Park View Surgery

Updated 23 January 2018

Park View Surgery is situated at 23 Ribbleslade Place close to the city centre of Preston in a residential area at PR1 3NA and is part of the NHS Greater Preston clinical commissioning group (CCG). Services are provided under a personal medical service (PMS) contract with NHS England. The surgery is housed in converted and extended residential accommodation and offers access and facilities for disabled patients and visitors. There is a stair lift to first floor treatment and consulting rooms. The practice website can be found at: www.parkviewpreston.co.uk

There are approximately 6080 registered patients. The practice population includes a higher number (36.9%) of people aged between 20 and 40 years of age in comparison with the national average of 27.5% and the local average of 28.3%. There are a lower number of people under the age of 20 and over 65 years of age compared to the local and national averages. Public Health England (PHE) indicates that 33.8% of the practice population are of non-white ethnicity.

There are high levels of deprivation in the practice area. Information published by PHE, rates the level of deprivation within the practice population group as two on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The average life expectancy for both men and women is lower than national averages; 75.5 years of age for men (79.4% nationally) and 80.2 years of age for women (83.1% nationally).

The practice opens from 8am to 6pm Monday to Fridays and extended surgery hours are available on Monday from 6pm to 8pm and 9am to 12 noon on Sunday at a neighbouring practice. When the practice is closed, patients are able to access out of hours services offered locally by the provider GotoDoc by telephoning NHS 111.

The practice has three GP partners (two male and one female) one salaried GP (female), a clinical pharmacist, a locum practice nurse, an assistant practitioner, a phlebotomist, a practice manager and deputy practice manager and seven reception and administration staff.

The practice is a training practice for doctors who wish to gain experience as GPs and also provides teaching for medical students.

Updated 23 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 8 April 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Park View Surgery on 5 December 2017 as part of our inspection programme to inspect 10% of practices before April 2018 that were rated Good in our previous inspection programme.

At this inspection we found:

• The practice generally had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, actions to manage the low risk of legionella in the practice water system needed to be implemented. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings.) Also, risk assessments for staff working conditions and for emergency medicines held by the practice needed completion.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. There was a practice quality lead who managed many aspects of practice quality improvement.
• Staff acted on information in patient safety alerts although these actions were not always clearly documented.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw three areas of outstanding practice:

• The practice clinical pharmacist worked with the lead pharmacist for medicines management training at the hospital to improve the way that discharge summaries were written. This work had resulted in further training for both junior and senior pharmacists at the hospital and a revised protocol for producing patient discharge summaries for all patients discharged from the hospital. We saw evidence that the lead hospital pharmacist had affirmed that this work had reduced errors made in patient hospital discharge summaries and the practice confirmed that there were fewer observed inaccuracies since this intervention.
• The practice quality lead took the lead in working with the local safeguarding team and a home for children with complex needs. As a result of this, several changes to procedure were made, the home employed a nurse to act as a focus for the children’s health needs and communications with the children’s service were improved. The practice clinical pharmacist also visited the home to advise on the storage of medicines. Also, as a result of this work, staff from the local safeguarding team reviewed how all children known to the local child and adolescent mental health team were transferred from other areas and subsequently managed. This improved patient safety for all local practices with regard to the transfer of patients from outside the area.
• Practice staff worked closely with staff from a local women’s probation service facility. They arranged for staff from the service to attend a practice meeting in order to set up procedures for prescribing medicines for patients in the service. This improved procedure associated with prescribing for these patients and ensured better patient safety.

The areas where the provider should make improvements are:

• Continue to implement the policy to reduce the risk of legionella in the practice water system.
• Consider introducing a confidential health questionnaire to risk assess working conditions for new staff.
• Consider documenting a formal risk assessment for emergency medicines held in the practice.
• Look at improving the documentation of actions taken as a result of patient safety alerts.
• Continue to improve the identification of patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 May 2015

The practice is rated as good for the care of people with long-term conditions. There was a high prevalence (48.9%) of patients with long standing conditions, such as cardiovascular disease and Chronic Obstructive Pulmonary Disease (COPD) amongst the patient population. Nursing staff had received appropriate training which enabled them to focus upon specific chronic conditions and appropriately assist in the management of them through a comprehensive schedule of clinics. These patients were recalled annually which ensured they had structured annual reviews to check their health and medication needs were being met.

GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care for those patients with the most complex needs. The practice offered enhanced services to meet the needs of patients with long-term conditions such as avoidance of unplanned admissions to hospital through care planning.

Updated 21 May 2015

The practice is rated as good for the care of families, children and young people. Systems were in place for identifying and following up children who were at risk. For example, children and young people who had a high number of A&E attendances. Immunisation clinics for babies and young children were available on a weekly basis. A range of enhanced services were available such as whooping cough in pregnant women, hepatitis B for new born babies, Measles Mumps and Rubella (MMR) vaccination for young people. Contraception services were available within the practice. Appointments both routine and urgent were available outside school hours and the premises were suitable for children and babies. Children and young people were treated in an age appropriate way and recognised as individuals. The population group of under 18 year olds accounted for 34.2% of the practice patient population which is slightly higher than both the Clinical Commissioning Group (CCG) and national average for this age group.

Updated 21 May 2015

The practice is rated as good for the care of older people. Nationally reported data showed that 20.8% of the patient population were aged 65 or over which was in line with the national average. The practice had good outcomes for conditions commonly found amongst older people. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, avoidance of unplanned admissions to hospital, timely diagnosis and support for people with dementia, and a shingles vaccination programme for those aged 70 and above. The practice was responsive to the needs of older people including offering home visits.

Updated 21 May 2015

The practice is rated as good for the population group of the working-age people (including those recently retired and students). The needs of this group had been identified and the practice had adjusted the services it offered to ensure these were accessible. Patients were able to book appointments and request repeat prescriptions using online facilities and there were extended opening hours for appointments including Saturday morning clinics. A full range of health promotion and screening services were available which reflects the needs for this age group was available within the practice. This age group was the largest group within the practice at 45% which was one of the highest in the Clinical Commissioning Group. (CCG)

Updated 21 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients within this group received a timely recall for their annual physical health check. The practice took all reasonable measures to ensure high quality of mental health care was available to patients within the limitations of the local service available.

The practice provided an enhanced service with a view to facilitating timely diagnosis and support for people with dementia which they were actively working to improve upon. This ensured timely assessment by the GP using a recognised cognitive process which could be carried out for patients identified as at risk of dementia. Staff told us they actively sought out patients with ‘hidden dementia’. This was done by discussion with patients at routine appointments. They had a process in place if a member of staff felt a patient had declined or needed further investigation they could raise this with one of the GPs who would arrange an appointment

Staff told us the practice had sign-posted patients experiencing poor mental health to various support groups, and they were proactive in helping patients address issues to improve all aspects of their health. The practice had successfully begun a pilot for the Clinical Commissioning Group. (CCG) area by having a Community Psychiatric nurse employed within the practice. This assisted patients in crisis and it was hoped that this support would reduce the need for this group of patients to attend A&E for support.

Updated 21 May 2015

The practice is rated good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances for example those with learning disabilities. Patients with learning disabilities were offered annual health checks and longer appointments were available if required. The practice effectively supported carers who were sometimes vulnerable themselves alongside the person they were caring for.

The practice supported patients living in residential facilities for people with alcohol and drug dependency problems. There was also a woman’s refuge and homeless shelter who registered temporary patients with the practice. The practice actively sought to include these vulnerable patients in the ongoing management of their care by a variety of means including offering appointments at short notice. The practice facilitated Help Direct to hold weekly clinics on their premises to assist patients with their housing, financial and social health needs.

One GP worked with the drug worker for substance misuse patients, seeing them at the surgery. This was beneficial to the patients as they were not attending the local clinics where they may be exposed to the substances they were trying to avoid.

The practice worked with multidisciplinary teams in the case management of vulnerable patients. Staff knew how to recognise the 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 and out of hours. We were shown evidence to demonstrate where the vigilance of administration staff had instigated activity to ensure the protection of vulnerable patients within the practice on a number of occasions.