Archived: The Surgery Chorley

Updated 4 August 2017

The Surgery Chorley, Chorley Health Centre, Collison Avenue, Chorley, Lancashire is part of the NHS Chorley and South Ribble Clinical Commissioning Group (CCG). Services are provided under a general medical service (GMS) contract with NHS England. The practice has approximately 3836 patients on their register.

The practice building is an older building maintained by NHS Property Services. The practice is located on the ground floor. There is one other GP practice located within the building along with a range of other NHS services including podiatry and fall prevention. A hearing loop to assist people with hearing impairment is available. Limited car parking is available at the practice,

The practice is a registered partnership between two male GPs and one female GP. The practice also employs two male salaried GPs, a practice manager, two assistant practice managers, one nurse manager, one advanced nurse practitioner, three practice nurses and two health care assistants. In addition a number of reception, administration and secretarial staff are also employed. The GP partnership has another GP surgery within the same CCG area and the majority of staff work between both registered GP practices.

The practice reception is open from 8am until 6.30pm Monday to Friday; and from 8am until 11am on alternate Saturdays.

When the practice is closed patients are asked to contact NHS 111 for Out of Hours GP care.

The practice provides online access that allows patients to book appointments and order prescriptions.

Information published by Public Health England rates the level of deprivation within the practice population group as five on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The average male life expectancy in the practice geographical area is 79 years and is reflective of both the England and CCG averages. Female life expectancy is 82 years which is below the CCG and England average of 83 years. The practice has a slightly larger number of patients under the age of 18 years and a slightly lower number of patients over the age of 75 years when compared with both the local and national averages. Approximately 7% of the local patient population is unemployed, which is higher that the local average of 3% and national average of 4%.

Updated 4 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery Chorley on 12 July 2017.

The practice had undergone changes in its registration and the current GP partnership took over the leadership and management at the practice in April 2016. However the data referred to in this report for the Quality and Outcomes Framework (QOF) refers to data collected and collated between April 2015 and March 2016. This was a period of significant change at the practice.

Overall the practice is rated as good.

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

• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice had undergone a period of change which had resulted in improved services for patients. The practice had a strong vision, which put working with patients to ensure high quality care and treatment as its top priority.
• The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The practice was committed to evidence based practice to improve the quality of care and treatment. Clinical auditing was based on up to date guidance and research to reflect innovation and the changing clinical needs of patients.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and 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.
• The practice had an online patient participation group (PPG) and plans were in place to develop this further to promote and encourage patient participation in the ongoing development and improvement of the practice.
• The practice was aware of the shortfalls in the building and facilities and had taken action to try to improve these.
• The GP was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

An area where the provider should make improvement is:

• Continue to identify and support patients who are also carers

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice had a team of nurses which included advanced nurse practitioners, practice nurses and health care assistants. Nursing staff had lead roles in the management of long-term disease and worked closely with community and secondary care health professionals to provide comprehensive care to patients.
• Quality and Outcomes Framework (QOF) for 2015/16 for diabetic indicators showed the practice performed below that of the local and national averages. However this data reflects the service provided by the previous registered GP provider.
• 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 4 August 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.
• Data from 2015/16 indicated that immunisation rates were similar to the local average for all standard childhood immunisations.
• Quality and Outcome Framework (QOF) 2015/16 data showed that 76% of patients with asthma on the register had an asthma review in the preceding 12 months compared to the CCG average of 77% and the England average of 75%. Exception reporting was lower at 2% compared with the CCG 12% and the England average of 8%.
• The practice’s uptake for the cervical screening programme was 84%, which was slightly below the CCG average of 85% but was higher than the national average of 82%. Exception reporting at 4% was lower than both the CCG and England average of 7%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practices maintained a register of young people who were also carers. They aimed to develop the support services further for this vulnerable group.
• 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.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 4 August 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 those 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 had effectively introduced regular multidisciplinary team meetings to review all those patients assessed as vulnerable or frail and ensured proactive management of these patients to offer more support to them. 

Updated 4 August 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.
• The practice offered flexible surgery times including, morning, afternoon and evening surgeries. The practice also opened every other Saturday morning from 8am until 11am.
• The practice had promoted the patient online access so that patients could now make GP and practice nurse appointments including long term condition review appointments. Feedback from patients was that they liked this service.
• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

Updated 4 August 2017

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

• Patients at risk of dementia were identified and offered an assessment.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice was aware that data from the period before they took over the service showed that only 46% of patients with schizophrenia, bipolar affective disorder and other psychoses had a care plan in place. They had worked to improve this and offered and encouraged all patients with a mental health condition to attend an appointment to review their healthcare needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 4 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 and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• Learning disability training for three staff was arranged for September 2017.
• 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 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.