Archived: Tarbock Medical Centre

Updated 30 April 2015

Dr S Singh's Practice is based in Huyton a town in the Metropolitan Borough of Knowsley, in Merseyside. The practice treats patients of all ages and provides a range of medical services. The staff team includes two GP partners, one salaried GP, a practice nurse, a practice manager, office manager and five reception/administrative staff.

The practice is open Monday to Friday with consulting hours in the morning from 8.30 -11.30. Afternoon consulting times start at 15:00/16:00 until 19:30 on Mondays, 18:30 on Tuesday, Wednesday and Thursday and until 19:00 on Fridays. The practice offers bookable appointments up to five weeks in advance and on the day appointments for urgent medical conditions. Patients can book appointments in person, by telephone or on-line. Telephone consultations are available and home visits are offered to patients whose condition means they cannot visit the practice. When the practice is closed patients access the GP out-of-hours provider operated by UC24.

The practice is part of NHS Knowsley Clinical Commissioning Group. It is responsible for providing primary care services to approximately 3,668 patients. The practice is situated in an area with average levels of economic deprivation when compared to other areas nationally. The practice has a large proportion of older patients with around thirty percent of the practice population aged 65 years and over. Twenty three percent of patients have caring responsibilities and 51% have a long standing health condition. The practice has a Personal Medical Services (PMS) contract.

The CQC intelligent monitoring placed the practice in band 5. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

Updated 30 April 2015

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Dr S Singh's Practice which is registered with the Care Quality Commission to provide primary care services.

We undertook a planned, comprehensive inspection on 25th February 2015 at the practice location. We spoke with patients, staff and the practice management team.

The practice was rated overall as Good. A caring, effective, responsive and well- led service was provided that met the needs of the population it served. However, improvements were needed to ensure the practice was operating safely.

Our key findings were as follows:

• There were systems in place to protect patients from avoidable harm, such as from the risks associated with medicines and infection control. However, improvements were needed in respect of staff recruitment as the recruitment records did not demonstrate that all necessary checks were undertaken to demonstrate suitability for their roles. Improvements were also needed to the systems in place to ensure that checks of electricity systems and water services were carried out.

• Patients care needs were assessed and care and treatment was considered in line with best practice national guidelines. Staff were proactive in promoting good health and referrals were made to other agencies to ensure patients received the treatments they needed.

• Feedback from patients showed they were overall satisfied with the care given by all staff. They felt listened to, treated with dignity and respect and had confidence in the GPs and nurse. Patients felt involved in decision making around their care and treatment.

• The practice planned its services to meet the differing needs of patients. The appointment system allowed good access to the service. The practice encouraged patients to give their views about the services provided and took these views into account when reviewing service provision.

• There was a leadership structure in place and clear lines of accountability. The practice had systems to seek and act upon feedback from patients using the service. Quality and performance were monitored, risks were identified and managed.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Take action to ensure its recruitment policy, procedures and arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff and the required information in respect of workers is held.

• Protect patients against the risks associated with unsafe equipment by ensuring that the electrical wiring is properly maintained and suitable for purpose.

The provider should:

Carry out an assessment of the risks presented by legionella and take appropriate action to address these risks.

Carry out an assessment of access for patients with a physical disability and take appropriate action where any reasonable adjustments can be made.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 April 2015

The practice is rated as good for the population group 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 asthma. This information was reflected in the services provided, for example, reviews of conditions, screening programmes and vaccination programmes. The practice had a system in place to make sure patients attended regular reviews for long term conditions. The practice nurse visited housebound patients to carry out long term condition reviews. The practice had identified all patients at risk of unplanned hospital admissions and a care plan had been developed to support them. A dedicated number was given to healthcare professionals supporting patients who were at risk of unplanned admission to hospital to ensure quick access to clinical services. The practice had implemented the gold standards framework for end of life care. One of the GPs took the lead for this group of patients. They had a palliative care register and liaised with other health care professionals to discuss the care and support needs of patients and their families. Patients at high risk of hospital admission and receiving end of life care had a care co-ordinator and a named GP to ensure continuity of care.

Updated 30 April 2015

The practice is rated as good for the population group of families, children and young people. Child health surveillance and immunisation clinics were run on a weekly basis. 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. Staff were knowledgeable about child protection and a GP took the lead for safeguarding. Staff put alerts onto the patient’s electronic record when safeguarding concerns were raised. The practice liaised with the health visiting service to discuss any children who were at risk of abuse and to review if all necessary GP services had been provided.

Updated 30 April 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. The practice had a record of carers and used this information to discuss any support needed and to refer carers on to other services if necessary. The practice ensured each person who was over the age of 75 had a named GP. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice had identified all patients at risk of unplanned hospital admissions and a care plan had been developed to support them.

Updated 30 April 2015

The practice is rated as good for the population group of working-age people (including those recently retired and students). The practice was open Monday to Friday and offered extended hours GP appointments until 19:30 on Mondays, 18:30 on Tuesday, Wednesday and Thursday and until 19:00 on Fridays. The practice offered bookable appointments up to five weeks in advance, on the day appointments for urgent medical conditions and telephone consultations. Appointments could be booked on line and repeat prescriptions could be ordered on-line. The practice monitored patient satisfaction with access to the service through patient feedback. Patient feedback indicated patients were overall satisfied with the arrangements for access to the service. The practice offered health promotion and screening that reflected the needs for this age group such as smoking cessation. Health checks were offered to patients over 40 years of age to promote patient well-being and prevent any health concerns.

Updated 30 April 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). GPs worked with other services to review and share care with specialist teams. The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients an annual appointment for a health check and a medication review. The practice referred patients to appropriate services such as psychiatry and counselling services. The practice had information for patients in the waiting areas to inform them of other services available. For example, for patients who may experience depression or those who would benefit from counselling services for bereavement.

Updated 30 April 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. The practice was aware of patients in vulnerable circumstances and ensured they had appropriate access to health care to meet their needs. For example, a register was maintained of patients with a learning disability and annual health care reviews were provided to these patients. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance in order to ensure the length of the appointment was appropriate. Staff were knowledgeable about safeguarding vulnerable adults. They had access to the practice’s policy and procedures and had received training in this.