St Helens Hospital

Updated 10 January 2023

Marshalls Cross Medical Centre is managed by St Helens and Knowsley NHS Trust Teaching Hospital and is located in a purpose-built department in St Helens Hospital:

2nd Floor, Orange Zone

St Helens Hospital

Marshalls Cross Road

Merseyside

WA9 3DA

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury and surgical procedures.

The practice is situated within the Cheshire and Merseyside Integrated Care System (ICS) and delivers Alternative Provider Medical Services (APMS) to a patient population of 6,000 people. This is part of a contract held with NHS England.

The practice is part of St Helens Central primary care network, a wider network of GP practices.

Information published by Public Health England shows that deprivation within the practice population group is in the second lowest decile (two of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is, 85.9% White, 1.6% Asian, 1.1% Mixed, 0.7% Black, 0.6% Other and 10.1% was not recorded.

The age distribution of the practice population closely mirrors the local and national averages. There are more working age patients registered at the practice.

The practice team was led and supported by a directorate manager and lead GP to deliver the primary care services for the trust. The practice staffing consisted of four GP’s, two advanced nurse practitioners and two practice nurses, a health care assistant, patient care co-ordinators, a practice manager a business manager.

The practice is open between 8 am to 6:30 pm Monday to Friday. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

Extended access is provided locally by St Helens Rota, where late evening appointments are available Monday 6:30pm, 6:45pm, 7pm, Wednesday 6:30pm, 6:45pm, 7pm, 7:15pm and Friday 7:45pm, 8pm, 8:15pm and 8:30pm. Out of hours services can be accessed via NHS 111.

Updated 10 January 2023

We carried out an announced comprehensive inspection at St Helens Hospital (Marshalls Cross Medical Centre) on 4, 6 and 12 October 2022. Overall, the practice is rated as Good.

Safe - good

Effective - good

Caring - good

Responsive – good

Well-led - good

Following our previous inspection on 18 August 2018 the practice was rated requires improvement overall and for key questions safe, effective and well-led and good for providing caring and responsive services.

Marshalls Cross Medical Centre is run by St Helens and Knowsley Teaching Hosptials NHS Trust and comes under St Helens Hospital location regulated activities. It is not required to register with the Commission as a separate GP practice location.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for St Helen’s Hospital on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection in line with our inspection priorities.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included :

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

• The practice had implemented a system for ensuring that patients on long term or high-risk medication were monitored. Uncollected prescriptions were followed up and monitored.
• Detailed risk assessments for the premises, facilities and to provide services for patients on the specialist allocation scheme had been undertaken and were regularly reviewed.
• Safeguarding processes had been strengthened.
• Systems were in place to monitor NICE and other best practice guidance.
• Staff had completed essential training relevant to their role and responsibility.
• Effective clinical audits had been undertaken and an annual audit programme was in place.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Patients could access care and treatment in a timely way.
• Clinical oversight and governance systems for the practice had been reviewed and integrated into the Trust’s community services directorate.
• The governance arrangements, strategy and plans for the practice were regularly reviewed and monitored.
• There were effective systems and processes for identifying, managing and mitigating risk.

Whilst we found no breaches of regulations, the provider should:

• Continue to improve uptake for cervical screening and childhood immunisations.
• Continue to monitor patient medication reviews.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

Updated 19 January 2016

The medical services at St Helens Hospital were rated as good because patients received compassionate care and their views were considered as to how services were designed and provided.

Staff were aware of how to report incidents and could clearly show how and when incidents had been reported. Lessons were learned from incidents and staff felt confident about reporting them. Feedback was shared and discussed in team meetings and learning applied. A monthly patient safety first newsletter was disseminated to staff and the trust had committed to the national sign up to safety campaign.

Staff received their appraisals in a timely way and felt supported to do their job. There was evidence of good multidisciplinary team working and staff were aware of their responsibilities around the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.

Meetings on bed availability were held four times a day to determine priorities, capacity and demand for all specialities. These were attended by both senior management staff and senior clinical staff. As part of managing the admission and discharge processes there was a daily board round on Duffy suite attended by members of the multidisciplinary team. The Allen Day unit would change appointment times at short notice to try to accommodate patients’ needs and at times were able to rearrange for the same day.

The hospital was visibly clean and staff followed good hygiene practices. Staffing levels were largely sufficient to meet the needs of patients safely. Care was provided in line with national best practice guidelines and medical services participated in the majority of clinical audits.

The friends and family test showed that 100% of people would recommend the hospital to friends or a relative for inpatient care.

Staff were enthusiastic about their job and looked forward to going to work. There was good staff engagement with staff being involved in making improvements for services.

Updated 19 January 2016

There was a clear process for reporting and investigating incidents. We saw evidence that incidents were being reported and staff we spoke with were aware of the system and how to use it. We saw evidence of learning from incidents and how this learning was shared across the service and trust wide. We saw evidence of change to practice following learning from incidents.

The trust had electronic medical records that were easily accessible in a timely manner when patients visited the service. A contingency plan was in place to have access to patient information should the information technology system fail.

Staff were aware of their role in safeguarding, a reporting process was in place, and staff knew how to escalate concerns. Staff were aware of the policies and procedures to protect and safeguard children and adults. There was good practice in the outpatient and imaging departments to promote the safety of patients and staff.

The general environment was safe, passageways and waiting rooms were free from clutter and trip hazards.

Staff followed good practice guidelines in relation to the control and prevention of infection.

Cleanliness and hygiene was of a high standard throughout the hospital departments and staff followed good practice guidance in relation to the control and prevention of infection

Staff attended mandatory training and were trained and skilled to perform their role The trust had a clear training need analysis which identified mandatory training required and was role specific. Staff were positive about the access and quality of training provided.

Staffing levels were appropriate to meet the needs of patients. Managers were proactive in managing staffing pressures such as reviewing nursing staffing levels and sharing of radiologists across other providers.

Updated 20 March 2019

Our rating of this service stayed the same. We rated it as good because:

• Mandatory training compliance rates were good and above trust target in some areas.
• The service had a good staffing ratio and ensured the correct skill mix was accounted for.
• Staff were competent in their roles and managers encouraged professional development of junior staff.
• Staff had good awareness of the Mental Capacity Act, 2005 and patients were supported to make informed decisions about their care.
• Staff involved patients and their relatives in decisions about care and treatment.
• Patients we spoke to and feedback forms reflected good levels of satisfaction in the service.
• Patients felt listened to in the department.
• The department took complaints seriously and learning from complaints was evident.
• The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
• The trust had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. Services at the hospital were aware of the vision and strategy and how it affected surgery at St Helens.
• The services delivered met the needs of patients well.