Archived: The Cabin Surgery

Updated 5 October 2016

The Cabin Surgery provides primary medical care to around 4,521 patients within the small rural town of Rishton in East Lancashire under a general medical services (GMS) contract with NHS England. The practice is part of the East Lancashire Clinical Commissioning Group (CCG). The practice is located on Rishton High Street, Blackburn.

The practice building is owned by the principal GP and maintained by the practice. It is adjacent to Rishton community clinic, although this building closed recently and services moved elsewhere. The building is a single storey purpose built practice which has been adapted to accommodate increased services and staff.

The practice clinical team comprises a male GP sole provider and one salaried female GP and one female locum GP, as well as two female nurses and a GP community nurse who provides care for housebound patients aged over 75 for four local practices. A practice manager and team of seven reception and administrative staff support the clinical team. The practice is a GP training practice and was supporting one trainee GP at the time of our visit.

The patient population differs slightly from average practice populations, with more patients aged 50 and over and fewer patients aged 25 to 44 years old than average.

Male and female life expectancy is just below national averages (male: practice 77 years, England 79; female: practice 82 years, England 83).

Information published by Public Health England rates the level of deprivation within the practice population 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.

When the practice is closed out of hours services are provided by the ELMS out of hours service which patients contact by ringing NHS 111.

Updated 5 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Cabin Surgery on 7 September 2016. Overall the practice is rated as good.

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

• The leadership and approachability of the principal GP underpinned safe and caring clinical care for patients.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The majority of risks to patients were assessed and 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.
• There was good continuity of care, with urgent appointments available the same day, though the wait to see a named GP could be longer.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

The principal GP conducted regular checks of patient consultations for all other clinicians. The GP regularly discussed areas for improvement with locums and employed clinical staff.

The practice was forward thinking in adapting to new guidance and best practice and created templates to support clinicians during consultations. Where appropriate, these were shared with other practices locally which improved patient care more widely.

The areas where the provider should make improvement are:

• Complete the action plan to introduce a legionella control regime as recommended by the water safety assessment.

• Conduct a risk assessment for substances stored in the boiler cupboard to demonstrate that potential risk to staff and patients is reduced.

• Consider the introduction of a formal complaints log to document complaints handling in line with the practice policy.

• Implement a system to check that cleaning has been carried out in line with the cleaning schedule.

• Review personnel management processes for recruitment and training to demonstrate records are consistently up to date for all employees, including GPs. The recruitment policy should be consistently applied to all new staff, including appropriate checks for all employees and clinicians prior to their commencement of employment. Complete the work to bring all annual staff appraisals into date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 October 2016

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.

• The practice nurses were able to commence newly diagnosed diabetic patients on injectable insulin therapy if appropriate, which reduced the need for these patients to attend secondary care for enhanced diabetes support and management.

• 100% of patients with atrial fibrillation (AF, a heart condition) whose risk of stroke was clinically assessed as high were treated with appropriate medication which was above the CCG and national averages of 98%.

• All five indicators for diabetes were above or in line with local and national averages. For example, 87% of patients with diabetes had a recent blood sugar test which was within a normal range, which was above the CCG average of 79% and national average of 78%.

• Practice data for 2015/16 showed that 77% of patients with asthma and 96% of patients with chronic obstructive pulmonary disease (COPD, a lung condition)had attended a review in the previous 12 months.

• 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. 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 5 October 2016

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.

• 85% of eligible women had attended cervical screening which was above the CCG and national average of 82%.

• 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, health visitors and school nurses.

• Family planning and contraception advice and prescribing was available and the practice referred patients who required long lasting reversible contraception to local clinics.

Updated 5 October 2016

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. This included a GP community nurse who provided care for all housebound patients who were over 75.

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

• The GP community matron had worked with colleagues and a range of health providers during November and December 2015 to collect gifts which were donated to older people in the local area. Over 2,000 patients, some of whom were housebound and in residential settings received gifts as part of this scheme.

Updated 5 October 2016

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.

• Telephone appointments were available for patients who were unable to attend the practice during normal working hours.

• The practice provided minor surgery for excisions and injections for joint pain.

Updated 5 October 2016

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

• In 2014/15 71% of patients with dementia had their care reviewed during a face-to-face meeting in the last 12 months, which was below the CCG average of 82% and the national average of 84%. Practice data for 2015/16 showed this had increased to 84% although this had not been nationally validated at the time of our visit.

• 93% of patients with severe mental health conditions had their care reviewed in the previous 12 months, which was above the CCG and national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.

• 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 patients with mental health needs and dementia.

Updated 5 October 2016

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 and conducted an audit to ensure that relevant information on patients with learning disabilities who were referred to secondary care was shared to ensure that appropriate adaptations to services and appointments could be made to meet the needs of each individual patient.

• 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.