Albion Street Clinic

Updated 18 June 2015

St Helens Rota Ltd, who own Albion Street Clinic, is a not for profit, GP led co-operative, that provides out of hours care and treatment services to patients in the St Helens area. The clinic is delivered by GP’s from the 41 practices that the service covers. Out of hours periods are defined as being between 18.30 hrs and 08.00 hrs on weekdays and on a 24 hour basis on Saturday, Sunday and bank holidays. The clinic is registered with the Care Quality Commission (CQC) to deliver the regulated activities:

• Transport services, triage and medical advice provided remotely
• Treatment of disease, disorder and injury.

The service delivers a satellite clinic on a Sunday, in the Haydock area. This was not covered as part of this inspection.

Albion Street Clinic is located close to St Helens town centre. The clinic has some parking available for patients. A system of secure access is in place, whereby patients attending an appointment request access via an intercom. Patients are seen by a GP or nurse practitioner in one of the two fully equipped treatment rooms. The building has the facility to convert a third room to a consulting and treatment room, for example, when dealing with higher volumes of patients during peak periods in the winter.

Patients who require the services of a GP out of hours are diverted to Albion Street Clinic by the telephone system at their own GP surgery, or by ringing the out of hours service directly. Where patients have been unable to get an appointment with their own GP, they are referred to the service after their symptoms and condition has been triaged (assessed by phone) by their own GP. The clinic also receives electronic (computerised) prompts and information from the NHS 111 service. Any patient in the area that has called 111, and who has been assessed by that service as needing to see a GP, will have their computerised details sent immediately to the clinic. The clinic call handlers contact these patients to arrange an appointment at the clinic, or to arrange a home visit.

St Helens is a town in Merseyside, North West England. The proportion of people recorded as having a long term limiting illness in St Helens is higher than the England average. Deprivation rates are higher than average and just over 25% of children are defined as living in poverty. Positive performance indicators include the proportion of older people still in their own home for 91 days following discharge from hospital. In 2013-14 this figure was high, particularly for patients aged over 85 years and over, at 95% locally, compared to just 79% nationally.

Updated 18 June 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the Out of Hours service at Albion Street Clinic on 5 March 2015, between the hours of 17.00 and 23.30 hrs. Overall the clinic is rated as good.

The provider also runs a satellite clinic in Haydock on Sunday’s. This clinic was not visited by CQC and is not included in our inspection.

Our key findings were as follows:

• The clinic had systems in place that supported staff and GPs in the delivery of safe treatment of patients, both at the clinic or when attending patients in their home.
  • The service provided by the clinic was effective in terms of urgent care and treatment delivery. This was evidenced by data, for example, in relation to reduced numbers of children attending the local accident and emergency unit to access primary medical care.
  • The GP led Acute Visiting Service for older patients, responded to calls from paramedics of the North West Ambulance Service, who could seek advice from the on-call GPs. The response rate from the Out of Hours service to these calls was typically 15 minutes and contributed to reduced hospital admissions for older patients.
  • The clinic was responsive to the demand for services, by patients unable to see their own GP. The management at the clinic produced ‘real time’ reports that highlighted future pressure points on the service. This information was shared with the 41 practices it served and with the local hospitals who could plan for anticipated surges in demand.
  • The service provided was highly valued by patients who used it. We received 97 CQC comment cards, where patients had expressed their views. All comments were positive and described how patients had been seen and treated by caring, compassionate and helpful staff.

We saw areas of outstanding practice including:

• Responsive and flexible services which included children’s clinics which delivered a 20% reduction in numbers of children from the St Helens area, attending A&E.
• A pilot scheme with the North West Ambulance service, where GPs from the Acute Visiting Service provided by the clinic, worked with paramedics to stabilise and treat older patients at home, reducing the need to transport and admit older patients to hospital. Figures showed that 91% of ambulance call outs to older patients were turned around in this way, meaning patients’ were safely treated at home.

However, there were also areas of practice where the provider should make improvements.

The provider should:

• Retain copies of staff checks conducted on GPs and nursing staff.
• Evidence checks on the working hours of GPs and keep records alongside evidence of indemnity insurance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice