Archived: Lostock Hall Medical Centre

Updated 15 May 2018

Lostock Hall Medical Centre is situated in the Lostock Hall area of Preston and is situated in a two- story Edwardian building. The practice has a ramp to the front of the building and an adapted toilet. Treatment rooms are located on the ground floor and doorways are wide enough for people using a wheelchair to get around with ease. There is some on-site car parking for patients with on- road parking close by. There are plans to move the practice to another location by the end of summer 2018.

We did not visit the practice during this inspection but conducted a desk top review of evidence sent to us by the practice.

There is one female GP assisted by locum GPs and two female practice nurses. A practice manager and seven administrative and reception staff also support the practice. One of the reception staff is also the practice medicines co-ordinator. Two new advanced nurse practitioners have been recruited since the last inspection. The practice has access to community services such as community midwives, community nurses, health visitors and the mental health crisis team. A treatment room is provided by the practice for these services to hold regular clinics. The practice opening hours are 8am to 6.30pm Monday to Friday. Appointments are available from 9am to 5pm Monday to Friday. Extended hours are offered two Saturdays a month from 8.30am to 11.30pm. When the practice is closed, patients are able to access out of hours services by telephoning 111.

The practice provides services to 3,814 patients. There are similar numbers of patients aged under 18 years of age (20%) when compared to the national average (21%) and similar numbers of patients aged over 65 years of age (16%) to the national average of 17%.

The practice is part of the Greater Preston Clinical Commissioning Group (CCG) and services are provided under a General Medical Services Contract (GMS).

Information published by Public Health England rates the level of deprivation within the practice population group as eight on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Both male and female life expectancy is the same as the

national average, 83 years for females and 79 years for males.

The practice has a similar proportion of patients experiencing a long-standing health condition, 54%, compared to the national average of 53%. The proportion of patients who are in paid work or full time education is 73% which is above the local average of 64% and national average of 63%, and the proportion of patients who are unemployed is 2% which is below the local and national average of 4%.

Updated 15 May 2018

We carried out an announced comprehensive inspection on Lostock Hall Medical Centre on 26 June 2017. The overall rating for the practice was good, although the practice was rated as requires improvement for safety. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Lostock Hall Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 28 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach identified in the requirement notice.

The practice is now rated as good for safe services, and overall the practice is rated as good.

Our key findings were as follows:

• The practice had taken action to address the concerns raised at the CQC inspection in June 2017. They had put measures in place to ensure they were compliant with regulations.
• Appropriate arrangements were now in place for non clinical staff to process incoming mail to the practice.
• Summary information from patient paper records continued to be added to patient computerised records and the backlog reduced from 77% to 17%.
• The use of blank prescription forms and pads were now monitored.
• Control of substances hazardous to health (COSHH) data sheets were available.
• Recommendations made at the previous inspection, such as minimising disruption to power supply of vaccination fridges and making information available to patients who may wish to complain had been actioned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 August 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• 62% of patients with respiratory disease such as chronic obstructive pulmonary disease (COPD) had a review in the last 12 months which was similar to the clinical commissioning group (CCG) and national average of 69%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice provided a treatment room to host clinics such as diabetic eye screening and podiatry. These clinics were also open to patients from local practices.

Updated 8 August 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The GP had a special interest in gynaecology and provided pre-conception advice and sub-fertility investigations.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The practice provided family planning services including coil fitting.
• The practice’s uptake for the cervical screening programme was 77%, which was comparable with the local and national average of 71% and 73% respectively.

Updated 8 August 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services. For example, out of hours services, district nurses, the mental health team and a local hospice.
• We saw evidence to demonstrate there had been an increase in patients receiving pneumococcal vaccinations in the past year.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 8 August 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, Saturday appointments.
• 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.
• Telephone appointments were available with the GP for those patients who were unable to attend the practice.
• The practice was planning to introduce a patient messaging system that enabled patients to communicate with the GP electronically.
• A treatment room was available on the premises every Friday morning and appointments with the Quit Squad, a local support group for smoking cessation advice, were available.

Updated 8 August 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.
• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the local and national average of 81% and 78% respectively.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, 86% of patients on the mental health register had had a blood glucose check in the preceding 12 months which was better than the local and national average of 74% and 75% respectively.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 8 August 2017

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, refugees, travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability. The GP, practice nurse and practice manager attending a learning disability training event on 7 June 2017.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Those staff we interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.