Dr R Baghdjian & Dr Marcus Jacobs Surgery

Updated 3 March 2017

Dr R Baghdjian and Dr Marcus Jacobs Surgery is situated in Chorley Health Centre (Collinson Avenue, Chorley, PR7 2TH) which is a purpose built health centre building owned by the local hospital trust. There is a car park on site and a ramp to facilitate access for patients with mobility difficulties.

The practice is part of the NHS Chorley and South Ribble Clinical Commissioning Group (CCG) and delivers primary medical services to a patient population of 5175 patients via a general medical services contract with NHS England.

The average life expectancy of the practice population is slightly below the local and national averages (81 years for females, compared to the local average of 82 and national average of 83 years, 77 years for males, compared to the local average of 78 and national average of 79 years).

The age distribution of the practice’s patient population is broadly in line with local and national averages. The proportion of patients who experience a long standing health condition is slightly above the local and national averages (59.5%, compared to the local average of 55.9% and national average of 54%).

Information published by Public Health England rates the level of deprivation within the practice population group as five on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice is staffed by two GP partners (both male). The practice also employs an advanced nurse practitioner, a practice nurse and health care assistant (all female). Clinical staff are supported by a practice manager and a team of reception and administration staff. The practice also teaches fourth year medical students.

The practice is open between 8am and 6.30pm Monday to Friday, and between 10am and 2pm on a Sunday for extended hours appointments. Surgeries are offered between 8.30am and 11.50am each morning and 4pm until 5.40pm each afternoon from Monday to Friday, while Sunday appointments are offered between 10am and 1.35pm.

Outside normal surgery hours, patients are advised to contact the out of hour’s service by dialling 111 and provided locally by the provider GoToDoc.

Updated 3 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr R Baghdjian and Dr Marcus Jacobs Surgery on 6 January 2017. 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.
• Risks to patients were mostly assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. In most cases staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients were highly positive about their experiences at the practice. They 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice offered an extended hours clinic on a Sunday for those patients who could not attend during normal working hours. This, along with the way the practice had designed its appointment system assured us that any patient requesting an appointment the same day would have access to one.

The areas where the provider should make improvement are:

• Action plans should be documented following infection prevention and control audits and include details of action taken as a result of audit findings.

• The planned training for staff should be completed, for example training around ECG tests for the health care assistant and vaccination update training for nurse practitioner.

• The newly updated scanning and read coding protocol should be embedded into practice and an audit process initiated to ensure clinicians have sight of all necessary correspondence.

• The content of policies and procedures should be updated routinely to reflect current guidance and legislation.

• The prescription logging system should be extended to ensure the location of all blank scrips is recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2017

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.

• The practice’s QOF results for diabetes indicators were higher than local and national averages.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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 offered an anticoagulation service where patients’ bloods were tested and their anticoagulant medicine reviewed and dose changed as required. This meant they did not need to attend a separate specialist anticoagulant clinic.

Updated 3 March 2017

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 higher than local and national averages 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 practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 84% and the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 3 March 2017

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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice liaised with staff in the treatment room housed in the building and operated by community staff to facilitate mutually convenient appointments for patients, therefore reducing the need for multiple trips to the health centre.

• The practice held regular palliative care multidisciplinary meetings to ensure the needs of patients nearing the end of life were being met.

Updated 3 March 2017

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.

• Extended hours appointments were offered each Sunday for those patients who could not attend during normal working hours.

Updated 3 March 2017

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 89% compared to the CCG average of 91% and national average of 84%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record in the preceding 12 months was 98% compared to the CCG average of 94% and national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice 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.

• The practice 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 patients with mental health needs and dementia.

Updated 3 March 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 those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed 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.