Granville House Medical Centre

Updated 30 January 2017

Granville House Medical Centre is responsible for providing primary care services to approximately 8,300 patients. The practice is situated in Adlington, Chorley in Lancashire. The practice is based in an area with lower than average levels of economic deprivation when compared to other practices nationally. The number of patients with a long standing health condition is about average when compared to other practices nationally.

The staff team includes three partner GPs, two salaried GPs, one nurse clinician, two practice nurses, practice manager, assistant practice manager, medicines manager, data analyst, administration and reception staff. There are both male and female GPs. The nursing team and health care assistants are female. The practice provides training to GP registrars and medical students.

The practice is open 8am to 6.30pm Monday to Friday. An extended hour’s service for routine appointments is provided on two Saturdays a month from 8.30am to 11.30am. Patients were directed to telephone 111 if they required out of hour’s GP services. The out of hours service provider for the practice is Chorley Medics. Patient facilities are on the ground floor. The practice has a car park for on-site parking. Some nursing services are based in a small building located in the car park.

The practice has a General Medical Service (GMS) contract. The practice offers a range of enhanced services such as minor surgery, learning disability health checks, influenza and shingles immunisations and increased GP access to reduce unplanned hospital admissions.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Granville House Medical Centre on 8th December 2016.

Overall the practice is rated as good.

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

• There were systems in place to reduce risks to patient safety, for example, equipment checks were carried out, staff were trained to manage medical emergencies and procedures were in place to promote infection control.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt well supported. They had access to training and development opportunities and had received training appropriate to their roles.

• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We saw staff treated patients with kindness and respect.

• Services were planned and delivered to take into account the needs of different patient groups.

• Access to the service was monitored to ensure it met the needs of patients.

• Information about how to complain was available. There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

The areas where the provider should make improvements are:

• Put a system in place to record the action taken following the receipt of patient safety alerts.

• Ensure a daily record is made of the temperature readings for vaccine fridges.

• Staff recruitment records should contain evidence of information having been gathered about any physical or mental conditions which were relevant (after reasonable adjustments) to the role the person was being employed to undertake.
• Maintain a central record of all clinical training undertaken by staff to assist with monitoring their training needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 January 2017

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. The practice aimed to ensure that patients were able to see one nurse for all of their long term conditions to reduce the need for multiple appointments. The practice offered patients access to their care records and they were promoting this to patients with a long term condition. This encouraged patients to manage their conditions and may improve patients’ health by providing self-care tools. The nursing team took the lead for different long term conditions and kept up to date in their specialist areas. They made home visits to carry out blood tests where patients were unable to visit the practice. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access to specialist help when needed.

Updated 30 January 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Childhood immunisation rates for the vaccinations given were comparable to local and in some instances above national averages. Priority was given to young children who needed to see the GP and appointments were available outside of school hours. The GPs liaised with other health care professionals, such as health visitors to ensure the needs of vulnerable children were addressed. Accident and emergency attendances were monitored. The practice had recently met with the local authority domestic violence team to gain a clearer understanding of their role and the issues faced by some families.

Updated 30 January 2017

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. Each patient had a named GP to ensure continuity of care. The practice provided services to two local care homes. V isits were carried out by the same clinicians where possible to provide continuity. This service had led to better co-ordination of patient care and had assisted with avoiding unplanned admissions to hospital. A system was in place to ensure the needs of older patients’ discharged from hospital were reviewed in a timely manner and care plans were drawn up to support their care and treatment. The practice worked with other agencies and health providers to provide support and access specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients.

Updated 30 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice appointment system and opening times provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday. The appointment system provided pre-bookable and on the day appointments, where every patient who contacted the practice before 10.30am was offered an appointment that day. Patients could book appointments in person, via the telephone and on-line. Repeat prescriptions could be ordered on-line or by attending the practice. Appointments could be booked up to two weeks in advance. Telephone consultations were also offered. A text messaging service reminded patients about their appointments, requested information from patients to assist in their care such as up to date blood pressure readings and reminded patients about services provided such as the flu vaccination. An extended hour’s service for routine appointments was provided on two Saturdays a month from 8.30am to 11.30am.

The practice website provided information around self-care and local services available for patients. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, NHS health checks, smoking cessation advice and family planning services. Reception staff sign-posted patients who did not necessarily need to see a GP. For example to services such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP). In-house phlebotomy and cryotherapy services were provided which meant patients could receive these services locally rather than having to travel to another service.

Updated 30 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. Longer appointments were also offered. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services. The staff team had received training in dementia awareness to assist them in identifying patients who may need extra support. Staff had also received training in the Mental capacity Act 2005.

Updated 30 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient had a learning disability to enable appropriate support to be provided. There was a recall system to ensure patients with a learning disability received an annual health check. The practice prioritised patients who may be at risk of poor health due to vulnerability and had care plans in place to support these patients. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and children and all staff had safeguarding training relevant to their role. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. Members of staff acted as carer’s links and they were working to identify carers and promote the support available to them through organisations such as N-Compass Carers Services. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the Lancashire Well-being Service for support with social issues that were having a detrimental impact upon their lives