Barnoldswick Medical Centre

Updated 12 September 2017

Barnoldswick Medical Centre is in Barnoldswick, in East Lancashire. It provides Primary Medical Care to 11,642 patients under a General Medical Services (GMS) contract with NHS England and is part of East Lancashire Clinical Commissioning Group (CCG). The premises are owned by the GP partners and comprise a number of terraced houses which have been joined together. The building first became a GP surgery in 1915. The practice has been adapted and modernised where possible to increase the facilities available, and the practice are aware that the building has limitations in the delivery of modern healthcare. This is under discussion with the CCG and NHS Estates.

There are seven GP partners, five male GPs and two female GPs, five female nurses and two female health care assistants. They are supported by a practice manager, a reception manager and team of 15 staff. Barnoldswick is a training practice for GP trainees.

The practice is open between 8.00am and 6.30pm Monday to Friday. Appointments are from 8.30am to 6pm daily. Out of hours provision is provided by East Lancashire Medical Services.

Information published by Public Health England rates the level of deprivation within the practice population group as six 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), smoking and smoking related ill-health, cancer, mental health and dementia than national averages.

Updated 12 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Barnoldswick Medical Centre on 22nd March 2016. The overall rating for the practice was requires improvement as arrangements to monitor and improve quality and identify risks were not in place.

The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Barnoldswick Medical Centre on our website at www.cqc.org.uk.

This announced comprehensive follow up inspection was undertaken on 20th July 2017. Overall the practice is now 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.

• Risks to patients were assessed and 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.
• The practice was above average for its satisfaction scores on consultations with GPs and nurses.
• The health and wellbeing of patients in relation to their caring responsibilities was reviewed when they attended for a consultation or health check. They were directed to the various avenues of support available to them.
• Information about the services provided 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 told us they found it easy to make an appointment with the GP and there was continuity of care, with urgent appointments available the same day.
• The practice facilities were well equipped to treat patients; however access was restricted due to the structure of the building.
• 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.

There were areas where the provider should make improvements:

• Develop clinical team work by holding regular clinical meetingswith the practice nurses

• Consistently obtain written consent for minor operations

• Continue to identify and provide support for patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2017

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.

• The practice requested that  all newly registering patients completed a health questionnaire which helped to identify any long term conditions early in the relationship with the practice.

• Performance for diabetes related indicators was comparable to the national average. For example the percentage of patients with diabetes, on the register, in whom the last blood pressure reading was 140/80 mmHg or less in the period April 2015 to March 2016 was 77%. (CCG average 82% National average 78%). The diabetic nurse specialist was regularly contacted for advice and diabetic patients with complex problems were referred to the external diabetes service. One of the practice nurses had attended training to initiate and manage patients on injectable insulin with the support of the diabetic nurse specialist. This meant that patients need not travel to the hospital for this treatment.

• Clinics were held in the practice for patients with heart disease, chronic obstructive pulmonary disease (COPD) and asthma. This was also an opportunity to provide flu and pneumonia vaccination and issue patients with rescue packs including antibiotics for respiratory conditions.

• A smoking cessation service was offered by a local pharmacy.

• Longer appointments and home visits were available when needed.

• All these patients had 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 offered 24 hour ambulatory blood pressure monitoring and had blood pressure monitors to loan to patients.

Updated 12 September 2017

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

• There were comprehensive 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 and those who did not attend secondary care appointments.

• Immunisation rates for all standard childhood immunisation programmes achieved the targets set for 2016/17 according to unvalidated figures provided by the practice.

• 87% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compared to a CCG average of 82% and a 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 and health visitors.

• All parents or guardians calling with concerns about a child under the age of 18 were offered a same day appointment when necessary.

• Young people were signposted or referred to appropriate services such as Child and Adolescent Mental Health..

• The practice promoted the local “pharmacy first” scheme for patients who had minor ailments.

 Telephone appointment availability had been reviewed to increase access for this population group.

Updated 12 September 2017

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. It offered home visits, longer appointments and urgent appointments on the same day. Health checks were available for the over 75 years.

• The practice was providing an enhanced service in shingle and pneumococcal vaccination to this group of patients. The practice proactively identified patients who were entitled to this vaccination and then contacted them. There were leaflets available at the reception regarding shingles vaccination.

• Staff sign-posted older patients who were at risk of social isolation to a befriending service run by a voluntary sector agency.

• The health care assistant carried out home visits to review those who were unable to attend the surgery.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to national averages, 77% of patients diagnosed with dementia had a face-to-face review, which was comparable with the national average of 84%.

• 20 minute appointments were given to patients aged over 75 years old as routine.

• The practice actively identified older carers during annual immunisation campaigns.

Updated 12 September 2017

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

• 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. This included pre-bookable appointments from 8.30am and an on-call doctor available until 6.30pm.

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

• Health checks were available for patients aged between 40-74years.

• Telephone consultations were offered daily. There was flexible timing for telephone call backs from the GP. Urgent extra appointments were always available to see clinicians at the practice during opening hours. Patients were directed to Pharmacy first, NHS 111, or the local walk in centre when appropriate.

• Smoking cessation advice was available at a local pharmacy.Community physiotherapists worked in the practice two days per week and the practice offered weekly minor surgery clinics.

• Telephone appointments were available for patients who were working and unable to attend the surgery.

• Travel advice and immunisation was offered by the practice nurse.

Updated 12 September 2017

The practice is rated as Good for the care of people experiencing poor mental health.

• 77% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which was below the CCG average of 85% and the national average of 84%. Memory assessment was carried out either opportunistically or as part of the chronic disease review process.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record in the preceding 12 months. This was above the clinical commissioning group average of 88% and the national average of 89%. 87% of patients with mental health conditions had their alcohol consumption recorded in the preceding 12 months. This was comparable with the CCG average of 90% and the national average of 89%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations such as alcohol and drug services and registered patients who were resident at a local drug and alcohol rehabilitation service.
• Counselling and Improving Access to Psychological Treatment (IAPT) services were available within the practice.
• Staff had a good understanding of how to support patients with mental health needs and dementia. One of the receptionists had attended training in dementia.

Updated 12 September 2017

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. Alerts for direct access to GPs or nursing staff were added to records of these patients.

• The practice undertook health checks for patients with learning disabilities at an extended appointment when a nurse and a health care assistant wrote an individual care plan.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients including hospice staff, palliative care nurses and district nurses. This included multidisciplinary integrated care meetings to ensure patients received safe, effective and responsive care.

• Staff knew how to recognise signs of abuse in vulnerable adults and children.

• Carers were identified during appointments with practice staff who carers were offered health checks and flu vaccination.

• Home visits were available if the patient could not attend appointments at the surgery.

• There were interpreter services available which could be booked for specific appointments for patients who did not speak English as a first language. During the inspection we saw no written information appropriate for patients who did not speak English; however this was rectified within two days following the inspection.

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