West Derby Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed all the quality statements in this key question. Our rating for this key question has improved from requires improvement to good. At this assessment, we found improved systems to monitor and improve outcomes for people. We found improved systems for carrying out audits and monitoring patients health and medication. Feedback from people who used the service indicated that they were involved in decisions about their care and had confidence and trust in the clinician they saw or spoke to. Staff worked with other services to make sure patients could access other services easily. Multi-disciplinary meetings were held on a regular basis where the needs of patients with complex needs or those approaching the end of life could be discussed, reviewed and planned for. The provider had systems and processes to keep clinicians up to date with current evidence-based practice. Staff knew the requirements for patient consent to care and treatment. We found that the provider should continue to improve the uptake of childhood immunisations and cervical cancer screening.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people to the National GP Survey carried out from January 2024 – March 2024 indicated 86% of people were involved as much as they wanted to be in decisions about their care and treatment. These results were similar to the national averages.

Staff and leaders were aware of the needs of the local community. Staff told us how they checked people’s health, care, and wellbeing needs during health reviews. We discussed the way in which patients’ needs were assessed, and the provider was able to demonstrate that the practice staff shared clear and accurate information with relevant professionals when deciding care delivery for patients. The provider demonstrated that they used registers to identify people with specific needs, for example, people with learning disabilities, mental health conditions, long term conditions, palliative care and carers to ensure that needs were assessed and managed appropriately. Digital flags were used within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

The practice had systems and processes to keep clinicians up to date with current evidence-based guidelines and clinical tools. There were systems in place to ensure people’s immediate and ongoing needs were assessed. Staff worked with other healthcare professionals to assess people’s needs and deliver coordinated packages of care. There was a system to offer structured annual medicines reviews for patients with long-term health conditions. The provider had effective systems to identify people with previously undiagnosed conditions. The provider worked with specialist services to review patients with long term conditions with a view to improving peoples care and treatment and increase learning amongst the clinical team.

Feedback from people to the National GP Survey carried out from January 2024 – March 2024 indicated 88% of people had confidence and trust in the healthcare professionals they saw or spoke to. These results were similar to the national averages.

Staff and leaders told us how they learnt about new and innovative approaches that evidence shows can improve the way their service delivers care. Staff demonstrated how clinical meetings and educational sessions were used to ensure staff were knowledgeable about evidence-based care. There were informal daily clinical meetings where patients were discussed with peers to ensure best practice was being followed. The practice was working with the Primary Care Network (PCN) to improve care and treatment for patients. For example, they were involved in projects to improve the management of asthma and diabetes in accordance with best practice guidance.

Systems were in place to ensure staff were up to date with national guidance and evidence-based practice. People had access to appropriate health checks and assessments, and they were directed to relevant services when they needed extra support. People were being referred to other services in line with their needs. A system was in place to review consultation records for people who used the service to ensure that they contained the required information and were appropriately detailed. We reviewed a sample of records that demonstrated patients were having their health appropriately monitored and in accordance with best practice guidance. Where delays to health reviews were identified we saw that the patient had already been recalled.

There was no specific feedback from people who used the service about how staff, teams and services work together.

Staff told us that they had access to the information they needed to appropriately assess, plan and deliver people’s care, treatment and support. Referrals to other services were made promptly and people were also referred or signposted to local support services as appropriate to their need. Staff told us they were supported in their role by having access to clear procedures and training for their specific roles within the practice.

Leaders and staff told us they worked closely with colleagues in the local Primary Care Network (PCN) to meet the needs of the patient population. The Integrated Care Board (ICB) Cheshire and Merseyside told us that the provider kept them informed about how the service was operating and any challenges being experienced.

Systems were in place to ensure the provider worked effectively across teams and services to support people. There were systems to share information about patients’ needs when they were referred to different services. Multi- disciplinary meetings were held on a regular basis so that when people received care from a range of different staff, teams or services, this was co-ordinated. The provider had a process to identify patients when it was essential that information needed to be shared about them to support their care and treatment. Regular in-house meetings were held to ensure staff worked together to support patients. A system was in place for identifying and responding to clinical tasks. A system was in place for ensuring work was being managed within a reasonable timescale and tasks were correctly coded and actioned. Some document management tasks were outsourced with a monthly audit to ensure this was working effectively. The provider was responding to staff feedback about workload equity by looking at alternative ways of managing the distribution of tasks.

There was no specific feedback from people who used the service about supporting people to live healthier lives.

Staff and leaders told us how people were supported to manage their health and wellbeing and where possible reduce their need for future care and treatment. They were advised when they needed to seek further help and what to do if their condition deteriorated. They identified people who may need extra support and directed them to relevant services. For example, staff referred people to social prescribing services in order to improve their health and well-being. This service helped people to access a range of support including counselling, support with isolation and financial issues.

People had access to appropriate health assessments and checks. People were encouraged to attend cancer screening and take up vaccinations offered as part of national programmes. The most up to date published data for childhood immunisations (UK Health Security Agency 01/04/2022 – 31/03/2023) and cancer screening (NHS Digital snapshot 30/06/2023) showed that cytology screening had not met the national target of 80% (practice attainment 72%) and immunisations for children were below the 90% target (practice attainment for children aged 1, 2 and 5 ranging from 81% to 84%). The provider told us how this was being monitored and the steps they had taken to improve uptake. They shared more recent data with us to show that attainment for cervical screening had and was continuing to improve. They also told us that they had a high incidence of patients who took their children for private single immunisations which would not be reflected in the practice’s attainment for childhood immunisations. The provider should continue to take steps to improve the uptake of childhood immunisations and cervical cancer screening.

There was no specific feedback from people who used the service about monitoring and improving outcomes.

Staff and leaders told us how they monitored and made improvements to the outcomes for people who used the service. A phlebotomy service had been introduced to better monitor patients prescribed some medicines that required frequent blood testing. When incidents happened within the service, staff told us that the provider took steps to rectify these to mitigate the chances of them re-occurring. Staff told us how end of life audits were undertaken to look at the quality of end-of-life care.

There were systems in place for quality improvement. The provider used benchmarking from local and national sources to monitor performance and make improvements. Clinicians took part in national and local quality improvement initiatives. Audits were undertaken to look at the care and treatment provided to patients and whether improvements were required. Audits included antibiotic prescribing and management of peripheral vascular disease. Both were two-cycle audits and documented where improvements were needed, changes made, and further changes required.

Following the last inspection changes had been made to improve the systems in place for monitoring patients with or at risk of developing long term conditions and patients who required monitoring as a result of the medicines they take. Improvements included the employment of a clinical pharmacist, the introduction of more robust procedures, regular audits, and an improved call and re-call system assisted by a designated staff member. We reviewed a sample of records that demonstrated patients were having their health appropriately monitored. Where delays to health reviews where identified we saw that the patient had already been recalled.

Feedback from people who used the service to the National GP Survey carried out from January 2024 – March 2024 indicated 86% of people were involved as much as they wanted to be in decisions about their care and treatment. These results were similar to the national averages.

Staff told us how they ensured people fully understood what they were consenting to, and they demonstrated they were aware of the importance of obtaining consent before they delivered care or treatment.

Clinical staff had undertaken training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). Leaders and staff understood the requirements of legislation and guidance when considering consent and decision making. We looked at a sample of 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decisions in patient records. These were as required and raised no concerns about people’s experience regarding consent to care and treatment.