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Berry Lane Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 18 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Berry Lane Medical Centre on 1 December 2016. Overall the practice is rated as good and outstanding for providing responsive services. Our key findings across all the areas we inspected were as follows:

  • The practice is situated in a purpose built health centre. The practice was clean and had good facilities including disabled access, translation services and a hearing loop.
  • There were systems in place to mitigate safety risks including analysing significant events.
  • The practice was aware of and had systems in place to ensure compliance with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).
  • Patients’ needs were assessed and care was planned and delivered in line with current legislation.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Results from the national GP patient survey showed that patient satisfaction was above local and national averages in all aspects of delivery of care.
  • Information about services and how to complain was available. The practice sought patient views about improvements that could be made to the service.
  • Staff worked well together as a team and all felt supported to carry out their roles. There was a low turnover of staff and all staff we spoke with appreciated the open culture of the practice and that they felt valued in their work and were treated as equals.

There were outstanding elements of practice including:

  • The practice had identified the need for a full time nursing and residential home specialist nurse to avoid unnecessary hospital admissions and plan for good end of life care. This ensured a continuity of care for patients and support for their families. The practice specialist nurse had formulated a ‘stay at home template’ only for patients with DNARs in place that was signed by the patient where possible, carer, out of hours and the relevant GP to avoid any GP sending a patient unnecessarily to hospital unless the patient had experienced trauma.
  • In addition, the practice specialist nurse had provided educational sessions for care homes. For example, advice on keeping elderly patients hydrated to avoid medical problems.
  • The practice provided a minor injuries service responding to the needs of local farm workers and they had responded to the needs of patients in their rural setting by being open seven days a week.
  • The practice acted on innovative suggestions from staff. For example, as a result of one member of staff’s suggestion, the practice had produced an induction pack for medical students which were sent to them prior to them attending the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 January 2017

The practice is rated as good for providing safe services. The practice took the opportunity to learn from internal incidents and safety alerts, to support improvement. There were systems, processes and practices in place that were essential to keep patients safe including medicines management and infection control. However, there was no system to monitor the use of blank prescriptions for home visits. In addition systems to remove out of date medical equipment had not been applied in all instances. A risk assessment had concluded that there was no need to have any treatment for hypoglycaemia but in a semi-rural setting this decision should be reviewed.  External agencies had not asked the practice to provide reports about children at risk. However, the practice’s internal safeguarding meeting procedures should be improved. The practice had addressed these issues immediately after our inspection.

Effective

Good

Updated 18 January 2017

The practice is rated as good for providing effective services. Patients’ needs were assessed and care was planned and delivered in line with current legislation. Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. Clinical audits demonstrated quality improvement. Staff worked with other health care teams. Staff received training suitable for their role.

Caring

Good

Updated 18 January 2017

The practice is rated as good for providing caring services. Patients’ views gathered at inspection demonstrated they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We also saw that staff treated patients with kindness and respect. 

Responsive

Outstanding

Updated 18 January 2017

The practice is rated as outstanding for providing responsive services. The practice tailored its services to meet patient needs. For example,

  • The practice had identified the need for a full time nursing and residential home specialist nurse to avoid unnecessary hospital admissions and plan for good end of life care. This ensured a continuity of care for patients.

  • The practice operated a personal list system, enabling whole families to be registered with the same GP providing continuity of care for the patient and to help the GP be more familiar with the patient’s needs.

  • Access for worried parents to medical appointments, is available via the Emergency Surgery that runs twice daily, meaning that children are seen on the same day.

  • The practice runs a Saturday and Sunday morning clinic, for ease of access.
  • The emergency surgery has the capacity to act as an overspill clinic and means that people who work can be seen on the same day.

  • The practice had a minor injuries service, diverting appropriate cases away from A& E. Minor surgery and joint injections were offered (including weekends), avoiding hospital attendances.

Results from the national GP patient survey published in July 2016 (from 104 responses which is approximately equivalent to 1% of the patient list) showed that patient’s satisfaction with how they could access care and treatment were higher than local and national averages. For example:

  • 94% patients said they could get through easily to the surgery by phone (CCG average 74%, national average 73%).
  • 78% of patients got to see or speak to their preferred GP (CCG average 54%, national average 59%).

Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 18 January 2017

The practice is rated as good for being well-led. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity. The practice proactively sought feedback from staff and patients and had a PPG. Staff had received inductions and attended staff meetings and events.

Staff worked well together as a team and all felt supported to carry out their roles. There was a low turnover of staff and all staff we spoke with appreciated the open culture of the practice and that they felt valued in their work and were treated as equals.

Checks on specific services

People with long term conditions

Good

Updated 18 January 2017

The practice is rated as good for providing services for people with long term conditions. The practice had registers in place for all long term conditions including diabetes and asthma. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Patients on warfarin medication could have their tests carried out at the practice to reduce the need for hospital visits. 

Families, children and young people

Good

Updated 18 January 2017

The practice is rated as good for providing services for families, children and young people. The practice operated a personal list system, enabling whole families to be registered with the same GP providing continuity of care.

The practice regularly liaised with health visitors to review vulnerable children and new mothers.

The practice had an emergency clinic so children could be seen on the same day if necessary. There was a designated children’s play area in the waiting room.

Older people

Good

Updated 18 January 2017

The practice is rated as good for providing services for older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and offered home visits and care home visits.

The practice had identified the need for a full time nursing and residential home specialist nurse to avoid unnecessary hospital admissions and plan for good end of life care. This ensured a continuity of care for patients and support for their families. The practice specialist nurse had formulated a ‘stay at home template’ only for patients with DNARs in place that was signed by the patient where possible, carer, out of hours and the relevant GP to avoid any GP sending a patient unnecessarily to hospital unless the patient had experienced trauma.

The practice participated in meetings with other healthcare professionals to discuss any concerns.

Working age people (including those recently retired and students)

Good

Updated 18 January 2017

The practice is as rated good for providing services for working age people. The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible. There were online systems available to allow patients to make appointments.

The practice runs a Saturday and Sunday morning clinic, for ease of access. The emergency surgery has the capacity to act as an overspill clinic and means that people who work can be seen on the same day.

The practice had a minor injuries service which was used by farm workers as they were a group which was particularly prone to injuries which can be managed in a primary care setting rather than having to make a journey into Preston.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 January 2017

The practice is rated as good for providing services for people experiencing poor mental health. Patients experiencing poor mental health received an invitation for an annual physical health check. Those that did not attend had alerts placed on their records so they could be reviewed opportunistically.  All staff had received training for dementia awareness and the Mental Capacity Act.

The practice provided care for patients at two Lancashire County Council special needs children’s and young person’s homes.

People whose circumstances may make them vulnerable

Good

Updated 18 January 2017

The practice is rated as good for providing services for people whose circumstances make them vulnerable. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It had carried out annual health checks and longer appointments were available for people with a learning disability. 

The practice was one of two practices that provided care and end of life care, for patients at a local community hospital.