Neston Surgery

Updated 26 August 2016

Neston Surgery is responsible for providing primary care services to approximately 9,000 patients. The practice is situated in Mellock Lane, Little Neston, 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 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 five partner GPs, three salaried GPs, three practice nurses, a health care assistant, practice manager and administration and reception staff. Four GPs are male and four are female. The practice nurses are female. The practice is a training practice for GPs, medical students and nurses and at the time of our visit had two GP registrars working for them as part of their training and development in general practice and one student nurse.

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. The extended hours service operates from Neston Surgery on Monday and Thursday evenings form 6.30pm to 8.45pm. The practice offers minor surgery appointments on a Saturday at least 12 times per year. All patient facilities were on the ground floor. The Surgery had on-site parking.

The practice has a General Medical Services (GMS) contract. The practice offers a range of enhanced services including minor surgery, learning disability health checks, sexual health and near patient testing.

Updated 26 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Neston Surgery on 5 July 2016.

Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There were systems in place to reduce risks to patient safety, for example, infection control procedures, medication management and the management of staffing levels.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. However, the system for reviewing all long term conditions should be improved to ensure it is effective.

• Staff felt well supported. They received training appropriate for their roles and an appraisal every 12 months.

• Patients were positive about the care and treatment they received from the practice. The National Patient Survey January 2016 showed that patients’ responses about whether they were treated with respect, compassion and involved in decisions about their care and treatment were comparable to or above local and national averages.

• Services were planned and delivered to take into account the needs of different patient groups.

• The National GP Patient Survey results showed that patient’s satisfaction with access to care and treatment was in line with local and national averages.

• Information about how to complain was available. There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

The areas where the provider should make improvements are:

• A documented risk assessment should be put in place to minimise the risks from staff who have not had a DBS check and who act as chaperones.

• Establish a system to check the continuing suitability of GPs by checking the GMC and Performers List.

• Document reviews of significant events to demonstrate that actions identified have been implemented.

• Nationally published data showed patient outcomes were lower for some long term conditions when compared to local and national averages. The systems for monitoring that patients were receiving the health care checks they needed at the recommended frequencies should be improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 August 2016

The practice is rated as requires improvement 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 some of the services provided such as screening programmes and vaccination programmes. However, the practice did not have a robust system in place to make sure all patients were recalled for an annual review of their long term conditions. A system was in place for patients with some long term conditions such as diabetes but not for all long term conditions identified by the practice. The Quality and Outcomes (QOF is a system intended to improve the quality of general practice and reward good practice) results (data from 2014-2015) showed that the practice was performing in line with other practices nationally for the monitoring of some conditions such as hypertension, cervical screening and most diabetes checks. QOF results showed the practice was below national averages in providing annual reviews of asthma, chronic obstructive pulmonary disease and diabetes foot checks.

The practice was working with the CCG to establish the Year of Care model for patients. This patient centred model would provide an annual health check to patients with multiple long term conditions reducing the need for multiple appointments. The clinical 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 26 August 2016

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Appointments for young children were prioritised. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. The safeguarding lead staff liaised with the health visiting service, school nurses and midwife to discuss any concerns about children and how they could be best supported. Family planning and sexual health services were provided. The practice identified children/young people who were carers to ensure they were receiving the support they needed. The practice identified school leavers and offered them vaccination against meningitis. The Patient Participation Group were in the process of establishing a Facebook page to engage younger patients and help keep them updated with the services offered at the practice.

Updated 26 August 2016

The practice is rated as good for the care of older people. The practice worked with other agencies and health providers to provide support and access specialist help when needed. 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. Weekly visits were made to local nursing homes to review the needs of patients and respond to any health issues identified. There was a designated GP who visited the nursing homes to provide continuity of care. A review of poly pharmacy had been undertaken by a pharmacist employed by the practice. This enabled thorough medication reviews to be undertaken and patient welfare to be promoted given the close link between poly pharmacy and unplanned hospital admissions. Annual health checks were offered to patients over 75.

Updated 26 August 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 on-line which provided flexibility to working patients and those in full time education. A texting service was in operation to remind patients about their appointments and reduce the occurrence of missed appointments. The practice was open from 8am to 6.30pm Monday to Friday allowing early morning and evening appointments to be offered to working patients. Minor surgery appointments were offered on Saturday mornings and winter flu clinics at weekends. 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. The extended hours service operated from Neston Surgery on Monday and Thursday evenings form 6.30pm to 8.45pm.

The practice website provided information around self-care and local services available for patients. 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 26 August 2016

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice carried out assessments of patients at risk of dementia to encourage early diagnosis and access to support. 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. Clinical and non-clinical staff had undertaken training in dementia to ensure all were able to appropriately support patients.

Updated 26 August 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. There was a recall system to ensure patients with a learning disability received an annual health check. The staff we spoke with had appropriate knowledge about adult safeguarding and how to report any concerns. The practice worked closely with the community care team which provided social work, nursing, physiotherapy and occupational therapy support and brought the needs of vulnerable patients to the attention of the practice. 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 and to the wellbeing coordinator.