Archived: The Westgate Medical Practice

Updated 10 December 2015

The Westgate Medical Practice is part of the NHS Lancashire North Clinical Commissioning Group (CCG). Services are provided under a personal medical service (PMS) contract with NHS England. The practice has 8300 patients on their register.

Information published by Public Health England rates the level of deprivation within the practice population group as four on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male and female life expectancy in the practice geographical area is below the England average for males at 78 years and 82 years for females (England average 79 and 83 respectively).

National data showed that the healthcare needs and demands of the practice patient population were significantly higher than the averages for the CCG and England. The patient population over the age of 65 was significantly higher (23.2%) than the CCG average at 16.7% and the population for the over 75s (10.9%) was also higher that the CCG at 7.6%. The number of patients with health related problems in daily life (63.2%) was also significantly higher that the England average (48.8%). In addition, 72 per 1000 patients were claiming disability allowance compared with England average of 50.3 and the practice had a higher proportion of patients living within a nursing home at 1.1% compared to the 0.5% England average (data from 2010/11). Data also identified that the prevalence of patients with a long-term condition was also significantly higher than local and England averages.

The practice has three part time GP partners (two female and one male), two female salaried GPs, and one male long-term locum GP. The practice employed a nurse team leader, a triage/minor illness nurse, two practice nurses, three health care assistants, a phlebotomist, a practice manager, a deputy practice manager, an administrative office manager, two prescription officers and a team of receptionists, admin assistants and a secretary. In addition, the practice has the support of a part time pharmacist who is employed by the CCG.

The practice is a teaching practice and supports undergraduate medical and nursing students. The practice is a training practice for experienced qualified doctors who are training to be a GP.

The practice opens Monday Tuesday and Thursday 8am to 8pm and Wednesday and Fridays 8am until 6.30pm. The evening surgeries from 6.30-8pm are for pre booked appointments only. Emergency calls from 6.30pm are managed by the Out of Hours service provided by Bay Urgent Care, and contacted by ringing NHS 111.

The practice provides online patient access that allows patients to book appointments and order prescriptions.

The practice is housed in a purpose built building that is accessible to people with disabilities.

At the time of our visit, the practice was in the process of updating its registration with the CQC, as required by The Health and Social Care Act 2008 (Registration of Regulated Activities) Regulations 2009. One registered partner had left the practice and required removing from the registration and two partners required registration. The main partner was also in the process of registering as the registered manager.

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Westgate Medical Centre on 4 November 2015. 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 assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patients were complimentary about the staff at the practice.

• Information about services and how to complain was available and easy to understand.

• Patients said they found it difficult getting through to the practice on the telephone. Urgent appointments were available on the same day but patients had to wait up to three or four weeks for planned appointments with a named GP.

• The practice offered a triage and telephone call back service, calling between 50-80 patients each day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice was going through a period of transition. Two GP partners and third GP had left the practice within the last two years. New partners were now in place but there remained 1¼ GP full time vacancies.

• Despite the period of transition, there was a leadership structure in place and staff felt supported by management.

• The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

• Ensure all staff receive training in safeguarding appropriate to their role and responsibilities.

• Undertake an assessment of staffing capacity and an audit of patient demand to ensure there is sufficient staff to meet the increasing health care needs of the local patient population.

• Implement the practice policy consistently to monitor fridge temperatures and implement a system to ensure prescriptions not collected by patients are monitored and actioned.

• Continue to review telephone and appointment access to identify strategies to improve patient access to meet demand.

• Ensure a business strategy with clear priorities is developed and implemented to mitigate the risks of reactive management of situations.

• Develop the clinical governance of the practice by holding regular clinical meetings and implementing a planned programme of continuous clinical and internal audit to monitor quality and to make improvements.

• Ensure full team meeting are held so that all staff have the opportunity to contribute to the development of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 December 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.
• The number of patients registered with practice with a long term condition were higher than both the Clinical Commissioning Group (CCG) and national averages for example:

1. Diabetes prevalence 8.5%, (CCG average 6.3% and   England average 6.2%).
2. Chronic Obstructive Pulmonary Disease 3.1%, (CCG average 2.2% and England average 1.8%).
3. Hypertension 18%, (CCG average 13.4% and England average 13.7%).

• Longer appointments and home visits were available when needed. The practice offered evening appointments to people with a long-term condition and those who worked through the day.

• All these patients had a named GP and a structured annual review to check that their health and medicines 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 10 December 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.
• Good community links were established with a local children’s centre. The practice and the children’s centre coordinated service to improve access and availability of services such as sexual health advice and support for parents.
• Immunisation rates reflected the Clinical Commissioning Group (CCG) rates for all standard childhood immunisations.
• Cervical screening data from 2013/14 for women aged 25-64 was 74.9%, which was slightly below the CCG 75.5% and England 76.9% average. However, the practice’s exception rate was lower at 3.6% compared with 5.2% and 6% respectively. Data supplied by the practice for 2014/15 showed that 73% of women received cervical screening
• 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 10 December 2015

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.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• A rapid access telephone number was provided to those people considered at high risk
• Care plans were in place for those patients considered at risk of unplanned admission to hospital.
• 74% of over 65s had received influenza vaccine and 66% had received a shingles vaccine in 2014/15 (data supplied by the practice).
• All registered patients living in a care home had an agreed care plan in place and the care home staff had a rapid access telephone number to contact the surgery if they needed advice regarding a patient’s health.

Updated 10 December 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. For example, the practice was open until 8pm Monday, Tuesday and Thursday. Nursing appointments were also available during these times.
• 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.

Updated 10 December 2015

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

• The practice took part in the Closing the Gap dementia screening project and screened 264 patients. As a result the practice dementia register increased by 15 to 113 patients.
• The practice had 64 patients on their mental health register and confirmed that they met all the Quality and Outcomes Framework (QOF) targets for 2014/15.
• 8.6% of the practice population had a diagnosis of depression. This was higher than the Clinical Commissioning Group (CCG) 8.4% and the England average 6.5%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 local community mental health service use the practice consulting rooms in an evening to see patients.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 10 December 2015

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, travellers and those with a learning disability.
• 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.
• The practice 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.