Fulwood Green Medical Centre

Updated 26 May 2016

Fulwood Green Medical Centre is registered with CQC to provide primary care services, which include access to GPs, family planning, ante and post natal care. The practice is a long established GP practice working in the centre of Liverpool in a moderately deprived area of the city. The practice has a General Medical Services (GMS) contract with a registered list size of 6689 patients (at the time of inspection). The practice had a high proportion of patients between the ages of 25-34.

The practice has four GP partners, a practice nurse, nurse clinician and health care assistant, practice and finance manager and a number of administration and reception staff. The practice operates from 8am to 6.30pm with extended hours each Monday evening until 7.30pm. The practice has open access appointment for GPs for urgent cases each morning. Bookable appointments are available daily. Home visits and telephone consultations were available for patients who required them, including housebound patients and older patients. There are also arrangements to ensure patients receive urgent medical assistance out of hours when the practice is closed.

Updated 26 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fulwood Green Medical centre on 27 January 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Feedback from patients on the day of the inspection about their care was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand.

• Patients said they found it easy to make an appointment, there was good open access to GP appointment each day for urgent and emergency appointments.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw one area of outstanding practice:

• The practice offered a comprehensive, discreet and confidential sexual health clinic run by experienced GPs and practice nurses. The full range of sexual health services including sexual health advice, support, sexual transmitted disease (STD) testing and treatment and contraceptive advice was available for all patients. The clinic offered a drop in facility and operated alongside their extended hours from 5pm to 7pm on a Monday evening. Implants and contraceptive intra uterine devices (IUD/IUS) were also fitted by staff trained to undertake this extensive role. This enabled the patients access to a full range of sexual health services within the practice and patients we spoke with valued this service.

The areas where the provider should make improvement are:

• Infection control training should be undertaken by all staff.

• The provider should review the systems in place for the security ofmedicines prescription.

• The systems in place for responding to patient safety alerts should be reviewed. A lead person should be identified for this role to ensure that changes are made to patient care when alert information is received at the practice.

• All GPs should ensure that at risk children who fail to attend hospital appointments are followed up by the practice.

• A documented audit trail should be maintained for all patient complaints made to the practice.

• Staff files should have records and certificates to show the full and completed training undertaken for each staff member.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 May 2016

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Systematic nurse-led recall systems were in operation along with telephone consultations and home visits for the housebound. All these 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. This included access to a health trainer who ran clinics at the practice on a weekly basis.

Updated 26 May 2016

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. The practice had a “never refuse to assess” policy for all children under 12. Even outside the hours of their emergency surgeries there was always a GP or nurse clinician on hand to undertake an urgent telephone or face-to-face assessment if parents or carers were concerned. In 2014-15 the practice, with winter pressures funding from the CCG, were able to offer an open access clinic for children and young people every afternoon. This resulted in considerable reductions in the number of children who attended the local children’s hospital A&E department. Antenatal, well baby and immunisation clinics ran in conjunction with health visitor and midwife colleagues on a weekly basis with support from a GP. Immunisation rates at the practice were relatively high for all standard childhood immunisations.

Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. Contraception and Sexual Health (CASH) drop-in clinics were available for young adults each week on a Monday evening.

Updated 26 May 2016

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. 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, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Comprehensive geriatric assessments were undertaken for 145 older patients in 2015 enabling the early identification of needs. The practice had taken part in both the dementia enhanced service offering dementia screening and the avoiding unplanned admissions direct enhanced service mainly focusing on older patients. Recently the practice held a coffee morning for Macmillan Cancer Care raising money and reaching out to patients who may be more vulnerable and isolated. The practice nurse clinician case manages the care and treatment of housebound older patients with both long-term and acute conditions. The practice developed a ‘Frailty Register’ in October 2015 whereby those patients who met this criteria were coded and discussed at monthly in house clinical meetings. All patients who had been discharged form hospital were visited within a week by the practice nurse clinician to ensure that any changes needed to the care plan, such as medications, would be acted upon.

Updated 26 May 2016

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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. Extended hours was available each Monday till 7.30pm.

Updated 26 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). All of the patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff received training on how to care for people with mental health needs and dementia. The practice had a good working relationship with the local Mental Health Liaison Nurse, validating the disease registers and providing physical health checks. 

Updated 26 May 2016

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, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability and 95% of these patients had received a follow-up. It offered longer appointments for people with a learning disability. The practice had developed close links with the Citizens Advice Bureau to implement the ‘Advice on Prescription’ scheme. The practice had in-house assessment and therapy for patients with psychosexual problems. A private therapist was hosted at the practice. The practice current rate of physical health checks for vulnerable patients was 39.34% against a Liverpool threshold of 37% at the time of our inspection.