Archived: Station Road Surgery

Updated 2 November 2017

Station Road Surgery is situated in Sowerby Bridge HX6 3AB. Sowerby Bridge is a small town located approximately three miles from Halifax town centre. The surgery is located within a two storey converted police station, which has grade two listed building status.

There are currently 9,300 patients on the practice list. The National General Practice Profiles data shows that approximately 3% of the patient group are of mixed or Asian origin; with the remainder of white British origin. The practice provides General Medical Services (GMS) under a contract with NHS England. The practice offers the following enhanced services:

• Meningitis vaccination and immunisation
• Childhood vaccination and immunisation
• Extended hours access
• Services for timely diagnosis and support for people with dementia
• Influenza and pneumococcal immunisation
• Support for patients with learning disability, including an annual health check
• Minor surgical procedures
• Patient participation group
• Rotavirus and shingles immunisation
• Identification and review of patients at risk of unplanned hospital admission

The practice has three partners; one male and two female. Additional GP support is provided by five regular locums. The clinical team also comprises two practice nurses. One Health Care Assistant has recently been appointed. The practice receives support from a pharmacist, employed by the practice, who is present on site daily, as well as CCG pharmacist support. The clinical team is supported by a practice manager (interim at the time of our visit), and a range of reception and administrative staff.

The practice is a teaching and training practice, which means it provides training and support for qualified doctors wishing to specialise in general practice, as well as medical students.

The National General Practice Profile shows the level of deprivation within the practice population as five on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The age/sex profile of the practice is in line with national averages. Average life expectancy for patients is 78 years for men and 82 years for women. National averages are 79 years and 83 years respectively.

The practice is open:

• Monday 8.00am to 8pm.
• Tuesday to Friday 8.00am to 6.30pm.

Appointments are available between 8.30am and 11.30 am in the morning; and between 3pm and 8pm on Monday; and 3pm to 6pm Tuesday to Friday.

At the time of this inspection we learned that the practice had been successful in securing a bid to provide locality hub services offering extended hours to patients registered at the five practices within their local hub. This service was due to begin on 6 November 2017. This means that patients from all practices within the hub will be able to access appointments from 6.30am to 8pm Monday to Friday.

Although parking is limited on site; on street parking is available. There is a dedicated disabled parking space on site. All patient consultation rooms are on the ground floor, and are accessible to those patients with limited mobility, or those who use a wheelchair.

Out of hours care is provided by Local Care Direct, which is accessed by calling the surgery telephone number or by calling the NHS 111 service.

Updated 2 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Station Road Surgery on 14 June 2017. The overall rating for the practice was Good. However we rated the practice as Requires Improvement for providing safe services. The full comprehensive inspection report can be found by selecting the ‘all reports’ link for Station Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 24 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation which we identified at our previous inspection on 14 June 2017. The report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

The practice is now rated as Good for providing safe services.

Our key findings were follows:

• Processes for receiving and acting upon patient safety alerts had been improved. Systems had been streamlined. Searches were made in patient records to identify patients affected by any such alerts, and appropriate action was taken when necessary.
• Vaccine stock levels were logged and monitored.
• Communication with locums had been improved to encourage attendance at meetings, or disseminating of minutes from meetings where attendance was not possible.
• The practice was continuing to engage with patients to review satisfaction with access to appointments. The practice was participating in a CCG wide audit of patient satisfaction with access to appointments with GPs, which was due to end on 6 November 2017.

However we found one area where the provider should make an improvement:

The provider should:

• Deliver on their plan to carry out any remaining staff appraisals by December 2017.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 July 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• 79% of patients with diabetes, on the register, had a cholesterol reading which was within normal limits recorded in the preceding 12 months, compared to the CCG average of 81% and the national average of 80%.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• The practice had recently carried out searches on patient records. As a result 343 patients had been added to a number of disease registers.

• The practice had developed in-house chronic disease management templates.

• One of the practice nurses had received enhanced training in diabetes care and treatment. The nurse was qualified, with GP support, to initiate insulin treatment for diabetic patients where appropriate.

• We saw that patient information leaflets had been developed, to provide patients with diabetes with additional information to help them with managing their condition.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with the wider multidisciplinary team to deliver appropriate care packages.

Updated 27 July 2017

The practice is rated as good for the care of families, children and young people.

• The practice held monthly meeting with the health visitor. This allowed them the opportunity 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 accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Staff told us that children under five years of age were prioritised for same day appointments.

• The practice had employed a nurse who provided a full range of contraceptive and sexual health services to patients. They told us they were considering introducing a ‘drop in’ element to the service to broaden the appeal for younger people.

• The practice liaised with appropriate agencies, such as midwives and the local neonatal unit, to provide support for premature babies and their families following discharge from hospital.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 27 July 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. We saw that 93% of patients over 75 years taking multiple medicines had a review of their medicines completed in the preceding year. 57% of patients over 75 years had a care plan in place.

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

• The practice identified at an early stage older patients who may need palliative care. as they were approaching the end of life. The practice held quarterly palliative (end of life) care meetings with specialist nurses and the community matron. Weekly meetings with district nurses were also held. Older patients were involved in planning and making decisions about their care.

• The practice had identified over 2% of their population who were at risk of unplanned hospital admission; and followed up on these, and other older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services, such as out of hours (OOH) services.

• Before the inspection we sought feedback from a residential home for older people who were registered with the practice. They told us the practice provided a responsive and caring service to their residents.

Updated 27 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations 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 online services. In February 2017 the practice had changed their clinical system, which had resulted in the loss of 3000 patients who had previously registered for online services from the online access database. At the time of our visit the practice was actively promoting this service, and encouraging patients to re-register. When we visited, we saw that 896 patients (9% of the practice population) were registered for the service.

• The practice offered a full range of health promotion and screening appropriate to this age group.

• An ‘E-Consult’ service was available on the practice website, which enabled patients to complete details of their symptoms for minor illnesses; and the practice made contact to provide additional advice and support if needed.

• Students were encouraged to register with the practice as temporary patients during holiday periods.

• The practice was participating in a ‘Practice Assist’ pilot which gave patients contacting the surgery for an appointment the opportunity to receive a telephone consultation from a GP situated remotely, not attached to the practice.

• A men’s health event had recently been held in the practice. Out of 45 attendees, 35 had been found to have unmet health needs which required further follow up. 100% of attendees said they had found the event beneficial; and that they felt better informed about their health as a result.

Updated 27 July 2017

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

• The practice carried out advance care planning for patients living with dementia.

• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower than the CCG average of 82% and the national average of 84%.

• 100% of patients with dementia had a care plan in place at the time of our visit.

• The practice made use of pharmacists employed by the practice to monitor repeat prescribing for patients receiving medicines for mental health needs.

• 84% of patients with schizophrenia or other psychoses had their blood pressure recording completed in the preceding 12 months, which was lower than the CCG average of 90% and the national average of 89%.

• The practice worked with other professionals, such as mental health teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients with mental health problems, who were experiencing a crisis, were offered same day GP assessment.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 July 2017

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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• We saw evidence that 45 out of 60 (75%) of annual reviews for patients with learning disability had been completed in the previous year.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff we spoke with demonstrated their awareness of how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
• Before the inspection we sought feedback from a care home for younger physically disabled people who were registered with the practice. They told us that overall they were satisfied with the service; however they had experienced some difficulties in accessing the practice by telephone, and in relation to medicines requests. We fed this back to the practice who told us they would make contact with the home and develop improved systems of communication.