Regent House Surgery

Updated 7 June 2016

Regent House Surgery is situated at 21 Regent Road, Chorley, Lancashire PR7 2DH. Primary care services are provided under a General Medical Services (GMS) contract with NHS England

The practice is part of the NHS Chorley with South Ribble Clinical Commissioning Group (CCG) and has a practice population of 8,225 patients.

According to Public Health England, the patient population is comparable with CCG and National averages with 19.2% of patients over 65, 8.4% of patients over 75, 2.1% of patients over 85 and 19.5% under 18 years old.

The Income Deprivation Affecting Older People (IDAOPI) was 18% which was significantly higher than the CCG average of 14.1% and the national average of 16.2%. The Income Deprivation Affecting Children (IDACI) 15.9% which was below the CCG average of 14.5% and significantly below the national average of 19.9%.

There are five GP partners three male and two female. The practice is a teaching practice and at the time of the inspection there were two medical students at the practice. There are two practice nurses, a healthcare assistant and 14 administative staff.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8am to 1pm every morning and 2pm to 6.30pm daily. The practice offers extended opening Monday to Thursday 6.30pm to 7.30pm and Saturday 9am to 3pm. The practice refers patients to the NHS 111 service for healthcare advice when the practice is closed.

Information published by Public Health England rates the level of deprivation within the practice population group as six 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 (77 and 81 years respectively) in the practice geographical area reflects both the England and CCG averages.

63.3% of patients have a long-standing health condition compared to the local average of 55.9% and national average of 54%. The proportion of patients in paid work or full time education is 61.4% which is comparable with the CCG average of 62.4% and the national average of 61.5%. The percentage of patients who are unemployed (1.7%) is below the CCG and national averages of 3.2% and 5.4% respectively.

Updated 7 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Regent House Surgery on 27 April 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. All opportunities for learning from internal and external incidents were maximised.

• 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.

• Risks to patients were assessed and well managed.

• Staff had been trained to provide them with 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.

• The practice had a number of policies and procedures to govern activity and held regular governance meetings. The practice had strong and visible clinical and managerial leadership and governance arrangements.

• Staff demonstrated a good understanding of the issues relating to safeguarding vulnerable adults and children.

• The provider and staff were aware of and complied with the Duty of Candour regulation. The Duty of Candour places a responsibility on providers to be open and honest with service users about their care and treatment, including when it goes wrong.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Audit and quality improvement work demonstrated improved outcomes for patients, although some were not two cycle audits.

We saw several areas of outstanding practice:

The practice offered services to other practices such as substance misuse, ophthalmology and physiotherapy. The practice provided Doppler screening to check for deep vein thrombosis (DVT) (A Doppler is an ultrasound test to check the blood flow through the arteries). This helped to reduce hospital appointments and admissions and initiated treatment when required.

The practice carried out a medicines audit that identified not all patients prescribed Methotrexate were being appropriately monitored during Rheumatology outpatient appointments. (Methotrexate is a medicine prescribed to treat Rheumatoid Arthritis). One of the GPs produced a simple method of collecting data by producing slips which patients must complete before being issued with a repeat Methotrexate prescription. This meant that patients did not need additional hospital appointments to monitor this medication.

The practice maintained a register of patients with a learning disability. They were offered a yearly review with the lead nurse. Health action plans with personalised goals had been designed for the patients, including pictorial health action plans for patients with a learning disability.

GPs had implemented a system of peer reviews that included videoing each other's consultations with the aim of improving practice.

The practice had taken part in several charity events which benefitted the local community and maintained positive and proactive engagement not only with the practice population but also the wider community.

There was one area where the provider should make improvement:

• Implement a more structured system to support two cycle audits to demonstrate a complete audit process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 June 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.

The percentage of patients with diabetes, on the register, who had a record of an albumin: creatinine ratio test (The urine albumin test or albumin/creatinine ratio ACR is used to screen people with chronic conditions, such as diabetes) in the preceding 12 months was 82.7% which was above the CCG and national average of 80.7% and 80.6 % respectively. 86.4% of patients with diabetes had retinal screening which was above the CCG and national averages of 81.9% and 82.6% respectively.

The percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 90.66% above the CCG and national averages of 85.7% and 83.65% respectively.

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. Longer appointments and home visits were available when needed.

Practice staff followed up patients by telephone if they did not attend (DNA) their appointments.

Updated 7 June 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 relatively high for all standard childhood immunisations. For example, rates for under two year olds ranged from 96.9% to 97.9% and five year olds from 91.7% to 99% with the CCG average 89.9% to 98% and 89.4% to 98% respectively. The children’s immunisation clinics were flexible and the practice had in-house ante- natal and post-natal clinics.

Patients were supported to live healthier lives through regular health reviews and various screening checks. For example: 72.9% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months which was below the CCG 78.45% but above the national 69.7% averages.

Appointments were available outside of school hours and the premises were suitable for children and babies. There was a secure play area for children in the waiting area.

We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 7 June 2016

The practice is rated as good for the care of older people.

The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. District nurses provide weekly domiciliary visits for housebound patients.

The practice offered proactive, personalised care to meet the needs of the older people in its population. All patients over 75 had a named accountable GP and received regular reviews involving patients and where appropriate their carers.

Multi-disciplinary review meetings were held with other healthcare professionals to ensure appropriate care was offered for those patients nearing the end of their lives.

86.5% of patients with a diagnosis of dementia had their care reviewed in a face to face review in the preceding 12 months.

For the year ending 31 March 2015, the practice achieved a seasonal flu vaccination rate of 76% among its patients over the age of 65.

Updated 7 June 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.

The practice offered extended opening hours to accommodate patients unable to attend appointments during working hours. This included evenings and Saturdays. Telephone consultations were available for those patients who wished to seek advice from a GP. A text reminder service was used to help reduce non-attendance for appointments.

Feedback from patients was positive about their experience in obtaining an appointment quickly and at a time that was convenient to them. For example, the 2016 national GP survey indicated that 82.93% of patients were able to get an appointment to see or speak to someone the last time they tried compared to a CCG average of 77.61% and a national average of 76.06%.

Updated 7 June 2016

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

The practice manager had engaged with the CCG and had taken a lead role to support the ‘dementia diagnosis target rates’ initiative. The practice manager had developed a dementia training programme that was shared with other practices in the area.

Staff had a good understanding of how to support patients with mental health needs and dementia. The practice manager has worked with the CCG on the ‘Dementia Diagnosis Target’ rates initiative. This involved visiting local GP practices to share knowledge and improve dementia care for local people.

The practice carried out advance care planning for patients with dementia. 86.15% of patients diagnosed with dementia had a face to face review of their care in the past 12 months which was comparable with the CCG and national averages of 87.68% and 84.01% respectively.

The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health. 91.2% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This was comparable to the CCG average of 93.5% and in excess of the national average of 88.47%.

The practice website and information boards in the waiting room, provided information in the form of advice sheets and contact details of voluntary organisations that support patients experiencing poor mental health.

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.

Updated 7 June 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. For example multidisciplinary case review meetings were held for all patients on the palliative care register.

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.