Archived: Haydock Medical Centre Also known as Dr Breach & Partners

Updated 30 January 2017

Haydock Medical Centre is located in Haydock and is registered with CQC to provide primary care services. The practice has a General Medical Services (GMS) contract with a registered list size of 7462 patients (at the time of inspection).

The male life expectancy for the area is 78 years compared with the CCG averages of 77 years and the national average of 79 years. The female life expectancy for the area is 82 years compared with the CCG averages of 81 years and the national average of 83 years. The percentage of the patient population who have a long standing health condition is 66% which is higher than the national average of 54%.

The practice has three partners (one female two male GPs) and four salaried GPs, (two male and two female). They are also supported by one long term locum GP, two trainee GPs, two practice nurses and two health care assistants. The practice manager oversees the work of administration and reception staff that are all multi-skilled. The practice is a training practice offering support and experience to trainee doctors.

The practice is open from 8 am to 6.30pm each day. One day a week either a Monday or Tuesday they offer extended hours from 6.30pm to 8.40pm. Appointments start at 9am to 5.45pm. Patients requiring GP services outside of normal working hours are referred on to the local out of hours provider, St Helens rota. Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits.

The practice staff acknowledged the building and its facilities do not fully meet patients’ needs however they are due to move to a new purpose built building in March 2017. Car parking is available.

The practice is part of St Helens Clinical Commissioning Group (CCG). The practice offers a range of enhanced services including, flu vaccinations and learning disability health checks.

Updated 30 January 2017

We carried out an announced comprehensive inspection at Haydock Medical Centre on the 11 January 2017. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• There was an open and transparent approach to reporting and recording significant events. Risks to patients were assessed and well managed for example, arrangements to safeguard vulnerable patients, recruitment checks for new staff and keeping medicines safe.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Feedback from patients about their care was positive. They felt there had been a lot of changes over the last couple of years with staff leaving but they felt that the practice team had become more stable. Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• The practice sought patient views about improvements that could be made to the service. This included the practice having and regularly consulting with a patient participation group (PPG) and conducting their own in house patient survey.

• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. Staff felt well supported in their roles and had undergone a regular appraisal of their work.
• The practice was in need of renovation but they were due to move to a new purpose built building in March 2017.
• The appointments system provided a range of appointments to meet patients’ needs including urgent and on the day appointments. Feedback from some patients was that they had difficulty getting through to the practice by phone and that they sometimes waited too long for a routine appointment. The practice had introduced some changes to their phone system and had an action plan to review improvements to patient satisfaction.
• Complaints had been investigated and responded to in a timely manner.
• The practice had visible clinical leadership and governance arrangements in place.

• Areas where the provider should make improvement:

• Monitor and audit phone lines to help identify peak times and to monitor how they were meeting patient demand.

• To review all results from the national GP patient survey that were lower than local and national averages and monitor actions and feedback responses from patients.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 January 2017

• 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.

• Practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health. They had revised how they reviewed their patients. In the last year they offered patients with several long term conditions a single, longer appointment to avoid multiple visits to the surgery.

• Data from 2015 to 2016 showed that the practice was performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions.

• For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. They referred patients to the COPD nurses and heart failure nurses.

• The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care. The practice had close links with their district nursing team who were located in the same building.

Updated 30 January 2017

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 who were at risk, for example, children and young people who had a high number of A&E attendances. Regular safeguarding meetings took place with health visitors to share information or concerns about child welfare.

• Immunisation rates were comparable for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. The practice had 1377 (18%) of patients aged under 16 and a further 152 (2%) of patients aged 16-18 years.

• Data for rates of cervical screening by the practice showed the percentage of women receiving this intervention was comparable with local and national averages, at 78%. (Clinical Commissioning Group average (CCG) 82% and national average 81%).

• Premises included baby changing facilities. Maternity services were offered in conjunction with locally commissioned services on site. Midwives provided maternity clinics.

• Babies and young children were always offered an appointment as a priority and appointments were available outside of school hours. Baby clinics were provided offering baby checks.

Updated 30 January 2017

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.

• Patients over the age of 75 had a named GP and had received a review to check that their health needs were being met. The practice had 129 patients’ age over 65 years, with the provision of care plans for patients at risk of unplanned hospital admission.

• Care planning was carried out for patients with dementia care needs.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

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

• 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.

Updated 30 January 2017

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. The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group. Online services included the booking of appointments and request for repeat prescriptions. Electronic prescribing was also provided. The practice had 4700 (63%) of patients aged between 18 and 67 years.Screening uptake for people in this age range was comparable with national averages. For example 67% of females aged 50-70 had been screened for breast cancer in the last three years, the national average was 72%.

• Extended hours appointments were provided daily one day a week 6.30pm to 8.30pm. They also provided flu clinics of a Saturday for patients to obtain their vaccination. Patients were offered telephone consultations for those patients who preferred to call the GP. This was advantageous for people in this group as it meant they did not always have to attend the practice in person.

Updated 30 January 2017

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

Updated 30 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients who had special needs such as 41 patients with learning disabilities, palliative care and 506 patients who were carers. The practice offered longer appointments for patients with a learning disability and were undertaking annual health reviews for these patients.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients and kept up to date lists of those patients with Deprivation of Liberty safeguards (DoLs) in place liaising with their local care homes in regards to this.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.
• 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