Earle Road Medical Centre

Updated 20 June 2016

Earle Road Medical Centre is registered with CQC to provide primary care services, which includes access to GPs, family planning, ante and post natal care. The practice is a long established GP practice working in the centre of Liverpool in a newly purpose built. The practice has a General Medical Services (GMS) contract with a registered list size of 4250 patients (at the time of inspection). The practice population is younger than the city average with a significantly higher proportion of children aged 0-4 years and proportionately fewer people aged 85+ years. It is estimated that around two-fifths (39.8%) of the population are Not White British/Irish , 10.6% are Black/African/ Caribbean/Black British and 9.3% are Asian/Asian British ethnicity with 18.4% of the population’s main language is not English. This is significantly above the Liverpool average and the highest in the city.

The practice is in the Picton neighbourhood which is the 4th most deprived in the city. In addition it is estimated that unemployment is significantly higher than the city rate (8.1% compared to 7.2%) and 5.7% of the population are long term sick or disabled. Around 43.1% of the population are economically inactive which is significantly above the city average and the 2nd highest out of all neighbourhoods across the city.

The practice offers a range of enhanced services including minor surgery, flu vaccinations, timely diagnosis of dementia and learning disability health checks. The practice has one lead GP, long term GP locums and F2 trainee doctors. They have one practice manager, practice nurse and health care assistant, practice and a number of administration and reception staff. The practice has open access appointment for GPs for urgent cases each morning. Bookable appointments are available daily. Home visits and telephone consultations were available for patients who required them, including housebound patients and older patients. There are also arrangements to ensure patients receive urgent medical assistance out of hours when the practice is closed.

Updated 20 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Earle Road Medical Centre on 19 April 2016. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

There were areas of outstanding practice as follows:

• The practice is based in a deprived area of Liverpool with a substantial bBME) patient profile. The practice team including the trainee doctors have been working hard to improve access for this population group, particularly in areas where there was poor uptake such as access to cervical screening and children’s immunisations. The practice was aware that some members of these communities were unaware of services available at the GP practice. To improve access they set up links with a local community centre and Liverpool CCG to provide health promotion and education sessions within the centre for females from the BME communities. Education workshops were held in the centre run by the practice team focusing on women’s health and well being covering topics such as childhood immunisation, women’s health, heart disease, cervical smears and diabetes. The practice advised that this work had

The areas where the provider should make improvement are:

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• The practice should provide written information in different languages to meet the profile of the patient population

• The provider should ensure that information is held for locum GPs including documentary evidence of their professional registrations, fitness to practice and records of their completed training.

• The provider should ensure full and completed minutes are kept for all multi disciplinary meetings taking place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 June 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. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required immunisations received these.

• The GPs had lead roles in chronic diseases and practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health. Patients with several long term conditions were offered a single, longer appointment to avoid multiple visits to the surgery.

• Data from 2014 to 2015 showed that the practice was comparable with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. For example, the percentage of patients with diabetes, on the register, who had had influenza immunisation was 96% compared to a national average of 94%.

• Longer appointments and home visits were available for patients with long term conditions when these were required.

• The practice contacted patients following admission to hospital to check if they required any services from the practice.

• The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

Updated 20 June 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and those who were at risk, for example, children and young people who had a high number of A&E attendances. A GP was the designated lead for child protection.

• Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.

• Child surveillance clinics were provided for 6-8 week olds and immunisation rates were comparable to the national average for all standard childhood immunisations. The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report any concerns they had identified to relevant professionals.

• The practice worked with local community groups to encourage patients from a BME background to improve their access to primary care services, including childhood vaccinations.

• Appointments were available outside of school hours.

• The premises were suitable for children and babies and baby changing facilities were available.

• Family planning services were provided and the practice had a lead for sexual health and contraception.

Updated 20 June 2016

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

• The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population. The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

• The practice provided a range of enhanced services, for example, the provision of care plans for patients over the age of 75 and screening patients for dementia.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or better than local and national averages.

• GPs carried out regular visits to local care homes to assess and review patients’ needs and to prevent unplanned hospital admissions.

• Home visits and urgent appointments were provided for patients with enhanced needs.

• The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.

• The GPs held special interests in conditions commonly found in older people and there was a designated GP lead for the care of patients over 75 years of age.

• Staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.

Updated 20 June 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Telephone consultations were available and this meant patients did not always have to attend the practice in person.

• The practice had extended opening hours on a Wednesday evening until 8.30pm.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group.

• The practice was proactive in offering online services including the booking of appointments and request for repeat prescriptions. Electronic prescribing was also provided.

Updated 20 June 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were similar to or better than average. For example, data showed that 93% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This compared to a national average of 84.%.

• The practice provided an enhanced service for screening patients to identify patients at risk of dementia and to develop care plans with them.

• Practice staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.

• Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they took.

• Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

Updated 20 June 2016

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 in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these. Patients spoke positively about the GPs attendance at these annual reviews.

• The practice provided primary care to people who have a learning disability who were living in a local care home.

• Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available.

• Information and advice was available about how to access a range of support groups and voluntary organisations.