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

Updated 22 November 2016

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

The practice had a higher number of older patients than the national and local clinical commissioning group (CCG) average with 25% of patients at the practice being over the age of 65. 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, care for frail elderly patients in avoiding unplanned hospital admissions, dementia care, and end of life care.

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

• Nationally reported data showed that outcomes for patients with conditions commonly found in older people were good. For example the percentage of patients with hypertension in whom the last blood pressure reading was 150/90mmHg or less was 76% and comparable to the CCG and national average. Whilst the percentage of patients with atrial fibrillation treated with anticoagulation or anti platelet therapy was 96% and also comparable to the CCG and national average.

• All the older patients had a named GP who coordinated their care and contacted patients over 75 following discharge from an unplanned hospital admission.

Updated 22 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.

• For example, it offered online bookings of appointments and prescription requests and telephone consultations. Appointments could be pre booked or booked on the day and emergency appointments were also available daily for those in need and all children.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group for example NHS health checks for those aged 40 to 75 years old.

Updated 22 November 2016

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

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to other practices (CCG average - 86% and national average - 84%.

• 85% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months which was comparable to other practices (national average - 88% and CCG average - 93%).

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and could signpost to relevant specialist services.

• 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 and for those who did not attend appointments.

• Staff had a good understanding of how to support patients with mental health needs and dementia. Longer appointments were offered to those patients with poor mental health.

Updated 22 November 2016

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, those with substance or alcohol misuse and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability and an annual health check at an appointment convenient to the patient and carer.

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

• 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.