William Hopwood Surgery

Updated 31 August 2016

Dr N Nagpal’s Practice is located in a single storey building in residential area close to the centre of Blackburn. The original building was extended in 1991 and 2006 to add additional consultation rooms and a car park for patients. The internal design of the building creates potential access issues for patients with limited mobility but we were told staff assist patients as required and an additional entrance is available that can be used to provide direct access to the main consulting room corridor.

The practice delivers services under a Personal Medical Services (PMS) contract with NHS England to approximately 5400 patients, and is part of the NHS Blackburn with Darwen Clinical Commissioning Group (CCG).

Male and female life expectancy in the practice geographical area is comparable to the CCG averages but slightly below the England average for males at 74 years and 80 years for females (England average 79 and 83 years respectively). The practice population includes a higher proportion (31%) of people under 18 years of age, and a lower proportion (9%) of people over the age of 65 years, in comparison with the national averages of 21% and 17% respectively. The practice also has a higher percentage of patients who are unemployed (17%) than both the national average (5%) and the CCG average (7%).

Information published by Public Health England rates the level of deprivation within the practice population group as one 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 two GP partners (one male and one female) and a salaried GP (female). The GPs are supported by a practice nurse and a health care assistant. Clinical staff are supported by a practice manager, practice support manager and five administration and reception staff.

The practice is open between 8.45am to 8pm Monday, Tuesday, Wednesday, Friday and 8.45am to 6.30pm Thursday. In addition to pre-bookable appointments that could be booked up to four weeks in advance for GPs and six weeks in advance for nurses, urgent appointments are also available for people that need them. The practice was also able to offer appointments through the local Primary Care Access Centre (PCAC) hub. When the practice is closed Out of Hours services are provided by East Lancashire Medical Services and can be contacted by telephoning NHS 111.

The practice provides online patient access that allows patients to book appointments and order prescriptions.

Updated 31 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N Nagpal’s Practice on 8 July 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and 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.
• 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.
• Patients said they sometimes found it difficult to get through to the practice by telephone but it was possible 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. However, we noted building maintenance issues were not always dealt with in a timely manner and access within the practice was potentially difficult for those with mobility issues due to the internal design of the building.
• 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 several areas of outstanding practice including:

• A template had been developed and was being used by nursing staff to support patient consultations and provide the opportunity for patients to be more involved in their own care and to gain a greater understanding of how lifestyles affect their health.

• GPs would often work beyond normal appointment times to ensure all patients visiting the practice were seen.

• A GP would visit the homes of deceased patients, often outside of normal practice hours and at weekends, to provide priority support to bereaved families and enable them to act in accordance with religious beliefs.

The areas where the provider should make improvement are:

• Ensure infection prevention and control lead role and responsibilities are documented and understood to enable the effective oversight and scrutiny of associated activity.

• Ensure clinical audit activity is fully documented and supported by a quality improvement programme.

• Prioritise and address building maintenance issues.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 August 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.

• Performance for diabetes related indicators was between 80% and 97% and this was comparable to the national average range of 78% to 94%.

• 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. A comprehensive recall system was in place to support review attendance.

• 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.

Updated 31 August 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 comparable to local performance 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.

• The percentage of patients diagnosed with asthma who had an asthma review in the last 12 months was 80% which was comparable to the clinical commissioning group (CCG) and national averages of 79% and 75% respectively.

• Cervical screening uptake data from 2014/15 for women aged 25-64 years was 80%, which was comparable to the CCG and national averages of 80% and 82% respectively.

• 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 and health visitors.

Updated 31 August 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.

• A flexible approach was applied to consultations for older patients as they were seen if they arrived at the practice without an appointment.

• The practice proactively promoted vaccination campaigns to encourage patient uptake.

Updated 31 August 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.

• Appointments were available outside of normal working hours for those individuals unable to attend the practice during normal opening times.

Updated 31 August 2016

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

• 78% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%.

• 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the preceding 12 months, which was comparable to the national average of 88%.

• A record of alcohol consumption was recorded for 98% of patients with mental health related conditions compared to 90% nationally.

• 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 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. A member of the practice staff had received training and undertook the role of dementia champion.

Updated 31 August 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 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.

• The practice had facilitated the delivery of information sessions within the practice to patients by other health and support organisations.

• The practice provided clinical support to adults and children receiving assistance from a local women’s refuge.