Archived: Fiveways Medical Centre

Updated 22 October 2015

Fiveways Medical Centre is located in the Childwall area of Liverpool. It is responsible for providing primary care services to approximately 3352 patients. The practice is based in a less deprived area when compared to other practices nationally. Unemployment levels amongst the patient population are relatively low. The practice population are of mixed gender and ages.

Fiveways Medical Centre is managed by SSP Health Ltd. The staff team includes two regular GPs who are not directly employed by SSP Health Ltd, with additional GP services provided by temporary GPs (either employed by SSP Health Ltd or by an agency). There is a vacancy for a practice nurse and practice nursing was at the time of our visit being provided by a nurse employed by Liverpool Clinical Commissioning Group. Vacancies for clinical staff had been advertised and we were told that arrangements had been made to ensure that from October 2015 three regular GPs are working at the practice. There is a practice manager, medical secretary and two reception staff. The practice is open 08:00 to 18.30 Monday to Friday. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hours service provided by Urgent Care 24.

The practice has an Alternative Provider Medical Services (APMS) contract. The practice offers a range of enhanced services including minor surgery, flu and shingles vaccinations and learning disability health checks.

Updated 22 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fiveways Medical Centre on 25 August 2015.

Overall the practice is rated as good.

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

• Staff were aware of procedures for reporting significant events and safeguarding patients from risk of abuse. Overall, significant events had been appropriately managed. However, we found that the actions arising from one significant event had not been followed to ensure the safe management of medications.

• There were appropriate systems in place to reduce risks to patient safety, for example, infection control procedures. Access to emergency medication and needed improvement.
• Access to the service was monitored to ensure it met the needs of patients. Patients reported satisfaction with opening hours and ease of making appointments.
• A number of sessional GPs (locum or self-employed) were supporting the practice which did not promote continuity of care for patients. Patient experiences of seeing or speaking to a preferred GP were less than local and national averages (National Patient Survey July 2015). A GP who would be regularly based at the practice was due to begin work in October 2015 which would address this.
• The practice sought patient views about improvements that could be made to the service and acted on patient feedback. Information about how to complain was available.
• Patients were overall positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.
• Services were planned and delivered to take into account the needs of different patient groups.
• There were systems in place to monitor and improve quality and identify risk.

There were areas where the provider must make improvements:

• Improvements need to be made to access to medications required in the event of an emergency.

There were areas where the provider should make improvements.

Importantly the provider should:

• Ensure that actions arising from significant events are closely monitored to ensure they are being followed through.
• Make improvements to the continuity of GPs employed at the practice to promote effective communication between clinical staff and continuity of care for patients.
• Ensure that a contact person for GPs to approach for support around clinical issues or safety incidents is clearly available for staff to refer to.
• Ensure that the practice website contains sufficient health promotion information for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 October 2015

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 such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. Patients who were housebound were visited at home for annual reviews of long term conditions and these were planned alongside immunisations, such as flu, for patient convenience. Patients on multiple disease registers were offered extended appointments of up to 60 minutes so that their annual reviews could look at all their conditions together. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients. They kept a record of patients needing palliative care.

Updated 22 October 2015

The practice is rated as good for the care of families, children and young people. Child health development and immunisation clinics were provided. Childhood immunisation rates for the vaccinations given were comparable to or exceeded CCG averages. For example, childhood immunisation rates for the vaccinations given to children of 5 years were 100% which was above the CCG average. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns. There was a policy of same day appointments for all children. Early years fact sheets providing information around vaccination schedules, breast feeding and cytology were provided to new parents. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding children. Staff put alerts onto the patient’s electronic record when safeguarding concerns were raised.

Updated 22 October 2015

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice had identified patients at risk of unplanned hospital admissions and a care plan had been developed to support them. These patients also had priority access to the practice. The practice carried out home visits and also visited care homes in the area. Last winter the practice had a bespoke service whereby a consultant in elderly medicine and a team of advanced nurse practitioners were available to undertake comprehensive geriatric reviews and dementia screening for any patients in care homes.

Updated 22 October 2015

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 book appointments in person, on-line or via the telephone and repeat prescriptions could be ordered on-line which provided flexibility to working patients and those in full time education. The practice had introduced a system whereby patients could cancel their appointments by text which made it easier for patients to cancel appointments and aimed to increase access by reducing wasted appointments. Health checks were offered to patients who did not have any existing chronic disease to promote patient well-being and prevent any health concerns.

Updated 22 October 2015

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual health check and a high proportion had a mental health care plan agreed and reviewed. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

Updated 22 October 2015

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. Alerts were also available to ensure the length of the appointment was appropriate. Staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and they had access to the practice’s policy and procedures and had received training in this.