Dr Christopher Steere Also known as Neston Medical Centre

Updated 2 March 2017

Dr Christopher Steere also known as Neston Medical Centre is responsible for providing primary care services to approximately 7,400 patients. The practice is situated in Liverpool Road, Neston, Cheshire. The practice is based in an area with lower levels of economic deprivation when compared to other practices nationally. The practice has a slightly higher than average number of patients over the age of 65 and an about average number of patients with a long standing health condition when compared to other practices locally and nationally.

The staff team includes Dr Christopher Steere and three salaried GPs. An advanced nurse practitioner who is also the practice manager, three practice nurses, a health care assistant, an assistant practice manager and administration and reception staff. Two GPs are female and two are male. The nursing staff and health care assistant are female.

The practice is open 8am to 6.30pm Monday to Friday. An extended hour’s service for routine appointments and an out of hour’s service are commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. Patients are also able to access the out of hours service provided by Wirral Community NHS Trust. All patient facilities are on the ground floor. The practice has a small car park for on-site parking.

Dr Christopher Steere has a General Medical Services (GMS) contract. The practice offers a range of enhanced services including, minor surgery, timely diagnosis of dementia, avoiding unplanned hospital admissions and influenza and shingles immunisations.

Updated 2 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Christopher Steere, also known as Neston Medical Centre at on 20 September 2016. The overall rating for the practice was Good. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Christopher Steere on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 16 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 20 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

• The provider had ensured the premises were safely maintained. Evidence of a satisfactory electrical wiring inspection, up to date fire risk assessment and risk assessment of the premises had been made available.

The following improvements to the service had also been made:

• A formal process for reviewing significant events had been put in place.

• The system for ensuring staff understood how to identify child and adult safeguarding concerns had been reviewed.

• Improvements had been made to the records kept relating to staff recruitment.

• A recording system had been introduced to demonstrate that cleaning standards were being maintained.
• The system for identifying staff training needs and completion of training had been reviewed.
• All staff had either received an annual appraisal or an appraisal had been planned for February 2017.
• An annual review of complaints had been undertaken and the contact details of the Parliamentary Health Service Ombudsman was now included in correspondence sent to complainants.

However, there was an area of practice where the provider should make improvements.

• A proforma should be developed to demonstrate that persons employed were able by reason of their health (after reasonable adjustments) to perform the tasks for which they were employed. To ensure a consistent way of gathering and responding to this information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 November 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided such as screening programmes and vaccination programmes. The practice had a system in place to recall patients for reviews of long term conditions. Alerts were placed on patient records to ensure same day access where necessary. Nurses made visits to housebound patients with long term conditions. Quality and Outcome Framework (QOF) data 2014 -2015 showed the practice was performing in-line with other practices at a local and national level in the monitoring of long term conditions.  The practice reviewed the services provided to patients with long-term conditions following best practice guidance from the Clinical Commissioning Group (CCG) and National Institute of Clinical Excellence (NICE). The nursing staff took the lead for different long term conditions and kept up to date in their specialist areas. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice referred patients who were over 18 and with long term health conditions to a well-being co-ordinator for support with social issues that were having a detrimental impact upon their lives.

Updated 8 November 2016

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Immunisation rates were relatively high for all standard childhood immunisations. Appointments for young children were prioritised. Appointments were available outside of school hours and the premises were suitable for children and babies. Family planning and sexual health services were provided. The lead GP liaised with other health care professionals to ensure the needs of vulnerable children were addressed, they met with the health visiting service, staff had received safeguarding training relevant to their role and alerts were placed on patient records to identify any children subject to safeguarding concerns.

Updated 8 November 2016

The practice is rated as good for the care of older people. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients. The practice was working with neighbourhood practices and the Clinical Commissioning Group (CCG) to provide services to meet the needs of older people. The practice had provided an Early Visiting Service over the last two winter periods. This had the aim of improving patient access to GP services, enabling quicker access to the resources needed to support patients at home where possible and reducing emergency admissions to hospital and use of emergency services. The practice was also working with two other practices to set up more community led services, for example the practices were setting up a service for a practice nurse to visit elderly housebound patients to carry out medication reviews and health checks. A practice nurse visited housebound patients and patients residing in care homes to provide vaccinations and reviews of long term conditions.

Updated 8 November 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments, book on the day appointments and telephone consultations. Patients could order repeat prescriptions and book some appointments on-line which provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday allowing early morning and evening appointments to be offered to working patients. An extended hour’s service for routine appointments and an out of hour’s service were commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. Patients were also able to access the out of hour’s service provided by Wirral Community NHS Trust. The practice website provided information around self-care and local services available for patients. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening. Reception staff sign-posted patients who do not necessarily need to see a GP. For example to services such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP) and the Physio First service (this provided physiotherapy appointments for patients without the need to see a GP for a referral).

Updated 8 November 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services. The practice had information in the waiting areas about services available for patients with poor mental health. For example, services for patients who may experience depression.

Updated 8 November 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient had a learning disability to enable appropriate support to be provided. The practice worked with health and social care services to support the needs of vulnerable patients. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff was the carer’s link. The practice referred patients to local health and social care services for support, such as drug and alcohol services.