Archived: Sandy Lane Surgery

Updated 15 December 2016

Sandy Lane Surgery is situated on Sandy Lane in the Leyland area of Preston at PR25 2EB serving a mainly urban population. The building is a purpose-built health centre which has been extended over the years. It consists of two floors and all patient facilities are located on the ground floor. The practice provides level access for patients to the building with disabled facilities available and part of the reception desk has been lowered to facilitate wheelchair access.

There is limited parking provided for patients in the practice car park and the practice is close to public transport.

The practice is part of the Chorley with South Ribble Clinical Commissioning Group (CCG) and services are provided under a Personal Medical Services Contract (PMS) with NHS England.

There are two male and three female GP partners and three female salaried GPs assisted by four practice nurses and two healthcare assistants. A practice manager, deputy practice manager, office manager and 17 additional administrative and reception staff also support the practice along with two medicines co-ordinators who are employed by the practice and funded by the CCG. The practice is a teaching practice for GPs in training and also conducts research.

The practice is open from Monday to Friday from 8am to 6pm and extended hours are offered on Saturday from 8.45am to 11.45am for pre-booked appointments and on every second, third and fourth Sunday of the month from 9am to 3pm for pre-booked and urgent appointments. Appointments are offered from 8am to 11am and from 1.30pm to 5.40pm on weekdays and from 8.50am to 11am on Saturdays and from 9am to 11.20am and 12noon to 2.10pm on Sundays. When the practice is closed, patients are able to access out of hours services offered locally by the provider Chorley Medics by telephoning 111.

The practice provides services to 11,517 patients. There are higher numbers of patients aged over 55 years of age (32%) than the national average (28%) and fewer numbers of patients aged between 10 and 30 years of age (22%) than the national average (25%).

Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Both male and female life expectancy is the same as the national average, 83 years for females and 79 years for males.

The practice has a lower proportion of patients experiencing a long-standing health condition than average practices (53% compared to the national average of 54%). The proportion of patients who are in paid work or full time education is higher (64%) than the local and national average of 62% and the proportion of patients with an employment status of unemployed is 1% which is lower than the local average of 3% and the national average of 5%.

Updated 15 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sandy Lane Surgery on 1 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. The practice carried out a thorough analysis of the significant events and scheduled all actions taken as a result of events for further review.
• Learning points from significant events were shared both internally and externally to improve patient safety.
• Risks to patients were 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.
• The practice followed comprehensive protocols that defined how changes to NICE guidelines and patient safety alerts should be managed.
• 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 found it easy 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.
• 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:

• The practice had run patient health awareness days. As a result of a recent dementia awareness event, the practice had improved communication with patients suffering from dementia and their carers. They had undertaken a care review for every patient on the practice register.
• The practice had introduced home visiting for patients with learning disabilities to conduct health reviews when necessary. Staff had trained in accessible information standards and each patient’s preferred methods of communication were recorded on these patients’ records.
• The practice had introduced Sunday opening for patients who could not attend during normal opening hours as well as Saturday opening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 December 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 higher than the national average. For example, blood measurements for diabetic patients showed that 87% of patients had well controlled blood sugar levels compared with the CCG average of 82% and national average of 78%.
• 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.
• The practice had identified that some patients who had more than one long term condition were attending the practice for multiple health assessments. They streamlined appointments so that patients only needed to attend one appointment to address all of the health needs at once. This saved the patient time and was a more efficient use of staff time.
• A podiatrist visited the practice twice a month to provide foot checks for diabetic patients.
• The practice provided a blood monitoring service for patients who were taking blood-thinning medications for heart conditions.

Updated 15 December 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 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 81%, which was comparable to the local average of 84% and the national average of 81%.
• 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. The practice sent congratulations letters to new mothers and invited them to make the appropriate post-natal appointments with the practice. They followed up patients who did not respond.

Updated 15 December 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 carried out home visits for the annual review of all housebound and nursing home patients who had not been seen for review.

• Patients at risk of unplanned admission to hospital had an agreed recorded care plan in place to support them and their carers to take appropriate action when the patient’s health needs deteriorated. Care plans were reviewed regularly by the care co-ordinator.

• The practice contacted those vulnerable elderly patients when they were discharged from hospital after an unplanned admission and arranged for any necessary support.

Updated 15 December 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. They offered online access that included access to patient records and a comprehensive text messaging service.
• The practice offered a ‘Commuter’s Clinic’ on a Saturday morning and three Sundays in the month for working patients who could not attend during normal opening hours.

Updated 15 December 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face-to-face review compared to the CCG average of 91% and national average of 84%. Exception reporting for patients with dementia was zero.
• Practice staff had undertaken training in dementia awareness and had become dementia friends. The practice held a dementia awareness event and invited patients and a number of support organisations. Staff attended to carry out mental health assessments if needed and GPs were available for patient consultation.
• The practice allocated a dedicated staff member as the first point of contact for these patients and offered face-to-face annual reviews.
• Performance for mental health related indicators was higher than the local and national averages. For example, 94% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the CCG average of 92% and national average of 89%.
• 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.

Updated 15 December 2016

The practice is rated as outstanding 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 had increased the list of identified patients from 17 in 2014/15 to 41 in 2015/16. They also offered home visits to these patients so that every patient could be offered a face-to-face annual health review. There was one member of staff with responsibility for communication with patients with learning difficulties and every patient’s preferred method of communication was recorded on their record. At the time of our inspection, there were 57 patients on the register.
• 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 GPs provided weekly “ward rounds” to the local rehabilitation unit. This helped to prevent patient acute episodes of illness and enabled better communication with the unit .
• A clinic for patients who had a history of drug or alcohol misuse was offered by the practice on the premises, run by a GP and a member of the community team
• A national charitable organisation provided camouflage clinics at the practice as needed. This enabled patients with scars or other disfiguring skin conditions to cover them and increase self-confidence.
• The local hospice visited the practice monthly to provide palliative care support services to patients.

• The practice had appointed two members of staff as cancer champions. These staff attended local ink meetings and provided the practice with ideas to encourage patients to attend cancer screening programmes and to provide signposting for patients to other services.
• The practice gave the surgery ex-directory number to vulnerable patients to give them more direct access.