Archived: Lilford Park Surgery

Updated 13 June 2017

Following the previous inspection in September 2016 the practice was rated as requires improvement and we took regulatory action against the provider in the form of requirement notices. This inspection on 25 April 2017 was to check that improvements had been made.

Lilford Park Surgery is situated in a large purpose built health centre in the centre of Leigh. The health centre incorporates primary health care services including district nurses, health visitors, midwives and other services such as chiropody, speech therapy and dental services. The building has full disabled access, disabled toilets and specialist bariatric facilities. There is ample car parking, including disabled spaces, at the rear of the practice. The health centre is a small walk from public transport links.

The practice itself is on the first floor and is accessible by stairs and a lift for patients with difficulty using the stairs. Since our previous inspection, temporary signage had been erected to direct patients to the practice which had changed its name in 2010 when the previous founder had retired.

The practice provides a service to 3,800 patients in the surrounding areas of Leigh under a General Medical Services Contract run by Wigan Clinical Commissioning Group. This number of patients had increased by around 200 since our previous inspection. The building is situated in the third most deprived area in the country and the practice has a small number (around 4%) of black and Asian minority ethnic groups.

There are two GP partners, one male and one female and a male advanced nurse practitioner who is able to prescribe medicines. The nursing team comprises of a part time practice nurse (30 hours a week) and a part time health care assistant. The clinicians are supported by a practice manager and three reception/administration staff. They are a training practice and currently have a GP trainee in post that works 20 hours per week and is able to see patients under supervision.

The practice staff have access to a range of community staff and other services based in the health centre.

The practice is open

Monday 8am to 6.30pm

Tuesday 8am to 8pm

Wednesday 8am to 5pm

Thursday 8am to 6.30pm

Friday 8am to 6.30pm

A walk in service is available every morning between 9am and 11.30am and appointments in the afternoon can be pre-booked by telephone and on-line. On Wednesday afternoons the telephone lines are closed, but the reception is open for the collection of prescriptions and general enquiries. In addition, the surgery works in conjunction with the Wigan Federation working together HUB scheme and patients can access the service via the Hub booking centre. When the practice is closed, patients are directed to the out of hours service and the Walk In service is based in the same building.

Updated 13 June 2017

Letter from the Chief Inspector of General Practice

We carried out our first announced comprehensive inspection at Lilford Park Surgery on 30 September 2016 when the practice was rated as requires improvement overall. The areas where the provider was required to make improvements related to the safe, effective and well led domains. The full comprehensive report following that inspection can be found by selecting the ‘all reports’ link for Lilford Park Surgery on our website at www.cqc.org.uk.

We carried out this announced comprehensive inspection at Lilford Park Surgery on 25 April 2017 to check that the practice had made improvement. Improvements were demonstrated in all areas. The practice had taken action on each and every point highlighted at the inspection of 30 September 2016 and had introduced robust systems to address the concerns.

Overall the practice is now rated Good.

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

• The practice had introduced and embedded a number of systems to minimise risks to patients and staff since our inspection in September 2016. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The systems to manage risks and issues, introduced following our inspection in September 2016, demonstrated that people would be protected by a strong comprehensive safety system with a focus on openness, transparency and learning when things went wrong.
• Risks to patients were well assessed in particular those relating to medicines management, infection control, medical emergencies and staff training which had been highlighted as requiring improvement at the last inspection.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment and training was regularly monitored and updated.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with open access between 9.00am and 11.30am each 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 June 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.
• Data indicators showed that the practice effectively managed patients on the diabetes register. Blood glucose levels (HbA1c) in 85% of patients were within a recommended level compared to the CCG figure of 80% and the national figure of 78%
• 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.
• 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 13 June 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 between 91% and 100% for all standard childhood immunisations which was higher than the required standard of 90%.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics on a weekly basis.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 13 June 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.
• 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. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on 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 walk in centres, district nurses and the GP hub where patients could be seen during hours when the practice was closed.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. The practice offered health checks for the over 75s which included memory screening and falls risks.
• Home visits were offered for elderly and frail patients who could not attend the practice, including annual reviews by clinicians at home.

Updated 13 June 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, for example, extended opening hours and Saturday and Sunday appointments available through the GP borough-wide hub.
• A wide range of appointments were available due to open access surgery. The surgery provided 20 appointments on Tuesday evenings with a GP, advanced nurse practitioner and a practice nurse. This was 11 appointments more than the required standard for extended hours.
• 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 and there was a telephone ordering service for prescriptions.

Updated 13 June 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.
• 95% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average of 85% and the national average of 75%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. Patients suffering from acute mental health episodes were able to access the open surgery to be treated or referred to appropriate services quickly. An in-house counsellor or Improved Access to Psychological Therapies (IAPT) service was able and could provide appointments within two weeks.
• Patients struggling to attend phlebotomy services were seen by the nurse or health care assistant at the practice.
• Patients with mental health needs or those having difficulties and frequent admissions were discussed on a monthly basis through multi-disciplinary team meetings.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. Patients at risk of dementia were identified and offered an assessment.
• 100% of patients with mental health needs had a recent up to date care plan and a review within the last twelve months compared to the CCG average of 91% and the national average of 89%.
• 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 13 June 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 homeless people, travellers and 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.
• 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 interviewed knew 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.