Archived: Lance Lane Medical Centre

Updated 10 October 2016

Fiske and Partners known locally as Lance Lane 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 situated within the centre of Liverpool. This area has higher than average deprivation scores for income, employment, healthcare and deprivation affecting children and older people. The practice has a Primary Medical Services (PMS) contract with a registered list size of 7106 patients (at the time of inspection). The practice has five GP partners and one salaried GP. They are a training practice for medical students and trainee GPs. The practice also had three practice nurses, a healthcare assistant, practice manager and a number of administration and reception staff.

The practice is open between 8.30am to 6pm Monday to Friday with appointments bookable in a variety of ways. Extended access is available until 8pm on a Wednesday evening. Home visits and telephone consultations are available for patients who require them, including housebound patients and older patients. There are also arrangements to ensure patients receive urgent medical assistance when the practice is closed. If patients call the practice when it was closed, an answerphone message gives the telephone number they should ring to obtain healthcare advice or treatment.

Updated 10 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fiske and Partners on 3 December 2015. Overall the practice is rated as good.

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

• Systems were in place to ensure incidents and significant events were identified and investigated. All staff were aware of what constituted a significant event and they fulfilled their responsibilities to raise concerns and to report incidents. However the records maintained for these required improving.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients were treated with care, compassion, dignity and respect and they were involved in their care and decisions about their treatment. They were not rushed at appointments and full explanations of their treatment were given.

• 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.

• Written information about services and how to complain was readily available for patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

Action the provider MUST take to improve:

• The provider must ensure that robust recruitment procedures are in place. This must include full and comprehensive information to demonstrate the practice only employs staff who are able to provide appropriate care and treatment to patients. The information held must be in line with Schedule 3 of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014.

Importantly the provider should ensure;

• The process for recording significant events and incidents is reviewed. Written records should show the full detail of each incident, what actions were taken and what learning took place to ensure the risks to patients is reduced.

• The practice undertakes a risk assessment for legionella.

• Safeguard training is available and provided for all staff in regard to vulnerable adults and children relevant to levels needed to undertake their roles.

• That full and completed induction records are available for the induction of new staff. Written records should be maintained to show that all staff had completed an annual appraisal that this is used to inform their learning and personal development.

• That there is a documented audit trail of all complaints is held including the decisions reached, actions taken and the learning that has taken place.

• That the practice policies and procedures are up to date, valid and with sufficient detail.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 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. Performance for diabetes related indicators was better than the CCG and national average.

Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicines 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 February 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, for example, children and young people who had a high number of A&E attendances. Immunisation rates 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.  The percentage of patients having a cervical screening test was comparable to national figures. 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.

Updated 11 February 2016

The practice is rated as good for the care of older people. The practice offered proactive, personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.  Annual reviews of care plans took place with the patient and their carer, ensuring that unmet needs were identified. All older patients received an annual medication review. Annual flu clinics including stalls and information from care agencies and voluntary groups took place. Safeguarding policies and procedures were in place.  Support for carers including a carer support pack was available signposting patients to support agencies and services in the local area.

Updated 11 February 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 reflects the needs for this age group.

Updated 11 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 100% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months compared to 83% nationally. 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 had 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 where they may have been experiencing poor mental health. Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 11 February 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 offered longer appointments for people with a learning disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.  It had told vulnerable patients about how to access 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 in normal working hours and out of hours.