Archived: Waterside Health Centre

Updated 15 November 2017

The Waterside Health and Wellbeing Centre is based in Infirmary Street, Blackburn,BB2 3SF and is part of the Blackburn and Darwen Clinical Commissioning Group (CCG). The practice has 1890 patients on their register. The practice has held a caretaker (APMS) contract with NHS England since October 2016. It is run by Cornerstone Healthcare and is a Community Interest Company (CIC) meaning it is nonprofit making. Cornerstone Healthcare operates three other practices in the local area. There is shared management across all five sites.

Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). Life expectancy in the practice geographical area is 73 years for males and 80 years for females both of which are slightly below the England average of 79 years and 83 years respectively. There are 19% of patients with an Asian background; a number of whom do not speak English as a first language. Young people number 95% of the local population and older people 5%.

The service is provided by one male GP and three long term locums, one female and two male. The practice also employs a site manager, one female practice nurse, a male health care assistant (HCA) as well as a team of reception and administrative staff. There are also a team of staff providing support from the Cornerstone Healthcare group including a lead nurse and a quality and integrated care manager.

The practice is based in a purpose built health and wellbeing centre, under contract with NHS Property Services, and hosts a number of services such as an alcohol and drug worker, a listening service run by trained volunteers, a craft group providing art therapy, health and wellbeing workshops and a relationship counsellor. It is fully equipped with facilities for the disabled including disabled parking at the rear of the building, access ramps, double doors, and a disabled toilet; Consulting rooms are on the ground floor and the first floor meeting room is accessible by a lift. Patients benefit from a support worker for the local Asylum Refugee Centre, a Christians Against Poverty worker and a chaplain all employed by the CIC.

The practice is open 8am to 6.30pm on Monday, Wednesday and Friday, 8am to 8pm Tuesday and Thursday and 8am to 12.30pm Saturday. Appointments are available 9.00-12.00 and 2.30 to 5.30pm Monday and Tuesday, 9.15am to 1.30pm and 2.30 to 6pm Wednesday and Thursday with an evening session 6.00 to 7.30pm Thursday, 8.30am to 12.45pm and 2.00 to 5pm Friday and 9.00 to 12.00 Saturday. There is provision for ill children and older people to be seen the same day. When appropriate, patients are redirected to ELMS (East Lancashire Medical Services) , the out of hours service or to the ‘spoke’ clinics offered from two or three different locations in Blackburn where patients can access appointments up to 8pm on weekdays and through the day on Saturdays. The Acute Visiting Service (AVS) is also available.

The practice is accredited for training general practitioners and medical students.

Updated 15 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Waterside Health and Wellbeing Centre on September 19th 2017. Overall the practice is rated as Good.

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

• The practice had been managed via a caretaker agreement by Cornerstone Healthcare CIC since October 2016 and this provider was making significant improvement to patient outcomes.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety; however photographic identity checks were not always in place and employment references for locums were not recorded. The locum staff had been employed prior the current provider taking over the contract for the service.
• 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.
• 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.
• Patients we spoke with said they 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.
• 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.

We saw an area of outstanding practice:

• The practice provided holistic care, treatment and advocacy to vulnerable patients including those with health and spiritual needs for example those living in poverty and experiencing social exclusion. This included funded support from a practice chaplain, a worker supporting asylum seekers and a worker supporting people living in poverty.

The areas where the provider must make improvement are:

• 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:-

• The practice should continue to develop the patient participation group in order to reflect the needs of the community.

• Clinical audits should be further developed and completed to demonstrate quality improvement.

• The protocol to monitor the quality of care delivered and referrals made by GP locums should be fully embedded.

• All staff appraisal documentation should be completed.

• Consider a hearing loop in the reception area.

• The practice should continue to identify and support patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 November 2017

• The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Unvalidated data provided by the practice shows the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64mmol/mol or less in the period October 2016 to March 2017 was 50%.However it represents half year results and many patients had chaotic lifestyles which presented an additional challenge. 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.

• An effective call and recall system had been established since October 2016 which had led to improvements in patient outcomes including a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 15 November 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 the 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 required improvement.

• Children who were safeguarded were coded on the practice register, however alerts were inconsistent and any failure to attend appointments was not being followed up.

• Immunisation rates were relatively high for all standard childhood immunisations and the practice nurse telephoned all families who did not attend.

• According to unvalidated data in 2016/17 80% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years.

• 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 had a policy of seeing children in extra appointments at the end of surgery if there was clinical need or parental anxiety.

• 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 run by the lead GP and regular locums.

• A relationship worker employed by a voluntary sector agency ran sessions from the practice.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 15 November 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 same-day appointments at the end of surgeries

• Practice staff contributed to an Integrated Locality Team (ILT) including health, social care and third sector services which identified patients who required a holistic approach. This included the practice following up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs. The ILT met quarterly to discuss the needs of these patients.

• Advanced care planning had been introduced as an option for patients who wished to discuss and record their end of life preferences. An Electronic Palliative Care Coordination plan was under review by the local federation of GPs which could be shared with community colleagues.

• All repeat prescriptions were reviewed annually and as a result of support of the CCG the practice has targeted patients aged 65 and over.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

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Updated 15 November 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, extended opening hours in the evenings and Saturday appointments.

• 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.

• Results for cervical cytology had been improved by working with the local Primary Care federation to offer out of hours appointments.

Updated 15 November 2017

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

• Unvalidated data for 2016/17 indicated that 75%of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. 92% of patients with mental health conditions had their alcohol consumption recorded in the preceding 12 months.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• 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.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The GP undertook joint sessions with a drug and alcohol worker and group meetings were held at the surgery.

• 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 15 November 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 and provided information about accessing better healthcare.

• 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 such as the Age UK ‘Here to help@ project’ which enabled befriending, telecare and reduction of falls.

• The practice chaplain worked with vulnerable patients and their families to overcome health and social inequalities acting as an advocate where appropriate.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable.