Little Harwood Health Centre

Updated 23 January 2017

Little Harwood Health Centre is located on Plane Tree Road, Blackburn, BB1 6PH and provides general medical services from a purpose built building owned by NHS Property Services. A local NHS Foundation Trust operates a treatment room within the building and a consultation room is also used by the local GP federation.

The practice is part of the NHS Blackburn with Darwen Clinical Commissioning Group (CCG) and provides services to approximately 11500 patients under a General Medical Services (GMS) contract with NHS England.

The average life expectancy of the practice population is slightly higher than the local average and slightly below the national average (82 years for females, compared to the local average of 80 and national average of 83 years, 77 years for males, compared to the local average of 76 and national average of 79 years).

The age distribution of the total practice’s patient population is broadly in line with local and national averages although there is a higher percentage of patients over the age of 65 years (20%) when compared to the CCG and national averages (14% and 17% respectively).

The practice has a similar proportion of patients experiencing a long-standing health condition when compared to CCG and national averages (57% compared to the CCG and national averages of 56% and 54% respectively). The proportion of patients who are in paid work or full time education is also similar (59%) to the CCG average of 57% and national average of 62% and the proportion of patients with an employment status of unemployed is 8% which is slightly higher than the CCG average of 7% and the national average of 5%.

Information published by Public Health England rates the level of deprivation within the practice population group as four on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice is staffed by seven GP partners (four male and three female). In addition the practice employs one nurse practitioner, two practice nurses and one healthcare assistant. Clinical staff are supported by an assistant practice manager and a team of administration and reception staff. At the time of our inspection the practice had employed the assistance of two practice managers from local practices to assist in the management of the practice following the unexpected loss of the practice manager during 2016.

Little Harwood Health Centre is a teaching and training practice. They are accredited to train doctors to become GPs (registrars) and to support undergraduate medical students with clinical practice and theory teaching sessions.

The practice maintains good working relationships with local health and social services to support provision of care for its patients. Locally, they have close working links with care and nursing homes. Regular visits are made by the clinicians to these sites.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are also available during extended hours from 7.15am to 8am on Tuesday and 6.30pm to 8pm Monday, Tuesday, Wednesday and Thursday. The practice is part of a federation of GP practices and patients are also able to attend appointments within the practice and at a number of other local health centres as part of this arrangement.

Outside normal surgery hours, patients are advised to contact the out of hours service by dialling NHS 111, offered locally by the provider East Lancashire Medical Services.

Updated 23 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Little Harwood Health Centre on 7 December 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 a system in place for reporting and recording significant events.
• Risks to patients were assessed and generally 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. However, we noted the information did not include reference to the Parliamentary Health Service Ombudsman.
• Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they generally found it easy to make an appointment with a 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. However, we identified opportunities for the improvement of governance systems, processes and supporting documentation. We noted the practice was aware of some governance issues and was in the process of assessing and addressing future governance needs.
• 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.

The areas where the provider should make improvement are:

• Continue activity to review and improve governance systems and processes and ensure this includes consideration of recruitment records, management of safety alerts, maintenance of training records and the effectiveness of communication of information to all practice staff.
• Consider the development and improvement of complaint and significant event records to demonstrate learning and support timely and effective communication within the practice.
• Review and confirm that information about how to complain made available for patients is in line with recognised guidance and contractual obligations for GPs in England and includes reference to the Parliamentary Health Service Ombudsman.
• Review the support and training provided for the infection prevention and control lead to help them to carry out their role effectively.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 January 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.

• Performance for diabetes related indicators was between 66% and 96% and this was lower than the national average range of 78% to 95%.

• 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.

Updated 23 January 2017

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.

• Cervical screening uptake data from 2014/15 for women aged 25-64 years was 74%, which was lower than the CCG average of 80% and the national average of 82%. The practice was aware of this and was taking action to improve patient engagement and performance.

• 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 23 January 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.

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

• The practice actively monitored patients at risk of hospital admission and discussed their needs at integrated team meetings.

• A weekly clinic/ward round was in place at a local nursing home that was usually undertaken by the same GP to provide continuity of care.

Updated 23 January 2017

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 telephone consultations for patients unable to attend the practice.

• The practice offered ’flu’ vaccination clinics at weekends to increase availability for patients.

• The practice was part of a federation of GP practices and patients were also able to attend appointments within the practice and a number of other local health centres as part of this arrangement.

Updated 23 January 2017

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

• 72% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%.

• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the preceding 12 months, which was higher than the national average of 89%.

• A record of alcohol consumption was recorded for 94% of patients with mental health related conditions compared to 89% nationally.

• 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.

Updated 23 January 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.

• 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.

• 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.