The Clayton Medical Centre

Updated 13 July 2016

The Clayton Medical Centre provides primary medical services to around 6,626 patients in Accrington, East Lancashire under a personal medical services (PMS) contract with NHS England. The local Clinical Commissioning Group (CCG) is East Lancashire CCG.

The practice building was opened in 1990 and has seen a number of extensions to increase consulting rooms and administrative space.

There are three GP partners, two male and one female, one female nurse practitioner, two nurses, one of whom was also the community matron for over 75 year old patients, and an assistant practitioner. The practice is supported by a practice manager and a team of eight support staff. The practice is also a training practice, and supports medical students and GP trainees.

The practice is open from 8am until 6.30pm Monday to Friday, with the exception of one Monday each month when it is closed between 12.30pm and 3pm for staff training. During this time, patients are asked to contact a different number for urgent care.

Census data shows a varied practice population with double the numbers of over 75 year old than national averages. Male and female life expectancy is in line with East Lancashire Clinical Commissioning Group (CCG) and national averages (practice male 76 years , CCG 77, England 79; practice female 80 years, CCG 81, England 83).

Information published by Public Health England rates the level of deprivation within the practice population as four on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest).

East Lancashire generally has a higher prevalence of Chronic Obstructive Pulmonary Disease (COPD, a disease of the lungs), smoking and smoking related ill-health, cancer, mental health and dementia than national averages.

Updated 13 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Clayton Medical Centre on 9 June 2016. Overall the practice is rated as good.

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

• The practice had an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff training was prioritised to ensure staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• The practice had made improvements to patient access during the previous year and was monitoring the impact of this for patients.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review procedures for receiving and acting on nationally issued alerts to ensure that a record of alerts and actions taken is maintained.
• Streamline the complaints process and introduce a complaints policy which is shared with patients and staff.
• Review the protocol for numbers of blank prescriptions carried by GPs.
• Provide all staff with up to date information on the location of emergency equipment and medicines.
• Carry out a risk assessment for legionella and implement advised legionella control regime in line with the risk assessment.
• Review support for carers and patients who have experienced bereavement and introduce local policies to support these groups.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 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.
• Data for 2014-2015 showed that the practice had been an outlier in care for patients with long-term conditions. For example:
  • All five indicators for diabetes were lower than national averages. For example, 91% had a flu immunisation the preceding flu season, compared with 94% nationally. Local data showed this had increased to 100% for 2015-2016.
  • 72% of patients had a cholesterol test in the last 12 months which was within a normal range, compared with the national average of 81%. Local data for 2015-2016 showed an increase to 83%.
  • 74% of patients had a blood pressure reading which was within a normal range during the previous 12 months, which was below the national average of 84%.
  • 64% of patients with asthma had a recent annual review recorded in their record, which was also below the national average of 75%. Local data for 2015-2016 showed an increase to 79%.

Data shared with the inspection team showed that performance in a range of patient outcomes had significantly improved during 2015-2016, these included:

• Patients who had experienced strokes or mini-strokes,
• Patients with diabetes,
• Patients with chronic obstructive pulmonary disease (COPD, a lung condition).
• Patients with asthma.

• Longer appointments and home visits were available when needed, and reviews were carried out for housebound patients by the community matron.
• 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 practice nursing team and / or the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 13 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 in line with local achievement levels 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.
• 76% of eligible women had a cervical screening test in the preceding five years, which was below the national average of 82%. The data for 2015-2016 shared by the practice showed that this had also been improved to achieve the national average, although this had not yet been nationally validated.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with health visitors who ran a weekly clinic for all local children from the practice building. The practice offered baby clinics at the same time to reduce visits and travel for parents.
• The practice offered a range of sexual health and family planning services including fitting of long-term reversible contraception.
• The practice referred patients to a counselling service for young people where appropriate.

Updated 13 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 employed a community matron who provided care for older patients who were housebound, ensuring they received relevant care in their own homes, and making referrals where appropriate to additional support services.
• The practice was involved in a pilot scheme run by a local charitable organisation which aimed to increase support and reduce social isolation for older people with reduced mobility.

Updated 13 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.
• The practice offered a range of minor surgery and joint injections which reduced travelling and made access easier for all age groups and helped patients avoid taking time off work to attend appointments elsewhere.

Updated 13 July 2016

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

• In 2014-2015, 72% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%.
• 85% of patients with schizophrenia, bipolar affective disorder and other psychoses had a care plan documented in their record in the last 12 months, which was in line with the national average of 88%.
• A number of staff and GPs were trained as Dementia Friends.
• 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 informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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 13 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 had a higher number of patients with learning disabilities, 65 (1% of the practice list) and worked closely with two local residential learning disability centres. The practice offered longer appointments for patients with a learning disability, annual health checks and a quiet room for waiting or appointments at less crowded times for patients who found this easier.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, as well as supporting the development of the local Integrated Neighbourhood Team, which supported patients with social as well as health care needs.
• For particularly complex patients, case conferences and reviews were held in the patient’s home, and GPs or the community matron attended.
• 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.
• The practice worked closely with the local substance misuse service, which ran a monthly clinic from the practice premises and joint appointments with the GP were available where appropriate.
• Although the practice did not routinely accept requests for prescriptions by telephone, arrangements were in place to support vulnerable patients or carers with prescription requests by phone.