Archived: Slaidburn Country Practice

Updated 15 October 2015

Dr Karen Massey has a practice based in Slaidburn in East Lancashire in an NHS managed building which was purpose built but has, with changes in demand been extended to better meet the needs of the population of the village. The practice is within a rural community and is a dispensing practice as patients registered with the practice have to travel more than one mile to have their prescriptions fulfilled. It is part of the NHS East Lancashire Clinical Commissioning Group (CCG.) Services are provided under a general medical service (GMS) contract with NHS England. The practice is situated on a residential road at the end of the village with limited on street parking. The practice is the largest geographically within the CCG at 120 square miles but is the smallest numerically with 1040 registered patients.

The practice was originally set up under the government’s inducement scheme for rural areas but recently entered into a partnership agreement with East Lancashire Medical Services (ELMS) as the practice due to changes in funding could no longer sustain their viability. They now have support with all their services and can continue to provide a service to the population of the village

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. Deprivation affecting children with in the practice is rated at 4% compared with CCG averages of 22.9%. Deprivation affecting older people is rated at 8% compared with CCG averages of 22.3%. These results are well below the national averages of 21.8% for children and above for older people at 18.1% nationally. However the practice population live mainly in rented accommodation as the family of the squire of the village owns the majority of the properties, some of which were stated to be in a state of poor repair.

The practice has a permanent female GP, a long standing associate female GP, a practice nurse, a practice manager, a pharmacy technician / treatment room nurse and an administration team to support the running of the practice. These staff are supported by staff at ELMS in times of emergency.

The practice population includes a comparable proportion (33.1%) of people under 18 years of age, and a higher proportion (35.2%) of people over the age of 65 years, in comparison with the national average of 31.7% and 26.8% respectively. The practice also has a higher percentage of patients who have caring responsibilities (23.3%) than both the national England average (18.4%) and the CCG average (20.7%). The practice has a lower rate of patients with health-related problems in daily life (43.7%) compared with CCG and National averages of 53% and 48.7%.The practice has three patients registered with them who reside in care home facilities in a neighbouring town but have requested to remain patients with the practice.

The practice telephone lines open from 8.00 am to 6.30pm with appointments from 8.30am until 12 and then 2pm until 5.40pm on Monday to Friday. The practice closed on Wednesday afternoon for scheduled clinics but patients can still be seen. Staff training and meetings are carried out during the afternoon Wednesday. Appointments are available during the opening times with the GPs and appointments with the nurse are available over three days of the week. They hold seasonal Flu vaccination clinics at certain times of the year. These clinics are held in the local village hall and the practice invite Age Concern and the Fire Brigade along to speak to patients and offer support to keep them safe including offering fire alarms to eligible patients. Patients requiring a GP outside of normal working hours are advised to contact 111 who will refer them into an external out of hours at East Lancashire Medical Services. When closed the practice answering machine informs patients of this number.

Updated 15 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Karen Massey Slaidburn Health Centre at 23/09/2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• 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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

We saw some outstanding practice including:

• The practices proactive approach to safeguarding vulnerable patients and the provision they made to ensure all their vulnerable patients received the support and care they required.

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

Importantly the provider should;

• Ensure all induction training is fully documented when completed.
• Ensure meetings with health visitors are formally recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 October 2015

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. 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 medication 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 15 October 2015

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. 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 15 October 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. All patients over 75 had a named GP.

Updated 15 October 2015

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. The practice did not have late clinics for working patients as these had been trialled but found not to utilised fully, the GP informed us they would always stay late of needed to see patients.

Updated 15 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia. All patients experiencing poor mental health had received an annual physical health check. 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 (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

All staff were trained as dementia friends.

Updated 15 October 2015

The practice is rated as outstanding for the care of people who 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. The practice had carried out annual health checks for people with a learning disability and 95% of these patients had received a follow-up. 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.

The practice identified recent areas where they had proactively assisted vulnerable patients to ensure they received the care required to support their needs. For example the practice staff had assisted a pregnant patient who did not speak very good English to access the care required. Another example was a vulnerable elderly patient discharged from the local NHS hospital with no support at home that it was found had no food in her house. Arrangements were made by the GP practice to have food taken into them until someone could do their shopping. Frequent home visits by the staff be it delivering medication or GP visits allowed the staff to observe the home living conditions of the patient and to offer or report the need for support as required.

Patients told us they felt supported and could also identify where they were aware of incidents where the practice had supported vulnerable individuals. Comments cards told us how collecting medication from the remote locations had assisted patients who were vulnerable and less mobile to ensure they received their medication in a timely manner.

When the practice carried out annual flu clinics they used the village hall and invited other services to attend to offer support and guidance to all patients but also to ensure vulnerable patients have access to the correct support to meet their needs. This included the fire brigade offering fire assessments and alarms for the home, age concern offering support services and signposting to other areas. As the village local transport provision was limited staff and other patients often collected patients for their appointments or clinics to ensure their health needs were met fully.