Mere Lane Group Practice

Updated 19 April 2018

Mere Lane Group Practice provides GP services for approximately 6800 patients in a very deprived area of Liverpool. The practice is situated in a purpose built health centre which houses two other GP practices, community health care clinics and a pharmacy. The majority of the patient population is British.

The practice has four GP partners, one salaried GP and one long term locum GP, two practice nurses, a clinical practitioner and a healthcare assistant. Clinicians are supported by a practice management team and reception and administration staff.

The practice is open during the week, between 8.30am and 6.30pm. Patients can access out of hours by calling NHS 111.

The practice is part of Liverpool Clinical Commissioning Group (CCG) and holds a General Medical Services (GMS) contract with NHS England.

Updated 19 April 2018

This practice is rated as Good overall. (Previous inspection 14 April 2015– rated as Good overall)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Mere Lane Group Practice on 28 March 2018 as part of our routine inspection programme.

At this inspection we found:

• The practice had experienced difficulties with staffing over the past two years, including the loss of three GPs and their nursing team due to various reasons. The practice was now under a changed partnership and despite several setbacks had maintained the quality of care for patients and the safety of the practice. They had managed to secure two new partners, a new practice manager and nursing team.
• The practice recognised that their performance had suffered in terms of contractual performance targets and patient satisfaction with appointments because of the upheaval in change of staff structure. The practice was addressing this situation and had a set of strategic plans to improve.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Care Quality Commission (CQC) comment cards reviewed indicated that patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Results from the national GP patient survey from July 2017 showed that patients’ satisfaction with how they could access care and treatment was lower than local and national averages. The practice was aware of the results and had redesigned the appointment system. Urgent appointments were available the same day.
• There was a clear leadership structure and staff felt supported by management. The practice had recently achieved a Health and Wellbeing award. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware and acted on the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice had a recall system for health reviews managed by a dedicated administrator who ensured that patients’ alcohol status and smoking status were recorded during the phone call to make the appointment as opposed to during the consultation.
• The practice had carried out a review of its safeguarding practices and appointed the clinical practitioner as the deputy safeguarding lead who had two sessions a month dedicated to reviewing all safeguarding cases and updating any registers.

The areas where the provider should make improvements are:

• Maintain the overview and plans in place to improve on their quality outcomes framework results (QOF).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 June 2015

The practice is rated as good for the care of people with long-term conditions. The practice had a higher than national average number of patients with long standing health conditions (67.8% of its population). Patients with long term conditions were supported by a healthcare team that cared for them using good practice guidelines and were attentive to their changing needs. There was proactive intervention for patients with long term conditions. Patients had health reviews at regular intervals depending on their health needs and condition. For example 92% of patients with rheumatoid arthritis had received an annual review.

The practice maintained and monitored registers of patients with long term conditions for example cardiovascular disease, diabetes, chronic obstructive pulmonary disease and heart failure. These registers enabled the practice to monitor and review patients with long term conditions effectively. The Quality and Outcomes Framework (QOF) information indicated that patients with long term health conditions received care and treatment as expected and above the national average. For example, patients with asthma had received a review in the last 12 months and clinical risk groups (at risk due to long term conditions) had good uptake rates for seasonal flu vaccinations. Patients on the 'at risk of unplanned admissions to hospital' register had all had a care plan devised and agreed with them.

Clinical staff managed chronic long term conditions and diseases. Patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. Patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 11 June 2015

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, the practice maintained a register of children who had a child protection plan. Immunisation rates were average for standard childhood immunisations. We received positive feedback regarding care and treatment at the practice for this group. Patients we spoke with told us they were confident with the care and treatment provided to them. Appointments were available outside of school hours and the premises were suitable for children and babies including the provision of breast feeding and baby changing rooms. We saw good examples of joint working with midwives and health visitors. For example there were regular safeguarding meetings with health visitors. The practice responded to the needs of this group and children or young people were always given a same day appointment or urgent appointment as necessary.

Updated 11 June 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. For example the Quality and Outcomes Framework (QOF) information indicated that last year 77% of patients aged 65 and older had received a seasonal flu vaccination. This was higher than the national average. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, avoiding unplanned admissions, seasonal flu vaccinations and in dementia and end of life care. It was responsive to the needs of older people, and offered home visits to deliver care to those older patients who were not able to attend the surgery. The practice had led in the implementation of the OWLS (Older Wiser Living socially) project which supported and addressed social isolation in patients aged over 75.

Updated 11 June 2015

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 and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice offered flexibility in appointments and a range of services such as health promotion and screening that reflected the needs for this age group. For example smoking cessation and travel advice. Routine health checks were available to patients aged over 45. Online booking, cancellation of appointments and ordering of repeat medications facilities were available.

Updated 11 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Ninety six percent of people experiencing poor mental health had an agreed documented care plan and 83% of those diagnosed with dementia had received a review of their care in the preceding 12 months. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

The practice worked closely with the mental health services in Liverpool. The practice was able to signpost patients experiencing poor mental health to access various support groups and voluntary organisations including MIND. Patients with poor mental health were accommodated, where possible, with same day appointments with a preferred clinician. Some of the staff had received training on how to care for people with mental health needs and dementia.

Updated 11 June 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless people, children and adults at risk of abuse, patients with dementia, terminally ill and those with a learning disability. It had carried out annual health checks for people with a learning disability and it offered longer appointments for vulnerable patients.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It was able to signpost vulnerable patients and their carers to 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.