St Werburgh's Medical Practice for the Homeless Also known as Northgate Medical Centre

Updated 6 March 2017

St Werburgh's Medical Practice for the Homeless is responsible for providing primary care services for the homeless population of Chester and the surrounding areas. It provides a service for approximately 325 patients. Eighty two per cent of the patient population are male and 78% are aged between 16 and 50. The practice does not provide a service to patients under the age of 16. The practice has been established for 12 years and was originally set up bythe Primary Care Trust (PCT).

The practice is also one of the designated practices in the area providing services to patients who have been subject to immediate removal from a patient list of a primary medical services contractor because of an act or threat of violence. The practice has 20 patients who are potentially violent.

The staff team includes two salaried GPs, a specialist nurse practitioner, practice manager, counsellor and reception and administrative staff. A mental health specialist practitioner employed by Cheshire Primary Care mental Health is based at the practice two days a week. The practice is operated by Northgate Medical Centre which operates an additional GP practice.

The practice is open 8:30am to 5.00pm Monday to Friday. Patients requiring a GP outside of these hours are advised to contact Northgate Medical Centre and the GP out of hours services provided by Cheshire and Wirral Partnership NHS Foundation Trust. The practice has an Alternative Provider Medical Services (APMS) contract.

Updated 6 March 2017

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of St Werburgh's Medical Practice for the Homeless on 9 December 2015. The overall rating for the practice was Good. We carried out a desk based review on 19 September 2016 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 comprehensive inspection on 9 December 2015. At this inspection we identified further improvements were needed and therefore carried out a desk based review on 8 February 2017. The full comprehensive report on the 9 December 2016 inspection and the desk based review on 19 September 2016 can be found by selecting the ‘all reports’ link for St Werburgh's Medical Practice for the Homeless on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 8 February 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 19 September 2016. This report covers our findings in relation to this requirement.

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 and legionella risk assessment had been made available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 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, asthma and chronic obstructive pulmonary disease (COPD). 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. A high number of the patient population had respiratory and dermatological conditions due to their lifestyle. Appropriate guidelines and pathways were followed to ensure that they received the care and treatment needed. Many patients had long term conditions related to addiction to drugs and alcohol. The practice worked closely with local drug and alcohol support services. Screening for blood borne viruses were carried out by the community drugs team and the practice carried out screening for high risk groups and also offered hepatitis A and B injections (injecting drug users are at high risk from hepatitis  A and B due to sharing of injection equipment, sexual spread and living conditions). “Legal high”(a substance with stimulant or mood-altering properties whose sale or use is not banned by current legislation regarding the misuse of drugs) abuse was a current issue for the practice which was impacting on the personal well-being of patients and resulting in increased attendance at accident and emergency departments. The practice was working with a public health researcher locally to get an idea of the impact of 'legal highs' on health and other services. The clinicians provided a “one-stop” service to patients attending the practice due to their irregular attendance and lack of engagement with planned appointments. This meant that appointments were longer as several issues were dealt with and opportunistic screening and vaccinations were carried out.

Updated 11 February 2016

The practice is rated as good for the care of families, children and young people. The practice provided a service to patients who had children however it did not have any patients under 16 years of age. Some contraceptive services were provided and patients needing health care or other support with pregnancy were referred on to appropriate services. Due to the circumstances of the patient population any pregnancies identified were referred to social services in accordance with the children’s safeguarding procedures. The staff we spoke with had appropriate knowledge about child protection, had access to policies and procedures for safeguarding children and had received training appropriate to their role.

Updated 11 February 2016

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 used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice worked with other agencies and health providers to  provide support and access specialist help when needed.

Updated 11 February 2016

The practice did not provide a service to working patients (including those recently retired and students).

Updated 11 February 2016

The practice is rated 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 health check. The practice employed a counsellor and a bereavement counsellor was on secondment from a local hospice to respond to patients’ emotional and mental health needs. A mental health practitioner was available to provide advice to patients. They worked on a self-referral and open referral basis which meant that there was quicker access which encouraged patients to engage with this service. The mental health practitioner worked closely with the GPs at the practice and they were able to undertake mental health assessments when needed. They had links with secondary mental health services. They also provided training to the staff of the local homeless centre and housing trust staff to educate them in the needs of homeless or potentially homeless patients with poor mental health. Longer appointments were offered to patients with poor mental health.

Updated 11 February 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. A service was provided primarily to homeless patients and the practice understood the needs of this patient population and had tailored the service to meet them. It recognised that a high number of patients that were homeless experienced poor mental health and were alcohol and drug dependent. It also recognised that engaging patients to access primary medical and mental health services could be problematic. The services provided by the practice and in partnership with mental health services and other health services demonstrated the outstanding manner in which the practice had responded to these needs. For example:-

• An optician service came to the practice to encourage patients to have their eyes examined. We were informed that this service had already enabled additional health needs to be identified in some patients.

• A flexible appointment system was in operation. Patients where provided with longer appointments as needed. Patients were seen on a drop in basis and patients who frequently missed appointments were never turned away when they presented at the practice. As patients may not visit the practice frequently reviews of long term conditions and vaccinations, such as, influenza vaccinations were carried out opportunistically.

• The nurse practitioner had organised health events were patients were provided with information and guidance about specific issues. For example, a men’s health day was held which included a presentation from the Fire Service about the Princes Trust. An event was also held for female patients with a focus on relaxation techniques, the importance of sleep and this included a presentation from local police about domestic violence.

• The nurse practitioner had been awarded the Queen’s Nurse Award in 2012 for services to the homeless.

• Clinical services were provided twice a week to homeless people attending a local support centre.

• Representatives from the practice attended multi-agency meetings to review the needs of homeless people in the area and to develop strategies to improve the circumstances of individuals and the homeless population of Chester (and the surrounding areas).

• Close liaison took place with the staff at homeless accommodation centres and local support centres to encourage attendance at the practice for review and to collect prescriptions and to encourage attendance at hospital appointments.

• Support was provided to patients who misused alcohol, drugs or prescription medication. The practice worked closely with the drug and alcohol team to support these patients.

• Staff spoken with were committed to the provision of a responsive service that was provided in a non-judgemental manner.

• A shower was available on site for patients to use.

• Patients were escorted to appointments where this was possible or an escort was identified from another service. This provided emotional support for patients as well as ensuring their attendance.

• Donations were sought to enable patients to be provided with toiletries and clothing when needed, for example, toiletries and pyjamas had been provided to patients going in to hospital. A Christmas sock appeal took place every year so that new socks could be provided to patients.