Archived: The Lanehouse Surgery

Updated 6 July 2017

The Lanehouse Surgery is situated in the coastal town of Weymouth in Dorset. The practice provides a general medical service to approximately 3,200 patients and is part of NHS Dorset clinical commissioning group.

The practice is based on one level of a building in a residential area. The practice is situated near several public transport routes which are displayed clearly for patients in the practice, and there is patient parking available, including designated bays for disabled drivers.

The practice’s population is in the six decile for deprivation, on a scale of one to ten. (The lower the decile the more deprived an area is compared to the national average). The practice population is predominantly White British although there is a small Polish and Chinese population. There is a practice age distribution of male and female patients’ broadly equivalent to national average figures, with a slightly higher number of patients over the age of 55 years. The average male life expectancy for the practice area is 78 years which is slightly lower than the national average of 79 years; female life expectancy is 83 years which matches the national average of 83 years.

The practice is registered with CQC as a partnership of two GP partners, both of whom are male. However, at the time of our inspection we were informed that the practice now had one full-time male GP, the other GP having retired in February 2017. This change of registration is being dealt with separately to the report.

The practice also uses a female locum GP for half a day every week. The lead GP is supported by a nurse practitioner, a practice manager, and eight additional managerial, administration and reception staff. The practice also employed two practice nurses who provided a range of services including wound care, long-term condition management, travel advice, cervical smears and immunisations.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are offered between 8.30am and 12.30pm and between 2pm and 6pm. The practice offers a range of appointment types including book on the day, telephone consultations, home visits and advance appointments. Extended hours are offered on Tuesday evenings until 7.30pm. Outside of these times patients are directed to contact the out of hour’s service by using the NHS 111 number. Details are also given on the practice website and information leaflet of the nearest urgent care services.

Other services offered by the practice include: midwifery, chiropody, counselling, anticoagulation service and vasectomies.

The Lanehouse Surgery provides regulated activities from the main site at:

Lanehouse Surgery

Ludlow Road

Weymouth

Dorset

DT4 0HB

Updated 6 July 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at The Lanehouse Surgery on 21 October 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for The Lanehouse Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 2 May 2017. The key questions are now rated as good for effective, caring and responsive and requires improvement for safe and well led domains. Overall the practice is now rated as requires improvement.

Our key findings across all the areas we inspected are as follows:

• There was a new approach to the running of the practice with an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to the safe care of patients were more clearly managed, with the exception of those relating to medicines administered by health care assistants.
• Staff assessed patients who attended the practice had their needs and delivered care in line with current evidence based guidance.
• Staff had received updated training and had the skills, knowledge and experience to deliver effective care and treatment. However, knowledge of correct safe-guarding procedures was not always embedded.
• Patient feedback was positive about the standard of care received.
• Information about services and how to complain was available and easy to understand. Complaints were investigated appropriately and in a timely manner.
• 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 had created a new vision for its future sustainability and improvement and staff were highly supportive of this vision.
• The practice proactively sought feedback from staff and patients, which it acted on. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The provider was aware of and complied with the requirements of the Duty of Candour.

However, there remain areas where the provider must make improvement. The practice must:

• Ensure patient specific directions are authorised where Health Care Assistants are to administer medicines.
• Ensure staff are fully aware of the correct safe-guarding procedures and that policies reflect these procedures.

In addition the provider should:

• Review the systems in place for the recording of cleaning of clinical equipment.
• Review existing policies to ensure they reflect latest legislation and practice procedures

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by the service. Positive progress has been achieved by the leadership of the practice and there is a clear plan for future development.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 July 2017

The practice was rated as good for caring, responsive and effective and requires improvement for safe and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Patients at risk of hospital admission were identified as a priority.
• Nationally reported data showed that outcomes for patients with diabetes were comparable to CCG and national averages. For example, 65% of patients with diabetes had an acceptable average blood sugar level compared to a clinical commissioning group (CCG) average of 82% and the national average of 78%. Exception reporting for this indicator was 7% compared to a CCG average of 18% and national average of 13%.
• 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.

Updated 6 July 2017

The practice was rated as good for caring, responsive and effective and requires improvement for safe and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 national 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 81%, which was comparable to the CCG average of 83% and the national average of 81%. Exception reporting for this indicator was 3% compared to the CCG and national average of 7%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice ran a daily sit and wait clinic for children under 12 years of age which did not require patients to book appointments. Patients we spoke to felt reassured by this service.
• The practice worked with other professionals, such as health visitors, to ensure the needs of this group were met.
• The GP ran a vasectomy (male sterilisation) service for patients across the Weymouth and Portland locality.
• There was a dedicated health promotion board in the waiting area aimed at families with young children. 

Updated 6 July 2017

The practice was rated as good for caring, responsive and effective and requires improvement for safe and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Every patient at the practice including older patients aged over 75 years had a named GP.

• 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.
• Patients at risk of hospital admission were identified as a priority and were regularly reviewed to ensure all of their needs were met.
• The practice worked jointly with other practices in the Weymouth area to provide services for patients aged over 75 years to avoid admission to hospital and support patients living in residential homes.

Updated 6 July 2017

The practice was rated as good for caring, responsive and effective and requires improvement for safe and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 offered telephone consultations to meet the needs of this group.
• The practice offered extended hours until 7.30pm on Tuesdays.

Updated 6 July 2017

The practice was rated as good for caring, responsive and effective and requires improvement for safe and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 97% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the clinical commissioning group (CCG) of 86% and the national average of 84%.

• Performance for mental health related indicators was comparable to local and national averages. For example, 83% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months, compared to a CCG average and national average of 89%.
• 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.
• Practice data showed that 71% of patients with a mental health problem had received a physical health check.
• 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.

Updated 6 July 2017

The practice was rated as good for caring, responsive and effective and requires improvement for safe and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had a carers lead, who 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. Clinical 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. However, the correct safeguarding procedures to undertake was not embedded in all staff.