Longton Health Centre

Updated 21 December 2016

Longton Health Centre is located on Liverpool Road in Longton village, Lancashire approximately four miles from Preston. The large modern medical centre is near to the centre of the village. It is owned and managed by NHS Property Services and health visitors employed by Lancashire Care Trust are located there. There is easy access to the building and disabled facilities are provided. There is a car park on the site.

There are eight GPs working at the practice, six of whom are partners. Three of the partners are male and three female. There is also a female GP registrar and regular locum GP cover working up to five sessions each week. There is a total of six whole time equivalent GPs available. There are two female nurses, both who work part time for the practice. There is a full time practice manager, a medicines manager and a team of administrative staff.

The practice opening times are 8am until 6.30pm Monday to Friday. There is a session from 6.30 to 8pm on a Monday and from 8am until 11am Saturday. Appointments are available 8am to 12 midday and 2.30pm to 6pm Monday to Friday, 6.30 to 8pm Monday and 8am to 11am Saturday.

Patients requiring access to a GP outside of normal working hours are advised to call the 111 service who will transfer them to Preston Primary Care Centre, an out of hours service, call an ambulance or suggest they attend the Accident and Emergency department.

There are 10,989 patients on the practice list. The majority of patients are white British with a high number of patients over 65years (25% in comparison with 16% in the CCG as a whole and 17% nationally) and patients with chronic disease prevalence. On the Index of Multiple Deprivation the practice is in the least deprived decile with a score of ten.

The practice holds a General Medical Services (GMS) contract with NHS England and is part of Greater Preston Clinical Commissioning Group.

This practice has been accredited as a GP training practice and has qualified doctors attached to it training to specialise in general practice and also offers placements to medical students.

Updated 21 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Longton Health Centre on 6th September 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.

• Risks to patients were assessed and 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 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 said they found it easy to speak with a GP 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. 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.

We identified three areas of outstanding practice:

• The practice provided highly responsive support to patients with dementia and their families including seeking early identification, referral to the memory clinic for diagnosis, ensuring consent to share information, running events to help them understand the disease and undertaking advanced care plans to meet their wishes at the end of their life.Practice data indicated that referrals had doubled from 2014/15 to 2015/16 and diagnosis rates had done likewise.

• The Patient Participation Group (PPG) had supported a survey of young people and families and in response to the findings the practice had sought staff and PPG training from a local school about solvent misuse.

• An initiative had been put in place by the practice PPG to set up a car sharing scheme for patients who had mobility problems and had difficulty coming to the practice.

The areas where the provider should make improvements :

• Improve security of prescription pads by removing them from printers when they are not in use and monitoring the use of handwritten prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 December 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 better than the national average.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review in an extended appointment 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 provided a BMI and blood pressure self-monitoring machine within the surgery.

• Anti-Coagulant near patient testing clinics were run for all patients on Warfarin and home visits were made to those who were are immobile.

• The practice rated highly on appropriate anticoagulation in atrial fibrillation, treating fragility fractures and recording smoking status in chronic disease.

• One of the GP partners had a special interest in diabetes and another in asthma and chronic obstructive pulmonary disease (COPD).

• Searches had been changed in the last year to date of birth recall on anybody in particular diseases group which captured all patients.

• Nurses visited patients annually who could not attend at the surgery due to long term conditions.

• Arthritis Care, the Falls Team and the Fire Brigade came to the practice to help people in their daily lives make changes to help with their condition.

• An initiative had been put in place by the practice PPG to set up a car sharing scheme for patients who had mobility problems and had difficulty coming to the practice.

Updated 21 December 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 and those who did not attend secondary care appointments. Cases were discussed with the GP’s at an informal coffee time meeting and at multidisciplinary meetings.

• Immunisation rates werehigh for all standard childhood immunisation programmes achieving100% for babies aged twelve months in 2014/15 and up to 100% for children aged two and five years. These were provided both at immunisation clinics and by appointment.

• 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.

• 97% of women aged 25-64 are recorded as having had a cervical screening test in the preceding 5 years. This compared well to a CCG average of 80% and a national average of 82%. The practice also offered chlamydia screening, contraception advice, and there was a supply of free condoms available. Information for this group of people was available via the practice website with links to specific web sites.

• Appointments were available outside of school hours as were telephone consultations and the premises were suitable for children and babies. There was a breast feeding policy in place.

• We saw positive examples of joint working with midwives, health visitors and school nurses including a community well baby clinic run by health visitors and a weekly clinic for pregnant mothers.

• All parents or guardians calling with concerns about a child were offered a same day appointment.

Updated 21 December 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. Electronic hand held tablets were in use for home visits to ensure continuity of information and care.

• Practice staff visited three care homes in the area to provide house calls and confer with staff and managers. The medicine management team provided advice on medicine management. The GPs and Healthcare Assistant (HCA) worked closely with the Community Matron in the locality and ensured good continuity of care.

• Warfarin initiation and prescribing was offered so that the rural community need not travel into Preston.

• The practice had invited all patients who were over 75years for a health check and completed a care plan for allpatients on the Avoidance of Unplanned Admissions at risk register

• A PPG newsletter was sent out giving details of Things to do in Longton and help to access support organisations.

Updated 21 December 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 including electronic prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group. The practice could offer an alternative Electronic Prescription Service to a nominated pharmacy of choice in the patients working area.

• The practice staggered appointments each day offering late afternoon appointments and running Saturday clinics to provide flexibility. Patients were rung back and offered appointments at a time slot suitable for them.

• The GPs performed minor surgery and joint injections, reducing patient waiting times and the need for any hospital admission.

• One of the GPs had significant experience in sports and musculoskeletal medicine, and provided teaching, updates and clinical reviews so that patients need not travel to secondary care appointments.

• Appointments late in the day were available for family planning, sexual health, asthma, travel vaccinations and International normalised ratio (INR) testing (for patients prescribed any blood thinning medication) during a clinic from 6.30 until 8pm on a Monday night.

.

• A vaccination programme applicable to students was available before they started attending university or college.

Updated 21 December 2016

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

• 97% 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 compared favourably with a CCG average of 86% and a national average of 88%.

• 91% of patients with mental health conditions had their alcohol consumption recorded in the preceding 12 months. This compared well with a CCG average of 88% and a national average of 90%.

• 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. Consent to share information with families or carers was put in place if agreed at an early stage of memory loss. The practice in conjunction with the Primary Care web tool tried to raise its dementia profile and had various initiatives to provide early diagnosis. Staff had a good understanding of how to support patients with mental health needs and dementia as training sessions had been put in place. Annually with the help of the PPG the practice ran dementia help talks for patients and their families which were well supported. Referrals to the memory clinic had doubled in numbers from 2014/15 to 2015/16 and diagnosis rate had followed the same pattern.

• 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.

• The practice staff reviewed all patients who had immediate discharges and concerns were highlighted to clinicians in order that new pathways for patients could be developed to avoid an unplanned admission in future.

Updated 21 December 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 homeless people, travellers and those with a learning disability.Alerts for patients to gain direct access to GPs or nursing staff were added to records of these patients.

• The practice offered longer appointments for patients with a learning disability includingan annual review with their carer. Suitable information regarding the appointment and the GP was offered. Cervical screening was offered to this group of patients at a time suitable to them.

• 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 meetings to ensure palliative care patients received continuity of care.

• 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.

• Practice staff maintained a register of carers. A carer’s information board was maintained in the waiting room. All carers were offered the influenza vaccination, Carers information packs were sent out and carer’s checks offered each year.

• An initiative was in place to set up a car sharing scheme for patients who had mobility problems and had difficulty getting to the practice.