The Park Medical Practice

Updated 30 January 2017

The Park Medical Practice is situated in a purpose built health centre (Cottam Lane Surgery, Preston, PR2 1JR) on the outskirts of Preston. A pharmacy is also housed within the health centre building. The premises are accessible for patients experiencing difficulties with mobility and there is ample space for car parking, including designated disabled spaces close to the main entrance of the building.

The provider also delivers services from another location (New Hall Lane Surgery, Preston), but presently this site is registered as a separate location with the Care Quality Commission so was not inspected as part of this visit. The practice informed us they were in the process of de-registering the New Hall Lane surgery as it was operated as a branch surgery from the main site at Cottam Lane. The practice had also recently merged with another practice (Dr Nath’s practice) which was also situated in the Cottam Lane surgery.

The practice is part of the NHS Greater Preston Clinical Commissioning Group (CCG) and delivers primary medical services to a patient population of 14,153 patients via a general medical services contract with NHS England. The practice has one contract with NHS England that applies across the two sites of Cottam Lane and New Hall Lane, so statistics and clinical performance indicators quoted in this report apply to both provider locations.

The average life expectancy of the practice population is slightly below the local and national averages (81 years for females, compared to the local average of 82 and national average of 83 years, 77 years for males, compared to the local average of 78 and national average of 79 years).

The age distribution of the practice’s patient population is broadly in line with local averages. However, the practice does cater for a slightly higher percentage of patients under the age of 18 years (24.2% compared to the local average of 21% and national average of 20.7%) and a slightly lower proportion of patients over the age of 65 years (13.4% compared to the local average of 16.2% and national average of 17.1%). The proportion of patients who experience a long standing health condition is slightly below the local and national average (51.2%, compared to the local average of 53.9% and national average of 54%).

Information published by Public Health England rates the level of deprivation within the practice population group as four 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 thee GP partners (two female and one male), thee female salaried GPs and four long term locum GPs (three male, one female). The practice also employs a clinical nurse specialist, a clinical pharmacist, five practice nurses and four health care assistants. Clinical staff are supported by a practice manager, deputy practice manager, medicines management coordinator and a team of reception and administration staff.

The practice trains registrar doctors, offers placements for foundation year doctors and trains medical undergraduate students from the University of Manchester.

The practice is open between 8am and 6.30pm Monday to Friday, and between 8am and 11am on a Saturday morning for extended hours appointments. Surgeries are offered between 9am and 12.30 each morning and 2pm until 5.40pm each afternoon from Monday to Friday, while Saturday morning appointments are offered between 8am until 10.50am.

Outside normal surgery hours, patients are advised to contact the out of hour’s service by dialling 111, offered locally by the provider Preston Primary Care.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Park Medical Practice on 18 November 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 comprehensively and systematically 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• An ethos of patient centred care was well established throughout the practice’s work force. Staff had been proactive in setting up regular ‘health walks’ in the local park to promote a healthy lifestyle for patients and offer social opportunities for patients who may otherwise be isolated.
• 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. We saw that the practice took a transparent approach to the management of complaints in order to maximise learning opportunities.
• Patients said they mostly found it easy to make an appointment with a GP, 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 three areas of outstanding practice:

• The newly appointed clinical nurse specialist had identified and reviewed 185 patients at risk of having poorly controlled diabetes and offered lifestyle advice and changes to medication as appropriate. A total of 62 of these patients had already been recalled and attended for a further review following these changes being implemented. Of these 62, 59 had been found to have improved control of their condition.

• We saw that the practice routinely wrote to care homes in its catchment area on a quarterly basis to establish whether any of their patients had deprivation of liberties safeguards in place.

• Practice staff had set up a weekly “health walk” in the local park each Thursday morning, and invited patients to attend. This promoted a healthy lifestyle as well as providing social interaction and networking opportunities for patients who otherwise may be isolated.

The areas where the provider should make improvement are:

• The planned training should be undertaken to ensure health care assistants are trained to an appropriate level in child safeguarding in line with recognised guidance. The planned appraisals for this group of staff should also be completed.

• Consider the simplification of documents available to staff for the management of incoming mail in order to further mitigate the risk of the GPs not having sight of correspondence they need to see.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 January 2017

The practice is rated as outstanding 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 newly appointed clinical nurse specialist had identified and reviewed 185 patients at risk of having poorly controlled diabetes and offered lifestyle advice and changes to medication as appropriate. A total of 62 of these patients had already been recalled and attended for a further review following these changes being implemented. Of these 62, 59 had been found to have improved control of their condition.

• The practice was able to initiate insulin medication for diabetic patients, and had developed a “starting with insulin” information pack which was given to all of these patients which included useful advice and information.

• A podiatrist specialising in diabetic foot care regularly attended the practice.

• The practice offered twice weekly anticoagulation clinics where medication was monitored and dosage updated as required. This prevented the patients needing to attend further appointments in a secondary care setting in order to access this care.

• 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.

• Patients with complex needs and multiple conditions were offered a single holistic annual review of their needs, meaning they did not need to make multiple trips to the practice.

Updated 30 January 2017

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 relatively 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 76%, which was slightly lower than the CCG and national averages of 81%. However, the practice’s exception reporting rate for this indicator was 6% lower than the local average and almost 4% lower than the national average.

• 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 30 January 2017

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.

• Double appointments were offered to patients over the age of 75 to ensure they had sufficient time in consultations for their health needs to be met.

• Regular multidisciplinary team meetings were held to ensure the needs of those patients approaching end of life were met.

Updated 30 January 2017

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 on a Saturday morning for those patients whose working patterns made it difficult for them to attend through the week.

Updated 30 January 2017

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

• 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 88% compared to the CCG average of 89% and national average of 89%.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 71% compared to the CCG average of 86% 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 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’s clinical pharmacist had a background in specialist mental health care. He was undertaking the annual reviews for patients on the practice’s mental health register and was offering these patients longer appointments in order to facilitate establishing a good rapport with them.

• 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. The clinical pharmacist reviewed all discharge correspondence and followed up these patients as required.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 30 January 2017

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.

• A shared care substance misuse support worker offered regular clinics at the practice.