The Care Quality Commission
  • Doctor
  • GP practice

Lostock Hall Medical Centre

Overall: Good read more about inspection ratings

Brownedge Road, Lostock Hall, Preston, PR5 5AD (01772) 529329

Provided and run by:
Dr Ewa Craven

Important: This service was previously registered at a different address - see old profile

All Inspections

During an assessment under our new approach

Date of assessment 12 July 2024 to 30 July 2024. Lostock Hall Medical Centre provides primary medical services from its location in Lancashire. There were approximately 6,200 people registered with the service at the time of our assessment. We conducted this assessment to look at how the practice managed learning, incident reporting and referral management. We assessed 3 quality statements across the safe and well-led key questions and have combined the scores for these areas with scores from the last inspection. At this assessment we found managers investigated concerns appropriately and staff were involved so any learning could be implemented. Referrals to secondary care were monitored to ensure people were seen. The recording of some information needed to be improved.

06 April 2022

During an inspection looking at part of the service

We carried out an announced inspection at Lostock Hall Medical Centre on 6 April 2022. Overall, the practice is rated as good. We inspected

Safe -Good

Effective -Good

Caring – Good (rating awarded at the inspection 5 December 2019).

Responsive – Good (rating awarded at the inspection 5 December 2019)

Well-led -Good

Following our previous inspection on 1 September 2021, the practice was rated Requires Improvement overall and for key questions safe and well led. The key question effective was rated good. We issued the practice with requirement notices for regulation 12(1) Safe care and treatment and regulation 17(1) Good governance. The key questions caring and responsive were rated as good at the practice’s inspection in December 2019.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Lostock Hall Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused follow-up inspection to follow up on areas identified at our last inspection which included two breaches of regulations.

We found that the issues identified at inspection in September 2021 had been addressed. These included:

  • Staff recruitment records were comprehensive and included satisfactory evidence of conduct from previous employment and included identify checks.
  • Systems to monitor clinical decision making for those working in advanced clinical roles were in place and this complemented the informal systems in place.
  • A system of monitoring and oversight of incoming patient clinical information that was work flowed was in place.
  • Systems to monitor the quality of patient medication reviews and review ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) agreements were in place.
  • A system of continuous quality improvement was established.
  • Since our last inspection the practice had ensured the oxygen cylinder was stored securely, records and monitoring of staff training including locum GPs were in place and complaint letters included reference to the health ombudsman.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Lancashire and South Cumbria. To understand the experience of GP Providers and people who use GP services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This included :

  • Conducting staff interviews using video conferencing and face to face
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting and reviewing evidence from the provider
  • A site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found that:

  • The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients received effective care and treatment that met their needs in a timely way.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic and continued to follow government guidance to mitigate the risk of this virus.

We saw two areas of outstanding practice including:

  • The lead GP promoted a collaborative approach working with the Community Frailty team and the local hospital trust to raise awareness of the two frailty pathways for care and treatment for patients assessed as frail. A presentation to explain the different pathways was being delivered by the GP to the local primary care team.
  • The lead GP had undertaken additional training and was a GP with an extended role in Menopause Care. The GP was proactive with her patients, and the local community raising the profile of menopause in the newspapers and on local BBC radio.

Whilst we found no breaches of regulations, the provider should:

  • Adapt the medicine monitoring log sheet to include oxygen masks and tubing and the expiry dates for medicines and equipment.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

01 September 2021

During an inspection looking at part of the service

We carried out an announced focused inspection at Lostock Hall Medical Centre on 1 September 2021. Overall, the practice is rated as Requires Improvement.

Safe - Requires Improvement

Effective -Good

Caring – Good (rating awarded at the inspection 5 December 2019).

Responsive – Good (rating awarded at the inspection 5 December 2019).

Well-led – Requires Improvement

Following our previous inspection on 5 December 2019 the practice was rated Requires Improvement overall. The key questions safe and well led were rated as requires improvement and key question effective, caring and responsive and all the population groups were rated as good. We issued the practice requirement notices for regulation 12 (1) Safe care and treatment and regulation 17(1) Good governance.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Lostock Hall Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a follow up focused inspection to review our concerns identified previously. The inspection found most the areas identified previously had been addressed. Other concerns with recruitment procedures and some monitoring systems were identified. Both safe and well-led key questions remain as requires improvement. We rated the practice good for providing effective services. We did not inspect key questions caring and responsive as these were rated good at the previous inspection. All population groups remain rated as good.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included

  • Conducting several staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit
  • Face to face interviews with some staff.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement

We found that the issues identified at inspection in December 2019 had been addressed. These included:

  • Systems of managerial monitoring for staff training, clinical professional memberships and staff immunisation status were established.
  • Staff were now encouraged to report and record significant events and incidents. Weekly clinical meetings and regular team meeting provided opportunities to share learning from these.
  • Actions identified in relation to health and safety including fire safety and Legionella were in place and safe.
  • Infection prevention and control (IPC) was well established and enhanced in response to COVID-19.

This inspection identified some areas that needed further improvement. We rated the practice as requires improvement for providing safe and well-led services because:

  • Staff recruitment records were incomplete. For example, the practice had not assured themselves that staff working at the practice were suitable as satisfactory evidence of conduct in previous employment and identity checks had not been obtained consistently.
  • Systems to monitor clinical decision making for those working in advanced clinical roles were informal and a system to monitor patient information work flowed to either a clinician or for filing was not in place.
  • Systems to monitor the quality of patient medication reviews and review Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) agreements were not established.
  • Governance processes around reviewing and updating policies and procedures were not comprehensive.
  • An overarching quality assurance framework was not in place.

However:

  • The practice had a clear vision, which had been delayed due to the pandemic but was now back on track to evolve the medical centre into a local community hub for social and health care activities.
  • Patients spoken with were wholly positive about the care and treatment they and their families received.
  • The practice team were committed to involving patients in their care and the type of services they provided.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.

We found two breaches of regulations. The provider must:

  • Ensure specified information is available regarding each person employed.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Take action to secure the oxygen cylinder either to a wall bracket or within an oxygen trolley.
  • Provide fire safety awareness training to locum GPs.
  • Complaint response letters should include contact details for the Parliamentary and Health Service Ombudsman.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

5 December 2019

During a routine inspection

We carried out an announced comprehensive inspection at Lostock Hall Medical Centre on 5 December 2019. The provider of the service had been inspected previously at a different location address. This location was registered in March 2019 and this was the first inspection of this service.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall and good for all population groups.

We rated the practice as requires improvement for providing safe and well-led services because:

  • There were gaps in systems and processes to keep patients safe; safety systems were not assured.
  • The practice governance arrangements were not always effective and there were gaps in systems to manage risks.

We rated the practice as good for providing effective, caring and responsive services because:

  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care. Patient feedback was consistently positive.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

We saw the following outstanding practice:

  • The provider evidenced a consistently high level of patient engagement. They used a Heritage Lottery funded project to involve patients in the move to the new surgery premises. The practice ran reminiscence workshops which helped to promote wellbeing, combat isolation and encourage socialisation for patients. Patients told us they felt improved ownership of the surgery.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Ensure comprehensive information relating to the practice is made available to all new GP locum staff.
  • Review the policy for managing patient urgent two-week-wait referrals to ensure it reflects best practice.
  • Improve the documentation of clinical discussion regarding changes in best practice guidelines.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care