Yorkshire Street Medical Centre

Updated 13 April 2016

Yorkshire Street Medical Centre provides services to 5,881 patients in the Burnley area of East Lancashire from a three storey grade two listed Edwardian Building in the centre of Burnley. The practice provides services under a General Medical Services (GMS) contract with NHS England.

The practice has five GP partners, three male and two female, a nursing team comprising of two nurses and an assistant practitioner (a non-clinical member of staff trained to undertake various clinical tasks in line with clear protocols under supervision). They are supported by a practice manager and team of nine administrative staff. The practice supports second and fifth year medical students.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 11.30am every morning and 3pm to 6pm each afternoon. Extended hours surgeries are offered from 6.30pm until 8.15pm on Mondays.

Information from Public Health England suggests the practice has a predominantly white population, with slightly above average 45 – 49 year old female patients and more 60 – 79 year old patients than national practice averages.

Practice data shows more patients than average have a long-standing health condition, 71% compared to an average of 54%. Male and female life expectancy is just below East Lancashire Clinical Commissioning Group (CCG) and national averages (male: practice 76, England 79; female: practice 80, England 83).

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

Practice data showed a variation in the reported prevalence of coronary heart disease against expected prevalence which was discussed during the inspection.

Patients have access to minor injuries units in Accrington and Rawtenstall as well as a local urgent care centre. Out of hours treatment is provided by East Lancashire Medical Services Ltd on behalf of East Lancashire CCG.

Updated 13 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Yorkshire Street Medical Practice on 9 February 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.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• There were systems in place to assess and monitor risks to patients, though we noted there was no paediatric mask in place for emergency oxygen, some supplies were out of date and blind pulls had not been assessed to remove potential ligature points.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• 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 encouraged patients to attend exercise on prescription over many years.

• Feedback from patients about their care was consistently and strongly positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example, hand rails had been put up after a patient comment and a new ramp had been installed following feedback from the PPG.
• The practice had a clear vision with patient care as the top priority.
• The practice actively engaged with patient groups who may historically have been difficult to reach, for example parents of new born babies and 16 year olds.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Access to appointments was well managed. Patients said they found it easy to make an appointment and there was good continuity of care, with urgent appointments available the same day and routine pre bookable appointments always available within 48 hours.
• 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.

The areas where the provider should make improvement are:

• Complete actions to mitigate the risks identified including supplies and emergency equipment, blind pulls, alarm calls and prescription pads.

• Develop infection prevention and control procedures to incorporate relevant blood spill guidance and sample handling.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2016

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

• Practice nurses managed patients with chronic diseases under the guidance of GPs.

• 100% of patients with atrial fibrillation (a heart condition) whose stroke risk was assessed as high were treated with appropriate medication to reduce the risk of stroke compared with the national average of 98%.

• Patients with diabetes were referred to the expert patients programme and diabetic retinopathy screening.

• 97% of patients with diabetes on the register had an influenza immunisation in the preceding flu season (national average 93%).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice philosophy was to help educate and inform patients about long-term conditions to empower them to manage their own conditions where possible.

• Patients who had experienced breast cancer were invited for reviews with the practice nurses. The practice also worked closely with Lancashire cancer care network and signposted patients with cancer to various local support services.

• All patients with mobility difficulties were highlighted on the computer system and GPs and nurses saw them on the ground floor.

Updated 13 April 2016

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

• The practice provided ante natal clinics with the community midwife.

• The practice had identified the need to improve childhood immunisation rates and some years back began sending congratulations cards to parents of new born babies with advice for parents and immunisations schedules.

• A member of staff was responsible for coordinating childhood immunisations and took pride in achieving high immunisation rates for standard childhood immunisations. For example, rates for under 12 month olds were 90% and 95% compared to CCG figures of 72% and 84%. 24 month olds rates varied from 82% to 97% (CCG rates 75% to 86%).

• The practice reviewed access to baby clinics following an incident and now ran pre-booked appointments. Practice staff told us parents were much happier with the new arrangements.

• The practice invited mothers of new born babies to 40-minute post-natal checks with a GP.

• Unwell babies and children were seen the same day.

• The safeguarding lead met with health visitors to discuss children “of concern”. The practice had adopted a low threshold to identifying children and families who may require additional support. There were excellent 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 or missed immunisations were discussed and referrals to social services were made where appropriate.

• 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.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked closely with health visitors and school nurses.

• The healthcare assistant had conducted a survey of young people as part of her training. As a result of this work, the practice had begun sending birthday cards to patients who turned 16, including age appropriate information about access to health services and advice.

• Patients were encouraged to use social networking to engage with the practice and text messaging was used for appointment reminders, health promotion information and feedback.

• A member of staff was responsible for coordinating cervical screening for women. Data showed 83% of eligible women had attended screening in the previous 3 years compared to 73% nationally.

• There was relevant information and signposting to domestic violence support within the practice.

• A newly appointed nurse completed training in family planning as part of appraisal and continuous professional development planning.

• One of the nurses identified that the nationally issued patient group directive on influenza vaccination missed out pregnant women, so contacted NHS England who revised it to include expectant mothers.

• The practice offered family planning and sexual health screening for the wider local population.

Updated 13 April 2016

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

• The practice offered same day appointments for older patients.

• All patients who were over 75 had a named GP and were offered an annual health check.

• The practice had a carers register with 3% of the population recorded as carers. Patients were signposted to the local carers contact and invited to annual health checks.

• A carers display board in the practice gave details of support available to carers.

• The practice offered proactive, personalised care through a care plan and worked with other professionals to deliver good care to this age group.

• Home visits were carried out by the GPs and practice nurses to housebound patients and joint working with community staff ensured these patients were supported in their own homes.

• The practice had access to a CCG funded community geriatrician who advised in management of patients with complex conditions and contributed to care planning.

• 83% of patients aged 65 and over had received a seasonal flu vaccination the previous flu season, higher than the national average of 73% (2013-14 data).

• The practice worked closely with two specialist nurse practitioners who conducted ward rounds in all local care homes and liaised daily with GPs where there were concerns.

• The GPs supported patients in intermediate care beds locally for patients who could not manage on their own but did not require full hospital care.

• The practice sent bouquets to patients who were 100 years old (all centenarians had been female to date).

Updated 13 April 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 sent details to the local university for local students to promote access to health care for this population group.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Extended hours appointments were available on Monday evenings for patients who had difficulty attending during normal hours.

• The practice offered a full range of sexual health screening and family planning services to their own patients as well as those of other local practices.

• The practice was proactive at using social media to engage with patients and encouraged feedback through a variety of mediums.

Updated 13 April 2016

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

• < >

  92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months, compared to 89% nationally.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Counselling and wellbeing support services were offered from the practice by partner organisations.

• The practice had comprehensive system in place to follow up patients who had attended hospital where they may have been experiencing poor mental health.

• All staff had completed Dementia Friends training and wore Dementia Friend badges.

Updated 13 April 2016

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

• The practice held registers of patients living in vulnerable circumstances and met bi-monthly with the integrated neighbourhood team to ensure health and social care needs were met.

• The practice conducted thorough annual health checks for people with a learning disability and had proactively identified some patients with health concerns who were treated to avoid further significant illnesses.

• The GP responsible for conducting annual health checks for patients with learning disabilities had built up a good relationship with many patients who had previously not engaged with health services, and ensured they regularly attended the practice and other health services as required.

• The practice worked with a local substance misuse service to support patients with drug and alcohol problems.

• Ex veterans were identified, offered an annual health check and signposted to local support groups.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff clearly recognised 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.