• Doctor
  • GP practice

Bay Medical Group

Overall: Good read more about inspection ratings

Morecambe Health Centre, Hanover Street, Morecambe, Lancashire, LA4 5LY (01524) 511999

Provided and run by:
Bay Medical Group

Latest inspection summary

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Background to this inspection

Updated 10 December 2015

Coastal Medical Group has three practice locations and is based in and around Morecambe and Heysham. The three practices are all within purpose built buildings and all except West End Practice are maintained by NHS building support services, West End is owned by another company but maintained by Coastal Medical Group. The practices are part of the NHS North Lancashire Clinical Commissioning Group (CCG.) Services are provided under a personal medical service (PMS) contract with NHS England. The practices offer onsite parking. Patients can access GP support at any of the three practices and can also access their own or another designated GP as part of the eight till eight access pilot. The practice has 31000 registered patients. During the inspection we visited the Heysham Health Centre site but we spoke to staff from all three sites either face to face or by telephone.

Information published by Public Health England rates the level of deprivation within the practice population groups as three on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Deprivation affecting children with in the practice is rated at 22% compared with the CCG average of 16.1%. Deprivation affecting older people is rated at 28% compared with the CCG average of 19.1%. These results are above the national averages of 21.8% for children and at 18.1% nationally for older people.

The practice population includes a comparable proportion (21%) of people under 18 years of age, and a higher proportion (33.2%) of people over the age of 65 years, in comparison with the national average of 26.9% and 26.9% respectively. The practice also has a higher percentage of patients who have caring responsibilities (21.6%) than both the national average (18.4%) and the CCG average (17.2%). The practice has a higher proportion of patients with health-related problems in daily life (58.3%) compared with CCG and National averages of 50.7% and 48.7%. The practice has a high proportion of low income and families on benefits and a large number of households have one or more family members with a serious illness or disability. A large percentage of the practice population have problems with drug and alcohol abuse. The practice has a poor uptake of screening services such as cervical, bowel and breast screening amongst their patient population and have tried a number of ways to increase this including ad-hoc attempts to encourage patients when they attend for other reasons alongside campaigns aimed directly at these group of patients.

The practice is a partnership GP practice with 19 partners (male and female) and five salaried GP’s. The practice is supported by a clinical nurse manager, three nurse practitioners, eight practice nurses, three treatment room nurses, one assistant practitioner, five healthcare assistants and three phlebotomists who work across all three sites. The senior management team included managers for medicine management, human resources, customer relations and an administration team lead by the practice manager and her deputy. The practice is a training practice for GP’s during their training with an identified training lead GP.

The practice opens from 7.30am to 6.30pm Monday to Wednesday and from 8am to 6.30 pm Thursday and Friday and does not close for lunch. The practice also offer appointments from 6.30pm to 8pm Monday to Friday and Saturday and Sunday 8am to 8pm under the improving access ‘opening doors’ pilot scheme.  The practice offers seasonal flu vaccination through specific clinics, opportunistically and by appointment as patients attend the surgery. Patients requiring a GP outside of normal working hours are advised to contact 111 who will refer them into the out of hours provider Virgin Healthcare. When closed the practice answering machine informs patients of this number.

The practice provides level access to the building and is adapted to assist people with mobility problems.

Overall inspection

Good

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Coastal Medical Group on 04/11/2015. 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. 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.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they sometimes found it difficult to make an appointment in advance with a named GP but there was continuity of care, with urgent and some non-urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice was currently taking part in an initiative offering patient’s access to a GP from 8am untll 8pm as part of a Prime Ministers Funding Initiative.
  • 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 some areas of outstanding practice:

  • The use of ‘Florence’ a simple tele-health service to advise and assist patients to manage their own conditions with arm’s length support from professional should a change in their condition be detected.
  • The practice had self-funded the employment of two advance nurse practitioners and one trainee advanced nurse practitioner as part of a continuity of care programme. This had allowed patients to have greater access to support in the practice, and had meant that GP’s had more free slots to see patients who required their specific assistance with their needs.
  • The practice had received national recognition for their work with the Gold Standard Framework (care for patients at the end of their lives) and Palliative Care.
  • The practice had a cohesive and effective medicines management team who worked alongside the GP’s for maximum optimisation of patient’s medication and they had managed to save £240,000 in last year through more effective medicine management.
  • The practice had successfully gained approval to offer third year student nurse placements at the practice and were now supporting other practices to achieve this status.
  • The medicine management team monitored patients who were prescribed an increasing dose of medication and contacted them to ensure they were managing their increases in a timely manner.

One area where the provider should make improvement is:

  • Developing an annual audit plan for the practice, this will allow the practice to plan their activity demonstrating a review of care and processes from a strategic level rather than adhoc audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

People with long term conditions

Outstanding

Updated 10 December 2015

The practice is rated as oustanding 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 practice ran ‘duty clinics’ to provide access to nursing expertise for patients who had exacerbation of diabetes and respiratory disease.
  • The practice used ‘Florence’ a simple tele-health service where patients are supported to manage and monitor their ongoing health conditions. Patients enter their vital signs including blood sugar reading and are advised against a protocol of the next steps for their care.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 10 December 2015

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 was below the Clinical Commissioning Group and national averages for cervical screening at 69.1% against 75.5% and 76.9% respectively. They also recorded a higher than average exception rate at 8.4%. The practice were aware of this and actively encouraged women to attend for screening and offered screening on an adhoc basis as patients attended for other appointments.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw examples of joint working with midwives, health visitors and district nursing teams.

Older people

Good

Updated 10 December 2015

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.
  • 21% of the practice population was over 65 years of age. Patients on the unplanned admissions register had access to a named clerk for contact at the surgery to assist them in a timely manner with their needs.

Working age people (including those recently retired and students)

Good

Updated 10 December 2015

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 was working as part of a Prime Minister Initiative offering eight until eight appointments with GP’s which assisted working age patients to have regular access for their on-going needs.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 December 2015

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

  • 68.2% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • 77.8% of patients with a mental health need had a comprehensive care plan in place.
  • 91.3% of all patients diagnosed with depression underwent a bio-psychosocial assessment on diagnosis and had had a review within 10-35 days after diagnosis. This was above both national and CCG averages.
  • 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 people with mental health needs and dementia. Staff were all being encouraged to undertake dementia friend training.

People whose circumstances may make them vulnerable

Good

Updated 10 December 2015

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 people with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice had told 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.