Fleetwood Surgery

Updated 19 July 2016

Fleetwood Surgery is based in Fleetwood, Lancashire. The practice is part of Fylde and Wyre Clinical Commissioning Group (CCG) and delivers services under a General Medical Services contract with NHS England

The practice is located in a large medical centre on the outskirts of the town. There is easy access to the building and disabled facilities are provided. All consultations rooms are on the ground floor. There is a large car park serving all of the medical facilities on the site. There are three male GP partners working at the practice. There is a further regular female locum. Fleetwood Surgery is a training practice and as such currently has a male GP registrar and a female trainee doctor. Fleetwood surgery also hosts placements for a medical student and student nurse. There are two female part time practice nurses, and two part time health care assistants (both female). There is a practice manager, one assistant practice manager and a team of administrative/reception staff.

Within the building there are two other practices and community services. The building is owned by a private company.

The practice opening times are 8.30am until 6pm Monday to Friday. Extended hours are available on Thursday evenings until 8pm and on Saturday mornings from 8.30am until 12pm.

Patients requiring a GP outside of normal working hours are advised to call NHS 111 service.

There are 4493 patients on the practice list. The majority of patients are white British. A high number of patients have a long-standing health condition (78% as opposed to the national average of 54%).

Updated 19 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fleetwood Surgery on 13 May 2016. Overall the practice is rated as good.

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

• Throughout our inspection we noticed a strong theme of positive feedback from staff, patients and other organisations who worked with the practice. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. The practice was committed to working collaboratively and worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services because of feedback from patients and from the patient participation group (PPG).
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The provider was aware of and complied with the requirements of the duty of candour.

• 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 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.

• The practice had a clear vision which had quality and safety as its top priority and was regularly reviewed and discussed with staff.

We saw several areas of outstanding practice including:

• The practice used social media to reach their younger patients. They shared health promotion advice (such as self care and smoking cessation) and practice specific information such as feedback and improvements made. The page had 94 followers at the time of our inspection. The practice has identified a lack of young people representation in their Patient Participation Group (PPG) and used this media to encourage younger people to join the group. The practice manager regularly reviewed the page for patient feedback in order to address issues and improve the service. 

• A GP at the practice had developed a comprehensive Personal Care Plan template which had been shared with the CCG and adopted by other health care providers. This plan was then co-written with patients through discussion and completion of a questionnaire. Based on the plan a number of ‘what if’ scenarios were documented to assist the patient, their carers and other health care providers to provide safe and effective care in accordance with the patient’s wishes.

• The practice took a proactive approach to understanding the needs of their patients who were carers. Practice data highlighted that there were 168 carers on the practices register and 3.7% of the practices list had been identified as carers. There was a dedicated carer’s lead in place and carers were offered support and regularly reviewed by the practice.The practice recognised the links between carers experiencing other conditions such as depression and offered opportunistic depression screening.

• The practice used various innovative IT methods to improve patient care. One GP developed a system which automatically generated a printed paper slip when a patient was prescribed opiates. This reminded patients of the side effects of this medicine. Patients diagnosed with COPD (Chronic Obstructive Pulmonary Disease) were encouraged and educated to use a telecare system. Currently four patients monitored their own vital signs and text these to the practice. A further 72 patients had been invited to take part in this scheme. This gave patients greater autonomy over the care of their condition and helped to identify issues early. The practice had also recently begun to take part in a local pilot to provide video consultations to patients.

• A transient population of overseas students from the local Nautical College were registered with the practice. A Health Care Assistant attended registration sessions at the college to allow students to be registered in a timely manner with limited disruption to their educational timetable.

However there were areas of practice where the provider should make improvements.

• The practice website should be updated to reflect current opening hours.

• Continue to ensure all staff have annual appraisals.

• Infection Control Audits should be conducted annually.

• Systems to ensure all policies are regularly reviewed and updated should be strengthened.

• Documentation of complaints should provide a clear audit trail of the responses given.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 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.

• Longer appointments and home visits were available when needed.

• Patients with a long-term condition 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. Regular multi-disciplinary team meetings took place with representation from other health and social care services. We saw that discussions took place to understand and meet the range and complexity of people’s needs and to assess and plan ongoing care and treatment.

• The practice encouraged and educated patients to use IT to monitor and manage their own health. A telecare system was available for patients with Long-term conditions including heart failure and Chronic Obstructive Pulmonary Disease (COPD). At the time of our inspection 4 patients had begun to use this service with a further 72 patients identified and encouraged to partake. Patient’s text the practice with details of their vital signs which allowed clinicians to anticipate exacerbations and potentially avoid hospital admissions.

Updated 19 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.

• The practice routinely offered new patient health checks to children. They used this to proactively identify any safeguarding concerns particularly in transient families. Family relationships were linked within computer records so known relationships could be documented.

• Systems were in place to identify and follow up children who were considered at risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multi-disciplinary meetings involving child care professionals such as health visitors and school nurses. We saw positive examples of joint working with midwives, health visitors and school nurses.

• 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.

• Vaccination rates for 12 month and 24 month old babies and five year old children were in line with CCG averages. Practice staff proactively contacted families who at failed to attend immunisation appointments and followed up any concerns.

Updated 19 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. All patients over the age of 75 had a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice was proactive in offering those older patients who could not attend clinic for Flu vaccinations or health checks this service in their own home.

• Older patients at risk of hospital admission and in vulnerable circumstances had care plans. Patients and or their carers were asked to complete a questionnaire which was used to inform the personalised care plan. A number of what if scenarios specific to the patient were documented to aid patients, carers and other health services to respond to their needs appropriately.

• Older patients in need of additional support were identified and assisted to book hospital appointments on their behalf.

• The practice worked together with the ‘Rapid Response’ community team, aimed at treating people in their own homes if at risk of needing hospital admission. Social Workers were available for the prompt coordination of any social needs alongside the patients’ health issues.

• The practice maintained a palliative care register. A GP chaired the monthly Gold Standards Framework Palliative Care meetings attended by a wide multidisciplinary team to enable sharing of information relating to patients to improve Palliative and End of Life care.

• Staff actively referred patients to the local Integrated Care Co-Ordinator to undertake a comprehensive and holistic assessments of needs. At the time of the inspection 25 patients were open to the service and had received a completed holistic needs assessment . The feedback from this service was extremely positive and confirmed high and appropriate referral rates from the practice.

Updated 19 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.

• Extended hours surgeries were offered between 6pm and 8.30pm every Thursday and between 8.30am and 12pm every Saturday for working patients who could not attend during normal opening hours. Appointments were available with GPs, nurses and HCAs. Telephone consultations were also available. The practice was due to act as a pilot site for video consultation

• The practice offered a full range of health promotion and screening that reflects the needs for this age group.

• The practice encouraged online Patient Access for booking appointments, ordering prescriptions, viewing medical records. Patients could contact the practice by a secure email. The practice had developed a social media page where information about health, the practice, and organisations in the local area were shared. This medium was also used to actively recruit PPG members from this age group and to monitor patient feedback.

• A transient population of overseas students from the local Nautical College were registered with the practice. A Health Care Assistant attended registration sessions at the college to allow students to be registered in a timely manner with limited disruption to their educational timetable.

Updated 19 July 2016

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

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

• Self-directed care plans had been sent to all patients on the practice mental health register in order to create personalised care plans.

• The practice had in-house mental health staff available via referral for counselling and Cognitive Behavioural Therapy.

• Staff had a good understanding of how to support patients with mental health needs and dementia. Staff had recently undertaken online dementia training and received face-to-face training to become ‘dementia friends’.

• The practice promoted and referred patients to ‘The Big White Wall’ a 24/7 online confidential mental health website providing support, counselling and information.

Updated 19 July 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability and other complex needs. Patients with serious social phobias were given the first appointment of the session to avoid busy waiting rooms.

• 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.

• Arrangements were in place to identify and support carers

• The practice had effective working relationships with multidisciplinary teams in the case management of vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.

• The practice took part in a ‘zero tolerance’ violent patient scheme. This meant that patients from across Fylde and Wyre and North Lancashire who had been removed from patient lists at other practices were guaranteed not to be turned away. 21 people from across the Fylde Coast and Lancashire had registered as patients at the practice and had access to the service. The practice risk assessed and put measures in place to ensure the safety of patients and staff.

• Patients at risk of developing medication addiction or abuse were referred to the Practice Pharmacist for management.  These patients were placed on weekly prescriptions and/or a mutually agreed reducing management plan