Patterdale Lodge Medical Centre Also known as Patterdale Lodge Group Practice

Updated 1 August 2018

Patterdale Lodge Medical Centre is operated by Patterdale Lodge Group Practice. There are also two smaller branch surgeries, High Street surgery and Burtonwood Surgery. We visited Patterdale Lodge Medical Centre and the Burtonwood Surgery. The main practice is situated in Newton-le-Willows and is based in an area with higher levels of economic deprivation when compared to other practices nationally.

Patterdale Lodge Medical Centre is responsible for providing primary care services to approximately 12,331 patients and provides a range of primary medical services including examinations, investigations and treatments. Clinics run at the practice includes diabetes, asthma and hypertension.

The practice is managed by three registered GP partners in addition there are five salaried GPs. The nursing team consists of advanced nurse practitioners, practice nurses and health care assistants. There are both male and female medical staff. The clinical team are supported by a practice manager, deputy practice manager and a team of reception and administration staff. The practice is a training practice for GP registrars.

The practice is open from 8am to 7.30pm Monday to Wednesday and 8am to 6.30pm Thursday and Friday. Patients can also access appointments at the two branch surgeries. The Burtonwood Branch is open Monday to Friday 8.30am to 12.30pm. The High Street surgery is open Monday to Friday at various times between 8.30am to 5.30pm. Opening times are advertised on the practices website. Patients who require a GP outside of these hours are advised to contact the GP out of hours service by calling 111.

The practice has a Personal Medical Service (PMS) contract. The practice offers a range of enhanced services including, avoiding unplanned hospital admission, minor surgery, family planning and flu and shingles vaccinations.

Following the previous inspection in October 2017 we made requirement notices in relation to the gaps in the recruitment processes. The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Patterdale Lodge Medical Centre on our website at .

Why we carried out this inspection

We undertook a comprehensive inspection of Patterdale Lodge Medical Centre on 11 October 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as good overall however the practice was rated as requires improvement in safe.

We undertook a focused follow-up inspection of Patterdale Lodge Medical Centre on 6 July 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

How we carried out this inspection

During our visit we:

• Spoke with a range of staff including administration staff, nursing and medical staff. We also spent time with the practice manager who had been in post for one week at the time of the inspection.
• Observed how patients were being cared for in the reception area.
• Reviewed a sample of the personal care or treatment records of patients.
• Reviewed comment cards where patients and members of the public shared their views and experiences of the service.
• Visited one practice branch surgery.
• Looked at information the practice used to deliver care and treatment plans.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Updated 1 August 2018

In addition, the provider should:

• Review incident reporting to ensure these are recorded in a timely manner.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 15 December 2017

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

• Nursing staff had lead roles in long-term disease management. However there was no effective system in place to recall patients for a structured annual review to check their health and medicines needs were being met.

• Patients at risk of hospital admission were identified as a priority.

• 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 employed a Practice Pharmacist to review those patients on multiple medicines to optimise their care.

• Longer appointments and home visits were available when patients needed them.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

Updated 15 December 2017

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

• Immunisation rates were high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 15 December 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice had established a pilot scheme to visit their patients living in care and nursing homes on a weekly basis to prevent unplanned admissions to hospital and to improve health outcomes for patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. The practice had two carer champions to support and signpost carers.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 15 December 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice appointment system and opening times provided flexibility to working patients and those in full time education. The practice was open from 8am to 7.30pm Monday to Wednesday and 8am to 6.30pm Thursday to Friday.

• The practice had two branch surgeries that patients could access GP and nursing appointment from throughout the week.

• Patients could book routine appointments in person, via the telephone and on-line. Repeat prescriptions could be ordered on-line or by attending the practice.

• The service offered a medical triage service to ensure patients were seen by the most appropriate clinician. Telephone consultations were also offered.

• The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, NHS health checks, contraceptive services, smoking cessation advice and family planning services.

Updated 15 December 2017

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

• GPs worked with specialist services to review care and to ensure patients received the support they needed.

• The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review.

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

• The practice referred patients to appropriate services such as memory clinics, psychiatry and counselling services.

• Patients were also signposted to relevant services such as Age UK, and the Alzheimer’s Society and were offered resources such as talking therapies and on-line self-help resources.

• The practice offered patients with poor mental health the option of ordering their medication over the telephone.

Updated 15 December 2017

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

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They knew how to contact relevant agencies in normal working hours and out of hours.