Excel Primary Care

Updated 20 June 2016

Skelmersdale Family Practice (formerly known as Dr S K Sur and Partners) is housed in Birleywood Health Centre in a residential area of Skelmersdale. At the time of inspection the provider had recently taken over a neighbouring GP practice (Skelmersdale Family Practice at Sandy Lane Health Centre) and the inspection team was informed that the intention was to operate the Sandy Lane site as a branch surgery of the Birleywood location. The provider was in the process of updating the registration with CQC to reflect this. At the time of inspection, the Sandy Lane site was still registered separately, so was not included as part of the visit nor data analysis quoted in this report.

The practice is part of the NHS West Lancashire Clinical Commissioning Group (CCG) and provides primary medical services to 9260 patients through a Personal Medical Services (PMS) contract with NHS England.

The average life expectancy of the practice population is below local and national averages for both males and females, with males on average living to 75 years and females to 79 years (CCG average being 79 and 82 respectively, national averages being 79 and 83 years). The practice’s patient population consists of a higher proportion of younger people, with 7.5% being aged four and under (CCG average 5%, national average 5.9%), 14.1% being aged between five and 14 years (CCG average 11%, national average 11.4%) and 25.8% being under the age of 18 (CCG average 19.8% and national average 20.7%). The practice also caters for a slightly higher proportion of patients with a long-standing health condition at 58.8%, compared to the CCG average of 55.5% and national average of 54%.

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.

There is parking available outside the premises, and there is a ramp to facilitate wheelchair access to the building.

The practice is staffed by five GP partners (all male), two nurse clinicians, two practice nurses and two health care assistants. Clinical staff are supported by an executive practice manager, a practice manager and a team of non clinical staff including receptionists, secretaries, notes summarisers and a medicines management coordinator.

The practice is open from 8.30am until 6.30pm Monday to Friday apart from Wednesdays when the practice closes at 4.30pm. Appointments are available between 9.00am and 11.40am each morning, and 3.00pm until 6.00pm each afternoon (apart from Wednesdays when they are available between 1.00pm and 3.00pm). Extended hours appointments are also available each Monday evening between the hours of 6.30 and 8.30pm. Outside normal surgery hours, patients are advised to contact the out of hours service, offered locally by the provider OWLS CIC Ltd.

Updated 20 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Skelmersdale Family Practice on 28 April 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.
• Appropriate learning outcomes were identified following analysis of significant events, and staff demonstrated they were aware of these. However in some cases communication channels for cascading this learning were informal and lacked a robust documented audit trail of what information had been passed to whom.
• Risks to patients were assessed and mostly 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.
• Information about services and how to complain was available and easy to understand. Complaints were handled in an open, transparent and timely manner.
• Patients said they did not always find it easy to make an appointment with a named GP, but the practice could demonstrate they had implemented a number of changes in order to address and rectify this.
• 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 when provided.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure documentation held around complaints provides a clear audit trail of the learning identifies and how this was shared within the organisation and with external stakeholders.

• Ensure changes made following the inspection around the monitoring of emergency medical equipment and chaperone procedures are fully embedded into practice.

• When a decision has been taken not to seek a DBS check for a member of staff, a risk assessment should be undertaken to provide clear documentation of the reasoning behind this decision. This applies to clinical staff where a recent DBS check from a previous employment has been deemed appropriate assurance that no risk is posed to patients. Update the practice’s recruitment policy to reflect this, and ensure the changes made around the retention of appropriate interview notes are fully embedded into the recruitment process.

• Ensure the protocol produced following the inspection detailing how communication channels for dissemination of learning were to be formalised is fully embedded into practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 June 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 generally in line with the national averages.

• 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.

• Review appointments were coordinated and offered in the month of the patient’s birth so as to make them more memorable and minimise the need for multiple visits to the practice for those patients with multiple health conditions.

• The practice also offered regular anticoagulant clinics where patients’ bloods were tested and their anti-coagulant medicine initiated, reviewed and dose changed as required. This meant they did not need to attend a separate specialist anticoagulant clinic.

Updated 20 June 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 89%, which was comparable to the CCG average of 82% and the national average of 82%.

• 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 20 June 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 GPs and nurse practitioners regularly attended local nursing homes to carry out ward rounds.

• The practice offered health checks to patients over the age of 75.

• Multidisciplinary gold standard framework meetings were held every three months to ensure patients nearing the end of their lives received the most appropriate care.

Updated 20 June 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.

• The practice offered an evening clinic each Monday evening until 8.30pm for working patients who could not attend during normal opening hours.

Updated 20 June 2016

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 88% compared to the national average of 84%.

• Performance for mental health related indicators was slightly above the national average.

• 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 mental health support worker also attended the practice to support patients suffering from schizophrenia and psychoses.

Updated 20 June 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.

• The practice told us how they worked closely to deliver care to patients resident in a women’s refuge centre as well as a children’s home, both of which were located outside the practice’s boundary.

• 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.