Christiana Hartley Medical Practice

Updated 14 November 2017

Christiana Hartley Medical Practice is located in a residential area of Southport. There were approximately 5,103 patients on the practice list and the majority of patients were of white British background.

The practice is a teaching practice managed by an individual GP. There is one salaried GP and a regular locum GP. Additional clinical staff include, two practice nurses, a healthcare assistant, a practice pharmacist and a phlebotomist. Clinical staff are supported by a practice manager, reception and administration staff. The practice is open 7.45am to 6.30pm Monday, Wednesday and Thursday and 8am to 6.30pm on Fridays and 8am-8pm on Tuesdays. Patients accessed the Out-of-Hours GP service by calling NHS 111.

The practice is commissioned by NHS Southport and Formby local clinical commissioning group and has a Personal Medical Service (PMS) contract and also offers enhanced services for example; extended hours.

Updated 14 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Christiana Hartley Medical Practice on 29 September 2017. Overall the practice is rated as outstanding. The practice is rated as outstanding for providing responsive services for older people, vulnerable people and those experiencing poor mental health; and well led services for all population groups and good for providing safe, effective and caring services.

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

• Safety was a key priority for the practice and comprehensive risk assessments and audits covering a range of issues were regularly conducted. The practice additionally utilised external auditors to ensure the safety of the practice systems and premises.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. There were systems to manage safety alerts. Learning from any incidents was discussed at internal and external meetings with other healthcare professionals to promote shared learning.
• The practice had invested in modernising the premises. The environment was pristine yet welcoming with plenty of information available for patients.
• 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. The practice sought additional training materials for staff. For example, comprehensive guides for infection control.
• Patients we spoke with and Care Quality Commission (CQC) comment cards 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.
• The practice had updated its telephone system to improve access. Patients we spoke with said they found it easy to make an appointment. Urgent appointments were available the same day.
• There was a strong and clear leadership structure and staff felt supported by management.
• Communications with staff had been well considered to ensure information was easily accessible and that staff carried out their roles effectively. For example, there was a communications noticeboard for staff to review two policies a week.
• 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 implemented a series of measures to help provide equitable access and health care provision for their patients. For example:

• The practice had set up a programme to review all their patients who were in care homes and nursing homes. These reviews took place every 12-15 weeks to ensure patients were receiving correct medicines and timely referrals when necessary. The reviews involved family, carers and staff from the homes attending the practice to co-ordinate care and provide holistic care for the patient. This was in addition to the GPs and nursing staff attending the homes. Patients on antipsychotic medicines were checked to ensure they were under the care of a psychiatrist .The structured reviews had resulted in a 6% reduction in the prescribing of antipsychotic medicines and a 2% reduction in emergency hospital admissions over the past 12 months for these patients.
• Accessible Information standards had been well considered. For example, the practice had conducted a telephone survey for visually impaired patients to improve their experience of the service provided. This had resulted in these patients being made more aware of the facilities available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 November 2017

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

• There was a system to recall patients for a structured review to check their health and medicines needs were being met. These reviews were conducted when necessary and not just annually.
• 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.
• The practice employed a pharmacist to assist with medication reviews. All newly registered patients received a medication review.

Updated 14 November 2017

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

• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics and provided immunisations.
• The practice offered after school and evening appointments.
• The practice had identified that teenagers were not often seen at the practice and had sent information leaflets out to all patients who were 15 inviting them to attend a health review with a clinician of their choice. The practice extended this invite to include a drop in service for instant help. The lead GP was in discussions with the local school nurses to further promote this service.

Updated 14 November 2017

The practice is rated as outstanding for the care of older people. This was because the practice is rated outstanding for providing both responsive and well led services for this population group.

• The practice had set up a programme to review all their patients who were in care /nursing homes. This involved the family/carers and staff from the care home. This was in addition to the GPs and nursing staff attending the care homes. These reviews took place every 12-15 weeks. The reviews included medicine reviews, health checks, DNAR status, the need for any referrals to other services, and a review of any DoLS in addition to addressing any family concerns. We saw statements of feedback from the care homes involved that the reviews had helped their staff support patients with their care plans.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. There was a named GP for over 75 year olds.
• The practice checked that housebound patients had some contact every six months and if not the nurse carried out a home visit or contacted the patient by telephone.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 14 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice offered evening appointments on a Tuesday with the nurse and GP.
• Appointments with the nurse, health care assistant and phlebotomist were available before 8am three times a week.

Updated 14 November 2017

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). This was because the practice is rated outstanding for providing both responsive and well led services for this population group.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice was able to signpost patients experiencing poor mental health to access various support groups and voluntary organisations
• Receptionists had received dementia friends training. The practice nurse was the dementia lead and carried out dementia reviews for housebound and care home patients. The practice actively tried to diagnose dementia diagnosis and promoted advanced care planning. Patients with dementia living in care homes were reviewed every 12-15 weeks to ensure all their needs were met.

Updated 14 November 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. This was because the practice is rated outstanding for providing both responsive and well led services for this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• The practice had carried out a telephone survey of visually impaired patients to make them aware of services available.