Background to this inspection
Updated
28 January 2019
Elizabeth Street Surgery is based in a residential area close to Blackpool town centre at 61 Elizabeth Street, Blackpool, Lancashire, FY1 3JG. The practice website can be found at www.elizabethstreetsurgery.nhs.uk. There is limited onsite parking available and the practice is close to public transport. The surgery is housed in a purpose-built, two-storey building comprising of consulting and treatment rooms, administrative office space and two patient waiting areas. On the first floor there are midwifery, baby immunisation and minor surgery facilities. The practice provides services to approximately 5600 patients.
The practice provides level access to the building and is adapted to assist people with mobility problems. Patients can access the consulting rooms on the first floor by using the stairs and there is a lift for those patients who need it.
The practice is part of the NHS Blackpool Clinical Commissioning Group (CCG) and services are provided under a General Medical Services Contract (GMS). There is one male GP provider who is assisted by a part-time locum female GP. The practice also employs two advanced nurse practitioners, two practice nurses, two health care assistants, one of which also works as an administrator and a clinical pharmacist. Non-clinical staff consisting of a practice manager, a business manager and five administrative and reception staff support the practice.
When the practice is closed, patients are able to access out of hours services offered locally by the provider Fylde Coast Medical Services by telephoning 111.
The practice patient population profile is similar to local and national profiles, with a slightly larger proportion of male patients aged between 25 and 35 years of age (8%) compared to local and national averages of 7%.
Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.
The practice caters for a higher proportion of patients experiencing a long-standing health condition (69% compared to the local average of 61% and national average of 54%). The proportion of patients who are in paid work or full-time education is lower (54%) than the CCG average of 55% and the national average of 62% and unemployment figures are lower, 3% compared to the CCG average of 6% and the national average of 5%.
The practice provides family planning, maternity and midwifery services, surgical procedures, treatment of disease, disorder or injury and diagnostic and screening procedures as its regulated activities.
Updated
28 January 2019
This practice is rated as inadequate overall. (Previous rating June 2016 – Good)
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Requires improvement
Are services caring? – Good
Are services responsive? – Requires improvement
Are services well-led? - Inadequate
We carried out an announced comprehensive inspection at Elizabeth Street Surgery on 24 July 2018 in response to concerns.
At this inspection we found:
- The practice systems to manage risk so that safety incidents were less likely to happen had not been followed. We saw little evidence to show when incidents had occurred, the practice learned from them and improved its processes. Some incidents had not been acknowledged or documented by the provider.
- Practice systems and policies to safeguard vulnerable patients were not comprehensive.
- Information coming into the practice was not managed safely.
- There was evidence some patient consultation records were not sufficient to ensure patient safe care and treatment.
- The management of staff training was not comprehensive.
- Communication with staff, patients and other services was lacking; care plans were not routinely shared for vulnerable patients.
- There was little evidence of quality improvement work by the practice to drive improvements in service.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients did not always find the appointment system easy to use.
- Some staff reported they did not feel supported or valued.
We saw one area of outstanding practice:
- The practice had developed a software application for patients that enabled them to communicate using their phone to access online patient services and communicate the results of self-monitoring tests, for example, blood pressure readings. This had been shared with other practices and was in the process of being developed further to provide wider community use. We saw approximately 25% of practice patients were using this application to communicate with the practice.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are:
- Continue with the implementation of electronic patient care planning.
- Maintain an overview of staff training, membership of professional bodies and staff vaccination status including records of staff completion of required safeguarding training.
- Continue engagement with the practice patient participation group.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice