Archived: Guttridge Medical Centre

Updated 4 May 2017

Guttridge Medical Centre (Dr Yerra Surgery) is situated on the Deepdale Road in Preston at PR1 6LL serving a mainly urban population. The building is a newly-converted church that has been occupied by the practice since August 2016. The practice shares the building with two other single-handed GP practices, a physiotherapy service and a pharmacy. The practice provides level access for patients to the building with disabled facilities available, fully automated entrance doors and a ramp to the reception desk to facilitate wheelchair access. Part of the reception desk is lowered to aid patient access.

The practice has parking for disabled patients and there is parking available on nearby streets for all other patients, and the surgery is close to public transport.

The practice is part of the Greater Preston Clinical Commissioning Group (CCG) and services are provided under a General Medical Services Contract (GMS) with NHS England. There is one male GP principal and one female long-term locum GP who provides one surgery session each week. A practice nurse, a practice manager, a head receptionist and three additional administrative and reception staff, one of whom is also the practice medicines co-ordinator, assist them.

The practice doors open from Monday to Friday from 8.30am to 6pm and telephone access to the practice starts at 8am and finishes at 6.30pm. Appointments are offered from 9.20am to 11.45am and from 3.30pm to 5.25pm on all weekdays except Thursday, and from 9.30am to 11.45am on Thursday. There is a rota for the three GP practices in the Medical Centre to cover any patient emergency appointments, including home visits, on a Thursday afternoon. The practice also offers extended hours appointments on one Saturday each month from 9am to 12noon. When the practice is closed, patients are able to access out of hours services offered locally by the provider GotoDoc by telephoning 111.

The practice provides services to 1,964 patients. There are considerably lower numbers of patients aged over 65 years of age (9%) than the national average (17%) and higher numbers of patients aged under 18 years of age (26%) than the national average (21%). The practice also has more patients aged between 30 and 49 years of age (33%) than the national average of 28%, the majority of these being male.

Information published by Public Health England (PHE) rates the level of deprivation within the practice population group as three on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The ethnicity estimate given by PHE gives an estimate of 2.5% mixed and 37.6% Asian.

The practice senior full-time GP partner left the practice in December 2016 and the part-time GP partner became full-time. At the time of inspection, the practice was in the process of changing its registration with CQC from a partnership to a sole provider.

Updated 4 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Guttridge Medical Centre (Dr Yerra’s Surgery) on 4 April 2017. 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 a system in place for reporting and recording significant events. Actions taken as a result of significant events were reviewed in a timely way.
• The practice had clearly defined and embedded systems to minimise risks to staff and patient safety. One of the neighbouring practices checked the shared emergency equipment to ensure that it was safe to use and fit for purpose although the practice had not had sight of these checks before our inspection.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, records of staff training were incomplete and there was no documented training programme to govern training.
• All staff had had an appraisal within the last 12 months although the appraisal process for one staff member needed review to allow in-house appraisal.
• The practice premises were new and had been designed to present no risks to staff working or to patients. The practice told us that they planned to produce health and safety risk assessments in the Summer of 2017 for ongoing assessment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their 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. The practice had stopped recording verbal complaints and told us that they would resume recording following our inspection.
• Patients we spoke with said they usually found it easy to make an appointment with the GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The surgery building was newly converted and had been designed for purpose.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Maintain an overview of checks carried out on emergency equipment in the building.
• Provide an overall programme to govern staff training activity, including timescales, and keep an accurate record of all staff training.
• Complete the health and safety risk assessments for premises safety and staff working as planned.
• Recommence recording patient verbal complaints in order to monitor trends.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 May 2017

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

• The practice nurse was trained in all aspects of long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable to the local average of 88%. The practice achieved 87% of the indicators for the management of patients with diabetes.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• 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.
• The practice provided a point-of-care blood monitoring service for patients in the local area, including practice patients, who were taking certain medications.
• At the time of inspection, the practice was working on being able to provide a one-stop clinic for diabetic patients with input from the podiatry service, the GP and the practice nurse.

Updated 4 May 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.
• Immunisation rates were high for all standard childhood immunisations. This achievement had been recognised by Public Health England, Screening and Immunisation department.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• 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.
• Staff sent letters to new mothers enclosing a new registration form for the baby and giving them details of the baby’s vaccination and immunisation programme and health checks.
• There was a dedicated room in the practice for breastfeeding mothers.

Updated 4 May 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 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 followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice produced personalised care plans which could be shared with local care services such as the ambulance service and the out of hours service.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. The practice offered health checks to patients aged over 75 who were not already registered for a routine health check. The practice also made patient referrals to the local social care service.
• The practice always tried to find time for a GP appointment, if requested, for elderly patients who were attending the premises for other services, to save an additional journey to the surgery.
• The practice gave a dedicated telephone number to the local A&E department and nursing home for urgent communications.

Updated 4 May 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, for example Saturday morning appointments. At the time of the inspection, the practice was in discussions with neighbouring practices regarding further provision of extended hours appointments.
• The practice nurse provided patient appointments until 6pm on a Tuesday and the GP would offer a late appointment for a patient on the basis of individual need.
• 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.
• Patients were able to receive travel vaccinations available on the NHS as well as those only available privately.
• Telephone appointments with GPs were available in addition to face-to-face appointments.

Updated 4 May 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 82% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which was lower than the national average of 84% but the practice had not excluded any patients from this indicator.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. All these patients were invited to the practice annually for a review of these needs.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 94% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• 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.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. Staff had trained in dementia awareness.

Updated 4 May 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.
• 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 offered longer appointments for patients with a learning disability and those with complex needs.
• 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.