Loomer Road Surgery

Updated 14 August 2017

Loomer Road Surgery is a suburban practice which provides care and treatment to 7,790 patients of all ages, based on a General Medical Services (GMS) contract. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. The practice delivers services from three locations to patients living in the Chesterton, Milehouse, Knutton, Silverdale and Bradwell areas.

The practice is part of the NHS North Staffordshire clinical commissioning group (CCG). We visited the following locations as part of our inspection:

• The Loomer Road Surgery, Loomer Road, Newcastle-Under-Lyme, Staffordshire, ST5 7JS.

• The Head Office, Unit 7, Brindley Court, Dalewood Road, Lymedale Business Park, Newcastle-under-Lyme, ST5 9QA.

• Basford House, 511 Etruria Road, Stoke-on-Trent, ST4 6HT.

At this inspection we did not visit the branch Lymebrook Surgery, located in the Milehouse Primary Care Centre in Newcastle-under-Lyme.

A new partnership and management structure supported the delivery of their new integrated, multi-site model of primary and social care. Recent changes directly affecting the practice included the introduction of new management positions to oversee the front line delivery of primary care services. A new telephone hub had also been introduced at the Loomer Road Surgery site. The practice is an approved training practice and is affiliated with local universities.

The area in which the practice is situated is in the third most deprived decile. Figures show that 62% of practice patients were in paid work or full-time education, compared with the national average of 63%. The percentage of patients with a long-standing health condition is 69% which is higher than the national average 53%.

The practice and its branch surgeries occupy purpose built premises where all treatment and consultation rooms are located on the ground floor. The practice has:

• Five GP partners (four male and one female)

• Four salaried GPs

• A business partner

• A professional lead nurse for nurse practitioners, two advanced nurse practitioners, two nurse practitioners, four practice nurses and a health care assistant (female)

• A pharmacist

• A team of managers supporting different areas of the service.

• A large team of administrative and reception staff.

The practice and its branch Lymebrook Surgery are open 8am to 8.30pm on Monday, 8am to 6:30pm Tuesday, Wednesday and Friday and 8am to 1pm on Thursday. GP appointment times are Monday, 9am to 11am, 11.30am to 2pm and 3pm to 8.30pm. Tuesday, Wednesday and Friday 9am to 11am, 11.30am to 2pm and 3pm to 6pm and Thursday 9am to 11am and 11.30am to 1.30pm. The enhanced service provided for violent and aggressive patients at Basford House offers appointments on a Tuesday afternoon and as required. When the practice is closed patients can access out-of-hours care via Staffordshire Doctors Urgent Care and the NHS 111 service.

Updated 14 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Loomer Road Surgery on 10 January 2017. The overall rating for the practice was requires improvement with inadequate for providing safe services and requires improvement for providing well led services. The full comprehensive report on the 10 January 2017 inspection can be found by selecting the ‘all reports’ link for Loomer Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 19 July 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, the provider was not always aware of incidents they needed to report to the Care Quality Commission.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice had developed the role of the Elderly Care Facilitators to bridge the health and social support for older and frail patients.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. The provider had reviewed the arrangements for medicines carried in GP bags for home visits. A risk assessment had been completed and a decision made not to carry any emergency medicines on GP home visits. However, the risk assessment did not consider all eventualities of how risk was mitigated for each individual emergency condition.
• 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 published in July 2017 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Some patients commented on the difficulty of accessing appointments especially at the branch practice. Results from the national GP patient survey supported these findings.
• 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 good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff spoke very highly of the support from the management.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice’s vulnerable adults safeguarding policy and the cold chain policy did not always reflect up to date guidance.
• An active and effective patient participation group had not been established at the practice to support patient feedback.
• The provider had introduced a varied skills and workforce mix within the practice to help to meet the health and social needs of patients.

There were areas of practice where the provider needs to make improvements.

The provider should:

• Review the Care Quality Commission (Registration) Regulations 2009 to support their understanding of incidents that are notifiable to the Care Quality Commission.

• Update the vulnerable adults safeguarding policy to reflect updated categories or definitions of the types of abuse for example, modern slavery. Update their cold chain policy to provide clear guidance on the transport of flu immunisations when providing offsite immunisations.

• Continue to ensure that appropriate decisions are made when exception reporting patients from the Quality and Outcomes Framework calculations.

• Continue to monitor and review patient access to appointments.

• Explore and implement ways to establish an active and effective patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 14 August 2017

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

• Patients with long term conditions such as diabetes and asthma were offered an annual health review in their birth month. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Nursing staff had lead roles in long-term disease management.

• The percentage of patients with diabetes, on the register, who had their blood pressure reading measured in the preceding 12 months and it was within recognised limits was 70%. This was lower than the Clinical Commissioning Group (CCG) average of 77% and the national average of 76%.

• 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.

Updated 14 August 2017

The practice is rated as good for the care of families, children and young people.

• The practice held regular meetings with the health visitor to discuss and share information relating to children of concern.

• Same day appointments were available for children.

• The practice provided a family planning service and post-natal checks for new mothers.

• There were systems in place to identify and follow up children 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 relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 14 August 2017

The practice is rated as good for the care of older people.

• The practice provided a step down service to facilitate earlier hospital discharge for older patients and patients with complex needs.

• The practice covered 140 nursing home beds and the GPs saw 30 of these patients on average each Tuesday.

• The practice had developed the role of Elderly Care Facilitators (ECFs) who carried out holistic domiciliary assessments for patients over 85 years of age. Assessment outcomes were shared with patients, carers or next of kin, and health and social care teams who needed to be involved.

• Patients who were housebound were identified in the practice’s computer system. Domiciliary flu immunisations and annual reviews were offered to this group of patients.
• The practice attended two weekly multidisciplinary team meetings and provided twice weekly care rounds at several nursing homes where they provided care for patients.
• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice followed up older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 14 August 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The practice offered extended hours on a Monday evening until 8.30pm and telephone consultations for working age patients who could not attend during normal opening hours.
• On line services were available to book appointments and request repeat prescriptions.

• The practice sent text message reminders of appointments and test results to patients whose mobile number had been verified.

• The practice offered well women/men checks.

Updated 14 August 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.

• 87% of patients diagnosed with dementia had a care plan in place that had been reviewed in a face-to-face review in the preceding 12 months. This was comparable with the CCG average of 87% and national average of 84%.

• 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 and an Elderly Care Facilitator, who was a dementia friend champion, helped to meet the needs of this group of patients.

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

• 89% of patients with a diagnosed mental health condition had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was comparable with the CCG and national averages of 89%.

• 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 14 August 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• Staff interviewed knew how to recognise signs of abuse in children, young people and vulnerable adults. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out of normal working hours.
• The practice held a register of patients with learning disabilities and offered annual reviews and longer appointments if needed.
• The practice took account of the needs and preferences of patients with life-limiting progressive conditions. There were early and ongoing conversations with these patients about their end of life care as part of their wider treatment and care planning.
• There were accessible facilities, which included a hearing loop, and interpretation services available.
• The GPs held regular multi-disciplinary meetings to support patients who were vulnerable. For example, meetings with the Integrated Local Care Teams (ILCT) and palliative care team.
• The practice had put in place a safeguarding team comprising of three lead clinicians to ensure the needs of vulnerable patients were reviewed and responded to.
• The practice provided a service for ‘violent and aggressive’ patients at Basford House in Hartshill, Stoke-on-Trent. This was a specialised service for patients with complex health and social care needs. The practice also provided a substance misuse service there.
• The practice had identified 219 patients as carers (3% of the practice list). The Elderly Care Facilitator provided help and support to carers and directed them to the various avenues of support available. Carers were also offered annual flu immunisations.