Archived: Dr Peter Ayegba

Updated 2 December 2016

Dr Peter Ayegba’s practice is based in a purpose built facility in a residential area of Huyton, Knowsley close to local amenities. The practice is based in a more deprived area when compared to other practices nationally. The male life expectancy for the area is 77 years compared with the CCG averages of 76 years and the national average of 79 years. The female life expectancy for the area is 80 years compared with the CCG averages of 80 years and the national average of 83 years.

The building is shared with three other GP practices and has a community pharmacy on site. There were 4060 patients on the practice list at the time of inspection. The practice has one lead male GP. A permanent salaried female GP had recently relocated and left the practice in July 2016. The provider has recruited a new GP due to start 22/08/16 and was using locum GPs in the interim. The practice is in the process of recruiting a permanent practice nurse and nurse practitioner and is using agency staff in the interim until permenant staff are in place. The practice has one healthcare assistant, a reception supervisor, a data manager, reception and administration staff and an interim practice manager employed for two days a week to assist the development of the practice until a permanent practice manager is in post. The provider had recruited two practice managers who did not take up their posts.

The practice opening times are Monday to Friday from 8am to 6.30pm with extended opening hours each Wednesday 6.30-8.30pm. Appointments are from 8.00am to 6pm. Patients requiring a GP outside of normal working hours are advised to contact the surgery and they will be directed to the local out of hour’s service called Options. Liverpool Community Health delivers the Options GP service for residents in Knowsley.

The practice has a General Medical Services (GMS) contract. The practice offers enhanced services such as health assessments for patients with learning disabilities and minor surgery. 

Updated 2 December 2016

GOOD

We had previously inspected Dr Ayegba in January 2016 and had found serious concerns. As a result the practice was rated as inadequate and placed into special measures. The inspection report was published in March 2016. Specifically, we found the practice inadequate for providing safe, effective, caring, responsive and well led services. Following the inspection the practice sent us an action plan of how they were going to address these issues. We carried out an announced comprehensive inspection at the practice on 17th August 2016. This was to review two warning notices served for Regulation 12 and Regulation 17 and to consider whether sufficient improvements had been made by the provider, and whether the concerns we had at the previous inspection had been addressed. The practice had made significant improvements. We have rated the practice as good for providing safe, effective, caring responsive and requires improvement for well led services. Overall the practice is rated as good.

Our key findings were:

• 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.

• An improved recruitment process had been implemented since our last inspection and this had been followed when recruiting new staff.

• Staff training needs had been addressed so that staff had 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 decisions about their treatment. Patients were positive about their interactions with staff.

• 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 there had been improvements at the practice and it was easier to make an appointment, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make further improvements are:

• Review recent improvements and consider how the practice can ensure the sustainability of improvements made and have effective succession planning in place.

• Update training records for all staff.

• Revise the documentation and storage in relation to PGDs and PSDs

• Review the need to document decisions made in discussions with multi-disciplinary teams.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 December 2016

• Staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice had access for referrals to the smoking cessation service and to a consultant for COPD clinics which were delivered to patients from the practice building. ECGs and spirometry tests could be delivered to patients at the practice premises.

• The practice offered an anti-coagulation service on site.

• Indicators for the care of diabetic patients were in line with local and national averages. 100% of patients with diabetes, on the register, had received an influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015) compared with the CCG average of 95% and the national average of 94%.

• Longer appointments and home visits were available when needed.

Updated 2 December 2016

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

• The percentage of women aged 25-65 whose notes record that a cervical screening test has been performed in the last five years, was 85% which was higher than the local clinical commissioning group (CCG) average of 80% and the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Priority appointments were made available for children.

• The practice held immunisation clinics, post natal baby checks and ante natal clinics with a midwife, and eight week child development clinics.

• We saw positive examples of joint working with health visitors.

Updated 2 December 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

• The practice had two designated staff who acted as direct contacts for carers, who liaised with the patients named GP, and who could interupt the named GP between consultations when circumstances required this.

• The practice promoted screening such as bowel screening and had worked on increasing the uptake of screening with patients who initially do not take part in these public health initiatives .

• The practice offers joint injections to help reduce the waiting times for secondary care and to offer a convenient service to their patients.

Updated 2 December 2016

• 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 and flexible.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice offered extended opening hours each Wednesday evening up to 8.30pm. Patients were offered telephone consultations when appropriate, rather than patients having to visit the practice.

• Health checks were offered to patients who were over 40 years of age to promote patient well-being and address any health concerns.

Updated 2 December 2016

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.

• The practice worked closely with the local, ‘Improving Access to Psychological Therapies’ (IAPT) service to offer self-referrals for patients.

• The lead GP is the clinical lead for mental health for Knowsley CCG and promotes up to date standards of care for patients with dementia.

• The practice gave guidance and support to patients experiencing poor mental health, and information on how to access various support groups and voluntary organisations.

Updated 2 December 2016

• The practice held a register of patients who had special needs such as patients with learning disabilities, palliative care patients, and patients who were carers.

• The practice offered longer appointments and annual health checks for patients with a learning disability.

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

• 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.

• The practice had a number of patients from different backgrounds who could also be vulnerable, for example, refugees or economic migrants. Staff used translation services to help communicate with these patients and usually booked double appointments to accommodate the use of interpreters.