Archived: Meadowside Medical Practice

Updated 14 January 2016

Meadowside Medical Practice is located in the city centre of Lancaster. In addition to the Lancaster practice, the provider is also responsible for a separate location registered in Heysham following a recent merger of the two practices. The Heysham practice has a branch surgery in Morecambe Health Centre. Patients registered with the practice are able to access services at any of the provider’s locations. The total patient list size across all sites is 14092. This inspection looked at the Lancaster site only, and data quoted in this report relates to the list size of 7174 patients that were registered with the Lancaster location prior to the merger and patient lists being combined.

The practice population includes a slightly higher proportion of patients under the age of 18 (17.6%) compared to the national average (14.8%). The practice has a lower percentage of patients with health related problems in daily life (39.2%) compared to the national average of 48.8%, as well as a lower percentage of patients with caring responsibility (13.5% compared to the national average of 18.2%).

The practice is staffed by six GP partners (five male and one female) and three salaried GPs (two female and one male). The GPs are supported by a clinical staff consisting of three nurse practitioners, four practice nurses, a treatment room nurse, a health care assistant, phlebotomist and a pharmacist. Non clinical staff consist of a practice manager, assistant practice manager and 25 administration and reception staff. Staff are shared across the different locations operated by the provider. The practice is a training practice, and currently has two trainee GPs.

The practice is open between 8:00am and 6:30pm Monday to Friday. It closes each Wednesday lunch time between 12:00 and 1:00 to allow for staff training, but a GP remains available during this time in case of emergencies. Extended hours surgeries are offered between 6:30pm and 9:00pm on a Monday evening and between 7:00am and 8:00am on Tuesday mornings. In addition, the practice’s patients can access primary care services offered between 6:30pm and 8:00pm Monday to Friday and between 8:00am and 8:00pm at weekends as the practice participates in the ‘opening doors’ pilot project in conjunction with four other local GP practices.

When the practice is closed, patients are advised to access out of hours care offered locally by Bay Urgent Care.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Meadowside Medical Practice on 18 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.
• 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 GP or nurse 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw some areas of outstanding practice:

• The practice cared for a number of patient groups who experienced challenging health needs, and had responded well to these needs.For example they liaised closely with the local Islamic girls’ college to ensure their residents health needs were met appropriately. The female nurse practitioner telephoned the college each morning to triage health concerns and had three appointment slots each day set aside for these patients to access. The practice had also recognised the difficulties in prescribing medicines presented by dietary restrictions faced by this population group and had acted by raising awareness of medicines appropriate for a Halal diet.

• The GPs provided GP urgent care services at the local accident and emergency department, which allowed a streamlined transition for their patients accessing emergency care back into primary care. The GPs would frequently visit their patients while they were in-patients enabling care plans to be put in place immediately.

The areas where the provider should make improvement are:

• Ensure policy documents and risk assessments fully take into account the role of chaperone for non-clinical staff. For staff who have not had a DBS check undertaken, documents should clearly state that they will not be left alone with patients, for example should the clinician leave the room.

• Ensure staff receive regular training around infection prevention and control.

• Ensure that the regular checks carried out for medicine stock levels and expiry dates, as well as those to ensure emergency equipment is functioning are documented and recorded.

• Ensure all written responses to complaints include information of whom to contact should the complainant be unhappy with the investigation, and include feedback from complaints in staff meetings in order to maximise learning from them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 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.

• Performance for diabetes related indicators was better than the national average. For example, the percentage of patients with diabetes on the register who had a record of an albumin:creatinine ratio test in the preceding 12 months was 91.38%, compared to the national average of 85.94%.

• The percentage of patients with diabetes on the register with a record of foot examination and risk classification within the preceding 12 months was 94.92%, compared to the national average of 88.35%.

• The percentage of patients with diabetes on the register who had had influenza immunisation in the preceding 1 September to 31 March was 97.44% compared to the national average of 93.46%.

• Longer appointments and home visits were available when needed.

• All these patients had 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 14 January 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. Immunisation rates were in line with local averages 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.

• The practice’s uptake for the cervical screening programme was 80.2%, which was comparable to the national average of 81.88%.

• 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 14 January 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.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• It had recently employed a nurse practitioner for an additional day each week to allow for visits to residential and nursing homes in order to review care plans and medication.

• Flu vaccination rates for the over 65s were 79.5% compared to the national average of 73.24%

• The practice made use of the Gold Standard Framework to identify and care for people approaching the end of life.

Updated 14 January 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.

• 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.

• A system was in place to offer text message reminders for appointments if a patient had opted in to use this.

Updated 14 January 2016

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

• One of the GPs held Section 12 approval for assessment and diagnosis under the mental health act. This meant they were able to advise whether a patient needed detaining in hospital due to mental health concerns.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice offered an enhanced service to facilitate a timely diagnosis of 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 people with mental health needs and dementia.

Updated 14 January 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 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 offered health care services for residents at a local drug and alcohol rehabilitation centre and there was a lead GP identified to coordinate their care.

• 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.