Archived: Princes Park Surgery

Updated 6 August 2015

Princes Park Surgery is registered with the Care Quality Commission to provide primary medical services. The practice holds an Alternative Provider Medical Services (APMS) contract and is located close to the centre of Liverpool. The practice is managed by SSP Health Ltd a corporate provider which has a number of GP practices across the North West of England. Doctors and practice staff work at the practice across the week. The practice has a primary health team consisting of GPs, two practice nurses, reception secretarial and administration staff.

The practice is part of Liverpool Clinical Commissioning Group (CCG).The practice is situated in an area with high deprivation with ethnically diverse patients from a number of cultural backgrounds. The practice has a high proportion (30%) of patients whose first language is not English. People living in more deprived areas tend to have greater need for health services. The practice population has a higher than national average patient group aged between 25-34 and there are higher deprivation scores for older patients and children compared to national figures.

The practice is open Monday to Friday from 8.00am to 6.30pm. There are no extended hours surgeries available. Patients can book appointments in person, online or via the phone. The practice provides telephone consultations, pre bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of medical services.

The Out of Hours service is provided by Urgent Care UK.

Updated 6 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Princes Park Surgery on 16 April 2015. Overall the practice is rated as inadequate. We found improvements were required for the safe, effective treatment of patients, how caring and responsive the practice was and how well the practice was led. We found the practice was good at caring for patients.

Our key findings were as follows:

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when things went wrong, reviews and investigations were not thorough enough and lessons learned were not communicated widely enough to support improvement.
• The provider did not deploy sufficient numbers of GPs to meet the demands of patients including in response to their urgent needs. The high usage of locum and agency GPs resulted in a lack of continuity of care, increasing the risk of patient incidents and complaints. There were insufficient numbers of patient appointments to meet the demands of the local population. Patients regularly had to wait outside the practice before it opened to ensure they got an appointment for later that day.
• Data showed that patients rated the practice higher than others for several aspects of care. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice did not have systems in place to ensure locum GPs were monitored closely enough to ensure any changes to a patient’s care and treatments was actioned. There was no evidence that GPs completed clinical audits to assess and continually evaluate practice. Actions plans were not routinely developed when patient complaints or safety incidents occurred.

There were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Review the system in place for reporting incidents. The written record of incidents and the information gathered was not sufficient in detail to adequately identify risks. The system for sharing the learning from incident reporting required improvement. Locum and agency GPs did not attend meetings where patient incidents and complaints were discussed. (Reg 12)
• Review the current arrangement for providing GP cover to the practice. The practice was unable to meet the demands of patients including in response to their urgent needs at all times. The high usage of locum and agency GPs led to a lack of consistency of care and increased the risk of patient incidents and complaints occurring. We found instances where locum GPs had not actioned changes required to patient’s medicines when they were reviewing patient discharge summaries. Systems should be set up to ensure that the work of locum GPs practice is monitored and feedback can be given. (Reg 12)
• Take timely and appropriate action to ensure accurate and up to date patient records are kept. There were significant delays to patient information being scanned onto their records, notably in the period before our inspection. This meant that patients attending the practice for a follow up appointment after their hospital visit were not seen by GPs with their full updated medical history. (Reg 17)
• Ensure that GPs complete clinical audits to assess and continually evaluate their practice.
• Ensure an action plan is developed to increase the practice performance for cervical smear uptake. (Reg 17)
• Review the appointment system to ensure there are sufficient numbers of patient appointments to meet the demands of the local population. (Reg 17)

In addition the provider should:

• Ensure doctors have emergency drugs available for use or have in place a risk assessment to support their decision not to have these available for use in a patient’s home.
• Include specific detail within the practice vision and strategy on how the particular cultural needs of patients living in this community will be met.
• Ensure that actions plans are developed when a patient complaint is made or a patient safety incident has occurred.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 August 2015

There were aspects of care and treatment that were inadequate that related to all population groups. Nursing staff had lead roles in chronic disease management and the care of patients at risk of hospital admission were identified as a priority. The practice had a recall system for patients with long term conditions which had improved in recent months due to closer monitoring of this population group. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice has a smoking cessation and counselling service within the practice.

Updated 6 August 2015

There were aspects of care and treatment that were inadequate that related to all population groups. The practice offered same day appointments for all children when ill. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. This included children and young adults with an alcohol related admission to hospital. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 6 August 2015

There were aspects of care and treatment that were inadequate that related to all population groups. The practice provides an older persons review service for all patients over 75 years living in a local care home. This included commissioning the services of a Consultant in elderly medicines and advanced nurse practitioners to work across the community assessing and screening older patients. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, offering flu vaccination and home visits if needed.

The practice had undertaken searches of this population group, including identifying those patients who lived alone and their carers.

Updated 6 August 2015

There were aspects of care and treatment that were inadequate that related to all population groups. The practice did not offer extended opening hours for working patients but they did offer online repeat prescribing of medicines and they had recently started online booking of GP appointments. The practice was proactive in offering a full range of health promotion and screening that reflected the needs of this age group.

Updated 6 August 2015

There were aspects of care and treatment that were inadequate that related to all population groups. The practice had a risk stratification and case finding tool to identify high risk patients who may benefit from dementia screening and referral to memory clinics. The practice worked closely with the local mental health team to identify and support those patients identified as being at risk. The practice had counselling and support clinics on site. Patients who had experienced episodes of poor mental health were members of the patient participation group, which meant the needs of this patient group, could be heard. The practice commissioned a consultant in elderly care to screen all patients over 75 years who lived in local care homes. This work included advance care planning for patients with dementia.

Updated 6 August 2015

There were aspects of care and treatment that were inadequate that related to all population groups. The practice held a register of patients living in vulnerable circumstances including those with alcohol and drug dependencies. Annual health checks for these patients were carried out and a GP session is arranged fortnightly to accommodate those patients on a shared care agreement for treatment of substance misuse. The practice has counselling services on site and they worked closely with the local mental health team to support vulnerable patients. Staff knew how to recognise signs of abuse in vulnerable adults and children. 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. Language and interpreter services were available to patients and their carers. The practice had a range of posters and patient information available in different languages, reflecting the needs of its diverse patient population.