Hall Green Surgery

Updated 25 July 2016

Hall Green Surgery is located in a converted detached residential property in the Upholland area of Skelmersdale. The premises have disabled access and adequate parking facilities.

The practice is part of the NHS West Lancashire Clinical Commissioning Group (CCG) and provides primary medical services to 7109 patients through a General Medical Services (GMS) contract with NHS England.

The average life expectancy of the practice population is below local and national averages for males and in line for females, with males on average living to 78 years and females to 83 years (CCG average being 79 and 82 respectively, national averages being 79 and 83 years). The practice’s patient population consists of a higher proportion of older people, with 24.8% being aged 65 years and over (CCG average 20.4%, national average 17.1%), 12.5% being aged over 75 years (CCG average 8.9%, national average 7.8%) and 3% being over the age of 85 (CCG and national averages both 2.3%). The practice also caters for a slightly higher proportion of patients with a long-standing health condition at 59.7%, compared to the CCG average of 55.5% and national average of 54%.

Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice is staffed by three GP partners (one female and two male) and a salaried GP. The practice is a training practice and a GP registrar was present on the day of inspection. Other clinical staff includes one practice nurse, one immunisations nurse and a health care assistant (HCA). Clinical staff are supported by a practice manager, two assistant managers and a team of non-clinical staff including receptionists, secretaries, and administrators.

The practice is open from 8.30am until 6.00pm Monday to Friday with appointments available between these times. Outside normal surgery hours, patients are advised to contact the out of hours service, offered locally by the provider OWLS CIC Ltd. Out of hours support commences at 6.30pm each evening until 8.00am the following morning. For the half hour before and after opening, calls are directed back to the practice and the practice continue to take responsibility for meeting its patients needs at these times.

Updated 25 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hall Green Surgery on 19th May 2016. 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. Identified incidents were investigated thoroughly and improvements to practice made as a result.
• 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.
• There was evidence of quality improvement including clinical audit, although learning and improvement could be further maximised by completion of second cycle audits.
• Patients were strongly positive about their experience at the practice. They said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had previously hosted a carers support and awareness training session attended both by the practice’s own staff as well as staff from five other local practices. The practice had been awarded a carers awareness training certificate and hosted regular carer support events on site.
• 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.
• Patients said they found it very easy to make an appointment with a named 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 and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice was proactive in its response to patients feedback in an effort to improve its patients experience of accessing healthcare. For example, it had successfully campaigned to have a pedestrian crossing installed on the busy road outside the building after a cohort of elderly patients had expressed that they felt unsafe visiting the practice.

• The practice had also facilitated community healthcare providers updating their protocols around cross boundary referrals after a number of patients experienced difficulties accessing appropriate secondary care.

The areas where the provider should make improvement are:

• Ensure practice policies contain sufficient detail and that all are readily available to staff.

• When a decision has been taken not to seek a DBS check for a member of staff, for example when a check has been recently completed by another employer, a risk assessment should be undertaken to provide clear documentation of the reasoning behind this decision.

• Ensure completion of second cycle clinical audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 July 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 acknowledged that diabetes outcomes were lower than average but were addressing this through staff accessing training programmes to increase skills in this area.

• 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.

• The practice also offered regular anticoagulant clinics where patients’ bloods were tested and their anti-coagulant medicine initiated, reviewed and dose changed as required. This meant they did not need to attend a separate specialist anticoagulant clinic.

Updated 25 July 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 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.

• The practice’s uptake for the cervical screening programme was 79%, which was comparable to the 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.

Updated 25 July 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.

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

• The practice delivered services to 96 patients resident in care homes. The staff at one of these homes had previously been acknowledged as lacking training and confidence. The practice were proactive in supporting the home’s staff in accessing appropriate training in order to best support their patient’s needs.

• The practice held Gold Standard Framework multidisciplinary palliative care meetings every three months in order to ensure patients nearing the end of their lives received the most appropriate care.

• Non clinical and nursing staff at the practice had received training in end of life care.

• The practice offered health checks to patients over the age of 75.

Updated 25 July 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 consultations were available for those patients needing health advice who could not attend the practice in person.

Updated 25 July 2016

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

• 86% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record in the preceding 12 months was 91% compared to the national average of 88%.

• 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 directly referred patients to a counsellor to ensure that patients accessed the care they required.

• 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 25 July 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.

• 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.