Archived: Dr George Ahad Also known as Station Surgery

Updated 30 December 2016

Dr George Ahad’s practice, also known as Station Surgery, is situated at 8 Golden Hill Lane in the Leyland area of Lancashire at PR25 3NP, serving a mainly urban patient population. The building was formerly a business premises and is a single-storey building. The practice provides level access for patients to the building with disabled facilities available.

There is parking provided for patients in the practice car park and the practice is close to public transport.

The practice is part of the Chorley with South Ribble Clinical Commissioning Group (CCG) and services are provided under a General Medical Services (GMS) Contract with NHS England.

There is one male GP assisted by a female practice nurse. A practice manager and three additional administrative and reception staff also support the practice.

The practice is open from Monday to Friday from 8am to 6.30pm and extended hours are offered on Monday, Wednesday and Friday from 6.30pm to 7pm and every other week on Saturday from 9.30am to 12.30pm. Appointments are offered from 9.30am to 12.30pm and from 4pm to 6.15pm on weekdays, with additional appointments on Mondays, Wednesdays and Fridays at 6.30pm and 6.45pm and from 9.30am to 12.15pm on Saturdays. When the practice is closed, patients are able to access out of hours services offered locally by the provider Go to Doc by telephoning 111.

The practice provides services to 2,654 patients. There are lower numbers of patients aged over 55 years of age (22%) than the national average (28%).

Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Both male and female life expectancy is comparable to the national average, 82 years for females compared to 83 years nationally and 79 years for males, the same as the national figure.

Despite a younger population, the practice has a higher proportion of patients experiencing a long-standing health condition than average practices (58% compared to the national average of 54%). The proportion of patients who are in paid work or full time education is the same as the local and national average of 62% and the proportion of patients with an employment status of unemployed is 12% which is much higher than the local average of 3% and the national average of 5%.

Updated 30 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr George Ahad’s surgery on 28 November 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 generally assessed and well managed. There was no risk assessment for the presence of legionella or building electrical safety certificate on the day of inspection but we saw evidence that the practice had arranged for these to be done in the week following our inspection.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice offered a “Father Christmas” baby clinic every year when Father Christmas attended the practice and gave out presents.
• Patients praised the caring nature of staff and said that they would go above and beyond normal practice to offer support to patients and we saw evidence of this.
• 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 the principal GP and 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 one area of outstanding practice:

• The practice had developed a system of monitoring patients who were referred to the hospital for urgent assessment (the two-week wait rule). They monitored that the appointments were timely and that patients attended. If a patient failed to attend, practice staff contacted them to ensure that they were seen at the hospital.

The areas where the provider should make improvement are:

• Introduce records of checks carried out on clinical equipment and medications and for clinical equipment cleaning.
• Implement any control measures identified by a legionella risk assessment and building electrical safety check.
• Introduce a formal system for documentation of reviews of actions taken as a result of significant events, complaints and patient safety alerts.
• Implement systems to improve the identification of carers in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 December 2016

The practice is rated as good for the care of people with long-term conditions.

• The practice nurse was trained in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was higher than the national average. For example, the percentage of patients with blood pressure readings within recommended levels (140/80 mmHG or less) was 84% compared to the CCG average of 79% and 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 identified patients at risk of diabetes, established clear policies for their review and developed a patient leaflet to provide lifestyle advice and support.
• A podiatrist visited the practice each month to provide foot checks for diabetic patients.
• The practice provided a blood monitoring service for patients who were taking blood-thinning medications for heart conditions.

Updated 30 December 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.
• 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 83%, which was comparable to the local average of 85% 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. The practice held a “Father Christmas baby clinic” every December. Father Christmas attended the baby clinic and gave presents to the children who attended.

• The practice sent congratulations cards to new mothers and invited them to make the appropriate post-natal appointments with the practice. The practice followed up patients who did not respond.

Updated 30 December 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.
• Patients at risk of unplanned admission to hospital had an agreed recorded care plan in place to support them and their carers to take appropriate action when the patient’s health needs deteriorated.
• The practice contacted those vulnerable elderly patients when they were discharged from hospital after an unplanned admission and arranged for any necessary support.
• The practice offered a minor surgery clinic to patients on the premises every week.

Updated 30 December 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 offered a ‘Commuter’s Clinic’ on Monday, Wednesday and Friday evening until 7pm for working patients who could not attend during normal opening hours. There were also appointments available every other week on a Saturday morning from 9.30am to 12.30pm.
• 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.

Updated 30 December 2016

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

• Performance for mental health related indicators was higher than the local and national averages. For example, 96% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the CCG average of 92% and national average of 89%.
• 100% of patients diagnosed with dementia had their care reviewed in a face-to-face review compared to the CCG average of 91% and 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 informed 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.

Updated 30 December 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 those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and for those with complex needs.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Meetings were held monthly to discuss patients’ health and social care needs.
• 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.
• We saw that the principal GP had provided support to vulnerable patients outside of normal working hours in evenings and weekends and these patients were given the GP mobile number for easy contact.
• A monthly clinic for patients who had a history of drug or alcohol misuse was offered on the premises, run by the GP and a member of the community substance misuse team.
• The practice welcomed vulnerable patients including refugees new to the UK.
• Following an audit, the practice revised the practice policy in relation to the identification of patients who were in need of end of life care to ensure timely identification and support.