The Ash Surgery

Updated 10 July 2017

The Ash Surgery is based in the Aigburth area of Liverpool.The practice treats patients of all ages and provides a range of medical services. The staff team includes four GP partners, four salaried GPs, three practice nurses, a healthcare assistant, a practice manager, an assistant practice manager and administrative and reception staff. The practice has Foundation doctors working for them as part of their training and development in general practice.

The practice is open Monday to Friday from 8.30am to 6.30pm. Patients can book appointments in person, on-line or via the telephone. The practice provides telephone consultations, pre bookable consultations, same day appointments and home visits to patients who are housebound or too ill to attend the practice. The practice closes one afternoon per month for staff training. When the practice is closed patients access the Out-of-Hours GP service by calling NHS 111.

The practice is part of Liverpool Clinical Commissioning Group. It is responsible for providing primary care services to approximately 6,500 patients. The practice is situated in one of the more affluent suburbs of Liverpool and caters for a population that has more nursing homes than average.

The practice has a General Medical Services (GMS) contract. The practice shares a building with a counselling service and community services such as health training and the podiatry service operate from the practice. An improvement grant had been applied for to enable the practice to extend the premises and make more room for clinics and other services.

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Ash Surgery on 15 April 2015. The overall rating for the practice was Good. However, the practice was rated as Requires Improvement for providing safe services. The full comprehensive report on the April 2015 inspection can be found by selecting the ‘all reports’ link for The Ash Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 17 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified at our previous inspection on 15 April 2015. 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:

• Action had been taken to ensure that a record of the required staff recruitment information was maintained.

• Action had been taken to ensure that the premises and equipment were safely maintained.

In addition, the practice had made the following improvements:

• A system had been put in place to record the receipt and allocation of prescription pads.

• Improvements had been made to the records of staff training to assist with the monitoring of training needs.

The areas where the provider should make improvements are:

• The practice should review the actions from the health and safety and fire audits on a three monthly basis to ensure these are fully completed. The fire audit should also include a check on furnishings to ensure compliance with fire safety regulations.

• In house weekly checks of the fire alarm and monthly checks of emergency lighting should be consistently undertaken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 June 2015

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, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions and to follow up unplanned hospital admissions in a timely manner. Varied appointments were offered to ensure long term conditions were adequately reviewed. For example, home visits were undertaken to housebound patients or those residing in residential care or nursing homes, longer appointments were offered depending on the number of conditions being reviewed. The practice had identified all patients at risk of unplanned hospital admissions and a care plan had been developed to support them. Clinical staff kept up to update in specialist areas which helped them ensure best practice guidance was always being considered. Multi-disciplinary team and palliative care meetings were held where patient care was reviewed to ensure patients were receiving the support they required. In response to patient need, the practice had developed a One Stop Diabetic Shop which enabled the majority of diabetic checks (apart from dietetic and retinopathy) to be carried out at the practice on the same day. This reduced the need for patients to attend for several appointments for different diabetic checks and increased the likelihood that patients would receive the care they needed. The Quality Outcomes Framework (QOF) data from April 2013 to April 2014 showed that patients were receiving their diabetes checks when they were needed.

Updated 25 June 2015

The practice is rated as good for the care of families, children and young people. A weekly child health surveillance clinic and an immunisation programme were provided. The practice monitored any non-attendance of babies and children at child health and vaccination clinics and worked with the health visiting service to follow up any concerns. The practice hosted a Weaning Mum’s Group, led by the health visitor once a month. The staff were responsive to parents’ concerns about their child’s health and prioritised appointments for children presenting with an acute illness. The extended hours service on a Monday evening allowed parents to bring children to appointments, preventing them from missing school. Staff were knowledgeable about child protection and a GP took the lead for safeguarding. Staff put alerts onto the patient’s electronic record when safeguarding concerns were raised. Regular liaison took place with the health visitor to discuss any children who were at risk of abuse and to review if an appropriate level of GP service had been provided. The safeguarding lead met with the health visitor, school nurse and midwife every 4 – 6 months or more often if required to discuss any needs or concerns about children and young people registered with the practice.

Updated 25 June 2015

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and information was held to alert staff if a patient was housebound. Home visits were made to housebound patients as requested and to carry out reviews of their health. The practice ensured each person who was over the age of 75 had a named GP and that a comprehensive geriatric assessment had been completed. The practice worked with other agencies and health providers to provide support and access specialist help when needed. Older patients with complex health needs were reviewed at multi-disciplinary meetings to ensure they were receiving all necessary GP services. The practice had identified that it had a higher than average number of patients living in nursing homes, one of the GPs chaired a Frailty Working group and was working alongside other GP practices to improve standards of care for older people in the local area. A manager from a local care home was a member of the practice’s Patient Participation Group which ensured that the views of this group of patients were represented.

Updated 25 June 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice was open Monday to Friday and offered extended hours GP appointments until 19:45 on Mondays. The practice offered pre- bookable appointments, on the day appointments for urgent medical conditions and telephone consultations. On line bookable appointments and on line prescription requests were available. The practice offered health promotion and screening that reflected the needs for this age group such as smoking cessation, sexual health screening and contraceptive services. Health checks were offered to patients who were over 45 years of age to promote patient well-being and prevent any health concerns.

Updated 25 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice had a mental health and dementia lead member of staff. GPs worked with specialist services to review care and implement new care pathways. The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review. The practice referred patients to appropriate services such as psychiatry and counselling services. An in-house counselling service was available for GPs to refer patients to. The practice had information for patients in the waiting areas to inform them of other services available. For example, services for patients who may experience depression.

Updated 25 June 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, a register was maintained of patients with a learning disability and annual health care reviews were provided to these patients. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance in order to ensure the length of the appointment was appropriate. Staff were knowledgeable about safeguarding vulnerable adults. They had access to the practice’s policy and procedures and had received guidance in this. Formal training in safeguarding adults was being arranged for staff who had not received this.