Archived: The Royle

Updated 11 August 2017

The Royle provides primary health care services to around 3870 patients in the small town of Great Harwood in East Lancashire under a general medical services contract with NHS England. The practice is part of the East Lancashire Clinical Commissioning Group (CCG).

The practice is based within Great Harwood Health Centre, Water Street, Blackburn, Lancashire, BB6 7QR. The building is owned and maintained by NHS Property Services Ltd.

The practice clinical team comprises two female GP partners, a practice nurse, a GP community nurse for patients aged 75 years and over and a sessional nurse for childhood immunisations. The clinical team are supported by a practice manager and team of seven administrative and reception staff.

The practice population varies from the national average with fewer patients aged between 10 years and 44 years than average, and considerably proportionally more female patients aged between 50 and 54 years old. The practice life expectancy is one year above CCG averages and one year below national averages for males and females, at 78 years for males and 82 years for females. NHS England data shows the practice deprivation level as four on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). East Lancashire has a higher prevalence of Chronic Obstructive Pulmonary Disease (COPD, a disease of the lungs), smoking and smoking-related ill-health, cancer, mental health and dementia than national averages.

The practice is open 8am until 6:30pm Monday to Friday. Out of hours treatment is provided by East Lancashire Medical Services Ltd.

Updated 11 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Royle on 14 July 2016. The overall rating for the practice was requires improvement. Risks to patients and staff were not fully assessed. There was limited evidence that audit was driving improvement in performance to improve patient outcomes. Records kept for staff training and induction were poor.

The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for The Royle on our website at www.cqc.org.uk.

This announced comprehensive follow up inspection was undertaken on 6 July 2017. Overall the practice is now 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 assessed and generally well managed.

• 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.
• 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 a named GP and there was continuity of care, with both routine and 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 areas where the provider should consider making improvements are:-

• Maintain an overview of significant events and complaints to enhance monitoring and identification of themes.

• Consider arranging more frequent staff and clinical meetings to share information and learning.

• Update the training of staff responsible for infection control audits to ensure the maintenance of the cold chain.

• The patient participation group (PPG) should be further developed to represent the voice of patients.

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Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 August 2017

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. This included patients with diabetes, asthma and chronic obstructive pulmonary disease (COPD).

• Performance for diabetes related indicators was lower than the national average. For example in 2015/16 the percentage of patients on the diabetes register in whom the last blood pressure reading was 150/90 mmHg or less in the period April 2015 to March 2016 was 78%. (CCG average 88%, national average 88%).However unvalidated figures provided by the practice indicated that in 2016/17 the practice achieved 85%.

• Practice nurses specialised in diabetes and respiratory conditions and offered personalised management plans and dedicated follow up.

• 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.

• A counselling service funded by the CCG was run in the health centre for people living with long-term illness.

Updated 11 August 2017

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 lower than average for all standard childhood immunisations with the practice achieving 64% uptake for one year olds and 8.6 out of 10 for two year olds against an average of 9.1 out of 10 nationally in 2015/16.

• 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.

• 72% of women aged between 25 and 64years had received a cervical screening test. This was lower than the CCG average of 82% and a national average of 81%. The practice were targeting females aged 24yrs 6 months with a view to achieving good attendance at aged 25yrs.

• 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 and health visitors such as antenatal sessions provided by the midwife for delivering prenatal care and advice and regular meetings between GPs and health visitors.

• A Well Baby Clinic was held in the Health Centre by the health visitor and community nursery nurse every Wednesday morning, and was an open walk-in clinic.

Updated 11 August 2017

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. This included a GP community matron hosted at the practice who supported the needs of patients over 75 in their own homes including those in sheltered housing.

• The practice population included 2.2% of patients over the age of 85 years. They invited these patients for annual health checks and all had a named GP.

• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.

• Multidisciplinary meetings were held every six to eight weeks and included discussions about patients who were at high risk of safeguarding, had complex needs or were at the end of life. These were attended by the GPs, district nurses and palliative care team.

• GPs provided weekly rounds at local nursing homes which included end of life care planning involving the patient, their family and the care team. Two local nursing homes had chosen to register all of their patients at this practice and community care home nurses worked jointly with them to provide consistent and timely care.

• A Christmas Presents for the Elderly scheme had been running since 2015 which was led by the GP community matron.

Updated 11 August 2017

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 such as appointment booking and ordering of prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• Appointments were provided between 8am and 6.30pm Monday to Friday so that patients who were working could attend outside working hours. Telephone consultations were available daily and patients could pre-book appointments on three days each week.
• Since January 2017 patients were able to access a Community Phlebotomy Service for blood tests which operated every evening. Appointments were booked via the practice.

Updated 11 August 2017

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

• All reception and administrative staff had recently attended “Dementia Friend” training.

  93% 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, which was higher than the national average of 89%.

• 89% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months, which was the same as the national average.

• The practice staff regularly referred to the Community Mental Health Team and patients were signposted to various support groups and voluntary organisations.

• The practice served several nursing homes including providing care for patients living with dementia. Care home nurses employed by the CCG and GPs from the practice visited the care homes and provided designated ward rounds each week to see patients in their own home and support staff in their care.

• There were daily emergency appointments available for people in distress.

• Reception staff rang patients with evident memory problems ahead of appointments to remind them to attend.

Updated 11 August 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.

• The practice offered longer appointments for patients with a learning disability or complex needs.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.