Background to this inspection
Updated
30 October 2018
The practice delivers primary medical services to a patient population of approximately 9808 patients under a General Medical Services (GMS) contract with NHS England. The practice main surgery is situated in the Fulwood area of Preston at 2 Broadway, PR2 9TH with a branch surgery in the Ingol Health Centre, at 87 Village Green Lane, PR2 7DS. We did not visit the branch surgery at this inspection.
Broadway Surgery occupies a converted residential property and is part of the NHS Greater Preston Clinical Commissioning Group (CCG). There is a small car park for patients and the practice is close to public transport services. The building is accessible by a ramp at the entrance and there is a lift to facilitate access to the first floor for patients experiencing mobility difficulties. Ingol Health Centre is a single-story, purpose-built health centre and the practice shares the building with some community services. There is car parking available and easy access to public transport.
The practice is staffed by six GP partners (three female and three male) and one male GP who works as a retained GP (the GP retention scheme allows doctors who might otherwise leave the profession to remain in clinical general practice). Other clinical staff consist of two urgent care practitioners, three practice nurses, an assistant practitioner and a trainee assistant practitioner. Clinical staff are supported by a practice business manager, deputy practice manager, a reception manager for the Broadway surgery and a site manager for Ingol and a team of reception and administration staff.
The practice also participates in the training of new GPs and is a teaching practice for medical students.
The life expectancy of the practice population is generally in line with the local and national averages (82 years for females, compared to the local average of 82 and national average of 83 years, 79 years for males, compared to the local average of 78 and national average of 79 years).
The practice’s patient population has a slightly higher proportion of older people than the local averages, for example 20% are over the age of 65 (CCG average being 16% and national average 17%), 11% are over the age of 75 (CCG average 7%, national average 8%) and 3% are older than 85 (CCG and national average 2%). The proportion of the practice’s patients with a long-standing health condition is 62%, which is higher than the local average of 52% and national average of 54%.
Information published by Public Health England rates the level of deprivation within the practice population group as six on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.
Outside normal surgery hours, patients are advised to contact the out of hours service by dialling 111, offered locally by the provider GoToDoc.
The practice is registered with CQC to provide family planning services, maternity and midwifery services, treatment of disease, disorder or injury, surgical procedures and diagnostic and screening procedures as their regulated activities.
Updated
30 October 2018
This practice is rated as Good overall. (Previous rating May 2017 – Good)
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
We carried out a comprehensive inspection on 21 September 2016 when we found that patients were at risk of harm because systems and processes were not in place to keep them safe and there was no systematic approach to assessing and managing risks. The governance arrangements within the practice were insufficient and policies were not easily accessible to staff and not all were detailed enough to adequately describe the activity to which they related. There was a lack of understanding around what training was required for staff, including safeguarding training, and several staff had not had an appraisal. The practice was placed into special measures. At our re-inspection on the 10 May 2017 we found the practice had made significant improvements; they were meeting all the required regulations and we took the practice out of special measures.
We carried out a further announced comprehensive inspection at North Preston Medical Practice on 9 October 2018. This inspection was in line with our new methodology to ensure the improvements found at our inspection in May 2017 had been sustained.
At this inspection we found:
- The practice had maintained the systems we saw at our last inspection and had further strengthened those arrangements.
- The practice 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. Learning from incidents was shared with all staff.
- There was a comprehensive meeting structure and support system for clinical staff.
- Staff were given opportunities to develop and staff training was central to the practice development and sustainability.
- 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.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- There was a clear management structure in place and staff had lead roles in many areas of practice service delivery. The practice team worked well together and practice governance processes were comprehensive.
- 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 one area of outstanding practice:
- The practice made good use of computer systems to strengthen the governance of the practice and to improve patient care. They had worked to populate an online computer system to store, share and maintain practice processes and procedures relating to many areas of the governance of the practice. They had also worked to strengthen the templates used at patient health appointments in order to follow best practice, better document consultations and share information with other services.
The areas where the provider should make improvements are:
- Improve the management of patient urgent, two-week-wait referrals.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.