Hamilton Medical Centre

Updated 10 July 2017

Hamilton Medical Centre is registered with the Care Quality Commission to provide primary care services. It provides GP services for approximately 2,366 patients living in Birkenhead, Wirral. The practice is training and teaching practice managed by individual male GP and has two sessional GPs (one male, one female) and also has a salaried GP (male). There is an advanced nurse practitioner, a nurse practitioner and a practice nurse. There is a practice manager and a team of administration and reception staff. Hamilton Medical Centre holds a General Medical Services (GMS) contract with NHS England.

The practice is open during the week; between 8am and 6.30pm. The practice offers extended hours on a Tuesday evening until 8pm. Patients can book appointments in person, online or via the telephone. Patients can access the Out-of-Hours GP service by calling NHS 111. 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 is part of Wirral Clinical Commissioning Group (CCG). The practice is situated in an area with high deprivation and has a high proportion of homeless patients compared with other practices in the area.

The practice carries out minor surgery but they were not registered with us to carry out this regulated activity. This was addressed during the inspection. 

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hamilton Medical Centre on 14 June 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• 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.
• 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 in the patient information leaflet and on the practice’s web site.
• The appointment system was regularly audited to check the practice was meeting patient demand. The practice operated a system for direct access to appointments and/or advice or priority for prescriptions for patients with greater needs.
• The practice is situated in an area of high deprivation and the practice provided GP services for homeless patients and patients living in nearby hostels.
• 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.
• Staff had worked at the practice for many years and the benefit of a small practice was that staff knew their patients well and could anticipate their needs. Staff worked well together as a team.

The areas where the provider should make improvements are:

• Have appropriate oxygen masks for adults and children for use in medical emergencies and update their monitoring system for emergency medical equipment for expiry dates.

• Secure the oxygen cylinder and have appropriate safety signage; and have a map of the building displayed at the front entrance of the practice with details of where the oxygen is stored for the fire service.

• Update safeguarding registers and coordinate details of other family members of patients who may be at risk.

• Periodically review incidents and all complaints to identify any trends and minimise the potential for reoccurrence.

• Display information in the waiting room about how to make a complaint or suggestion.

• Implement a plan of at least two cycle clinical audits to monitor quality outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 July 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All these patients had a named GP and there was a system to recall patients for 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.
• Patients on ten or more medications had regular medication reviews with the GP and a pharmacist.
• Patients with chronic obstructive pulmonary disease were given a purple card with a check list of symptoms that if patients developed were advised to contact the practice.

Updated 10 July 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 had emergency processes for acutely ill children and young people.
• All staff had received safeguarding children training relevant to their role.

Updated 10 July 2017

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

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• 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 had a gold access card scheme to provide a telephone number for patients who required rapid access.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 10 July 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 extended hours appointments on a Tuesday evening until 8pm.

Updated 10 July 2017

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 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
• The practice had an in house counselling service.

Updated 10 July 2017

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 those with a learning disability.
• The practice provided GP services for homeless patients and patients in nearby hostels.
• 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.