Archived: Westminster Surgery

Updated 9 June 2017

Cheshire and Wirral Partnership NHS Foundation Trust (CWP) became the registered provider for Westminster Surgery in May 2016, although we were told that they had operated the practice from July 2015. The practice is responsible for providing primary care services to approximately 2,717 patients. The practice is situated in Ellesmere Port in Cheshire. The practice is based in an area with higher than average levels of economic deprivation when compared to other practices nationally.

The staff team includes a salaried GP, a nurse clinician, a practice nurse, a health care assistant, clinical manager, acting business manager and administration and reception staff. The clinical staff are female. There are vacancies for a full time GP which is currently being covered by locum staff, permanent business manager and an administrative member of staff.

Westminster Surgery is open from 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. Patient facilities are located on the ground floor. Patients are able to park close to the practice and car parking spaces for patients with a physical disability were available.

The practice has an Alternative Provider Medical Service (APMS) contract. The practice offers a range of enhanced services including spirometry (a test to see how well lungs work) and anticoagulation monitoring.

Updated 9 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westminster Surgery Centre on 25 April 2017.

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, equipment checks were carried out, there were systems to control infection and keep the premises clean.

• 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.

• Staff felt supported. They had access to training and development opportunities and had received training appropriate to their roles.

• Patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.

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

• Access to the service was monitored to ensure it met the needs of patients.

• 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:

• Provide clear guidance to staff concerning the body to contact for advice about possible safeguarding concerns and ensure all requests for information for safeguarding meetings and the response are placed on patients’ records.

• The health and safety risk assessment specific to the practice should contain more detail about possible risks and how they are to be mitigated.

• In-house tests of the fire alarm and emergency lighting should consistently take place at the recommended frequencies.

• A planned programme of audits should be put in place.

• The salaried GP should have an in-house appraisal in addition to the external appraisal process.
• The plans in place for improving the patient recall systems to ensure patients are recalled for monitoring long-term conditions and routine screening for cancer should be periodically reviewed to ensure they are effective.
• A record should be maintained of all clinical training provided to assist with monitoring training needs.

• Information about how patients can make a complaint should be more easily accessible on the provider’s website. The procedure should include the contact details of who complaints should be directed to at the practice and a record should be made of the date responses were made to complainants.

• The systems for gathering patient feedback should be reviewed to ensure that this information is routinely sought.

• The website should contain information to describe the services offered for patients such as the staff available, clinics and it should provide health promotion information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 June 2017

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 and this was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. Quality and Outcome Framework (QOF) data for 2015-2016 showed the practice was overall performing in-line with other practices locally and nationally in the monitoring of long term conditions. The QOF results for 2016-2017 which were not verified showed an overall decrease in attainment. We were informed that improvements had been or were being made to the service to address this. For example, the system for ensuring patients had their conditions reviewed was being improved through a revised re-call system. The practice had also introduced the ‘Year of care’ for patients with long term conditions to streamline its management of long term conditions and minimise the number of appointments patients had to attend.

The practice ran clinics and had introduced initiatives to support patients with their long term conditions. For example, the health care assistant ran a lifestyle clinic, the practice hosted an Arthritis UK session where patients were given information and could ask questions about the condition. A monthly diabetic specialist nurse clinic was held which reviewed patients with complex or poorly controlled diabetes. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with the local housing trust to co-host a healthy living event. This was attended by other organisations such as leisure services and Age Concern. Clinical staff performed clinical checks at this event, such as blood pressure readings and gave lifestyle advice. 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 9 June 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. To increase uptake of vaccinations opportunistic vaccinations were offered and the practice had been working proactively with a local school to increase childhood vaccination rates. Cervical screening and contraceptive services were provided. Similarly the practice was working on improving cervical screening rates by offering opportunistic screening, additional cervical screening clinics and by promoting the practices relationship with local women by attending the local school sports day. Priority was given to young children who needed to see the GP and appointments were available outside of school hours. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. The practice was developing a sexual health and family planning clinic which would offer sexual health advice, chlamydia screening and family planning services.

Updated 9 June 2017

The practice is rated as good for the care of older people. 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 entered a pooled funding arrangement with other local practices in Ellesmere Port to commission an Early Visiting Service. 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 the use of emergency services. The practice kept registers of patients’ health conditions and used this information to plan reviews of health care and to offer services to older people such as vaccinations for flu and shingles. Staff told us that they looked for opportunities to refer older people to sources of social support. For example, socially isolated patients were referred to Trinity Church which provided chair based exercise and luncheon clubs.

Updated 9 June 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice appointment system and opening times provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday. Patients could book routine appointments in person and via the telephone. Telephone consultations were offered by the GPs, nurse clinician and practice nurse. Repeat prescriptions could be ordered by attending the practice. The practice was planning to introduce on-line ordering of repeat prescriptions. Telephone consultations were also offered. 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 (CWP).

The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, contraceptive services, smoking cessation advice and family planning services. Reception staff sign-posted patients who did not necessarily need to see a GP.

Updated 9 June 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). GPs worked with specialist services to review care and to ensure patients received the support they needed. The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services. Staff had attended training in dementia to highlight the issues these patients may face. The practice had a clear policy for patients presenting in mental health crisis. A GP appointment was offered the same day and the patient was admitted to hospital depending on the GPs assessment.

Updated 9 June 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. A register was kept of patients with a learning disability and there was a system to ensure these patients received an annual health check. The practice had a small travelling community and it offered these patients opportunistic health checks and vaccinations to support their needs and lifestyle. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and children and all staff had safeguarding training relevant to their role. 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 acted as a carer’s link and they were working to identify carers and promote the support available to them through organisations such as the Carers Trust. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the wellbeing coordinator. The practice hosted a regular debt advice and housing advice drop in service.