25 August 2016
Highfield Surgery Partnership is housed on the second (top) floor of the modern, purpose built South Shore Primary Care Centre in the South Shore area of Blackpool.
There is onsite parking available and the practice is close to public transport. The practice provides services to 13,744 patients.
The practice provides level access for patients to the building with automated entry doors and is adapted to assist people with mobility problems. The building has three floors, and the practice reception, consulting and treatment rooms are mainly on the second (top) floor. The practice also operates a service for managing patients with acute problems which is situated on the first floor, although this is not a walk-in service for patients. Access to the practice is by using stairs or one of two lifts.
The practice is part of the NHS Blackpool Clinical Commissioning Group (CCG) and services are provided under a General Medical Services Contract (GMS).
There are three male and three female GP partners and two male and two female salaried GPs. The practice is a training practice and two GPs are accredited trainers. The practice also employs three nurse practitioners, a nurse manager, three pharmacists, three practice nurses, a treatment room nurse and five health care assistants. The non-clinical team consists of a practice manager and 25 administrative and reception staff including two assistant practice managers and a reception manager who support the practice.
The practice is open between 8am and 7.30pm on Monday and Tuesday and 8am and 6.30pm on Wednesday to Friday. When the practice is closed, patients are able to access out of hours services offered locally by the provider Fylde Coast Medical Services by telephoning 111.
The practice has a larger proportion of patients aged over 45 years of age compared to the national average and 22.3% of the practice population are aged over 65 years of age compared to the national average of 17%.
Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.
The practice caters for a larger proportion of patients experiencing a long-standing health condition (60% compared to the national average of 54%). The proportion of patients who are in paid work or full time education is higher (60%) than the CCG average of 52% and unemployment figures are lower, 3% compared to the CCG average of 7% and the national average of 5%.
25 August 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Highfield Surgery Partnership on 15 July 2016. 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.
- The practice received patient safety alerts and acted appropriately. However, they did not keep records of patient safety alerts for any possible temporary members of staff such as locum doctors.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
- The arrangements for managing medicines, including emergency medicines and vaccines, in the practice kept patients safe. Medicines in GP bags were appropriate and in date although there was no formal process to check these on a regular basis.
- 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. 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 introduced an acute care service to manage up to 200 patient requests for urgent care each day.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- There were protocols relevant to infection control in place and staff had received up to date training. We noted that there was no overall infection control policy that referenced these protocols or provided details of the infection control lead.
- 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 practice had experienced difficulties in involving all staff in meetings and had addressed this by introducing a weekly communication flier which was circulated to all staff.
- The provider was aware of and complied with the requirements of the duty of candour.
We saw one area of outstanding practice:
- The practice had arranged training for one member of administrative staff in the testing of electrical equipment and purchased electrical testing equipment. This staff member was then able to check all practice electrical equipment on a rolling programme.
The areas where the provider should make improvement are:
- Ensure that patient safety alerts are retained by the practice for reference by temporary staff such as locum GPs.
- Put a formal process in place to check the medicines carried in GP bags to ensure that they are all in date.
- Introduce overarching infection prevention and control policy for the practice.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
25 August 2016
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.
- Blood pressure measurements for diabetic patients showed that 86% of patients had readings within the recommended levels compared with the national average of 78%.
- 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 worked with neighbouring practices to deliver training to the community nursing team in the management of patient chronic disease.
25 August 2016
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.
- Childhood immunisation rates for the vaccinations given were comparable to clinical commissioning group (CCG) averages except those given to children under one year of age which were lower.
- 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 78%, which was comparable to the CCG average of 81% and the national average of 82%.
- 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.
25 August 2016
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 had a memory assessment clinic for patients every month.
- A national charity provided two clinics every week in the practice to offer patients social care advice.
- The practice had invited members of the national patient bowel screening service to promote screening to patients in the surgery waiting area.
- The practice had a prescription clerk available each morning to answer queries for patients who were experiencing difficulties in ordering repeat prescriptions.
25 August 2016
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.
- There were appointments with a GP on Monday and Tuesday until 7pm and late opening on those days until 7.30pm.
- 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 acute care service offered telephone appointments to working patients who needed urgent advice during working hours.
25 August 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- 96% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the national average of 88%.
- 90% of patients diagnosed with dementia had their care reviewed in a face-to-face review compared to the national average of 84%.
- 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.
- The practice was able to refer patients to adult mental health services which were based in the practice building, to provide patient assessment and treatment.
25 August 2016
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 homeless people, travellers and 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.
- The practice nurse manager acted as the practice care co-ordinator and produced and reviewed care plans for vulnerable patients, contacting all patients when they were discharged from hospital.
- The practice recognised that it had many older, housebound patients and that 3% of their patients were living in care homes. They employed a specialist community nurse to provide care for these patients in their own homes. One of the practice nurse practitioners also visited housebound patients.
- The practice had access to an online service that enabled staff to print off patient information leaflets in easy read format. This same service provided video information on health using British sign language and videos for patients on subjects such as healthy living and chronic disease which were easy to understand.
- The practice had recently appointed a carers’ champion who was supported by two deputies. The carers’ champion’s role was to offer a point of contact for carers on the practice list, liaise with the local carers support organisation, offer health checks to carers and information packs on support services and optimise the identification of carers on the practice patient list.
- The practice had a policy for managing the care of patients who were lesbian, gay, bisexual or transgender (LGBT).
- One of the practice nurse practitioners was the main point of contact for patients with learning difficulties and invited those patients for annual health checks, visiting them at home if they were unable to come to the practice.