Roman Road Health Centre

Updated 3 January 2017

Roman Road Health Centre is located off Fishmoor Drive in a residential part of West Darwen, Blackburn, Lancashire. The modern medical centre is the property of NHS Property Services. There is easy access to the building and disabled facilities are provided. There is ample parking on the site.

The practice holds a Personal Medical Services (PMS) contract with NHS England and is part of Blackburn and Darwen Clinical Commissioning Group. It is part of East Locality Group which comprises five local practices.

There are two GP partners and two salaried GPs working at the practice. There is one female partner and one male. There are one female and one male salaried GP each working three sessions per week. There is a total of two whole time equivalent GPs available. There are two female nurse prescribers (practice nurses who can prescribe medicines for certain conditions), both are part time. Both nurses are Queens Nurses an award from the community nursing charity The Queens Nursing Institute. There is a part time practice manager, a medicines coordinator/secretary and a team of administrative staff. A NHS Property services administrator is also based at the practice.

The practice opening times are 8.30am until 6.30pm Monday to Friday. Appointments are available 8.30am to 12pm and 2.00pm to 6pm each day apart from Wednesday when appointments are available 8.30am to 11.30am. There are also late evening appointments available at three other locations Monday to Friday from 5pm to 7.45pm as the practice is part of the Blackburn with Darwen Federation.

Patients requiring a GP outside of normal working hours are advised to call NHS 111 and this puts patients in contact with East Lancashire Medical Services, the Out of Hours provider.

There are 4430 patients on the practice list. The majority of patients are white British with a high number of people aged under 40years. The practice population is in the most deprived decile in England.

This practice has been accredited as a GP training practice and has qualified doctors attached to it training to specialise in general practice. Staff were awarded a Quality Teaching Practice Bronze Award in 2014 from the University of Manchester for excellence in teaching medical students.

Updated 3 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Roman Road Health Centre on 11th August 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 make an appointment with a named 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. 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 improvements:

• Implement a risk assessment of the emergency drugs available.
• Consider undertaking a review of patients in caring roles so that appropriate support can be offered.

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Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 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 such as chronic obstructive pulmonary disease, diabetes and asthma.

• Performance for diabetes related indicators was better than the national average. The practice followed a protocol for newly diagnosed Type two diabetic patients and started appropriate patients on insulin. Diabetic education group sessions were run in house, there was telephone support access to a nurse 8.30am to 5.30pm and a diabetes newsletter was produced.

• Asthmatic patients had reviews of new inhalers after one month by phone or in person.

• There was pulmonary rehabilitation available for patients with Chronic Obstructive Pulmonary Disease (COPD).

• Longer appointments, home visits and evening appointments were available when needed including support with smoking cessation.

• 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.

• All patients at risk of hospital admission had an agreed care plan to try to avoid that eventuality..

• A monthly meeting was held with the Community Matron, District Nurse, Community Physio, Health Visitor, GPs, Practice Nurse, and the Practice Manager. If there were concerns regarding patients with a long-term condition these were discussed and an action plan was put in place to support the patient.

• Practice staff worked closely with the Achieving Self Care project (ASC) which aimed to improve the self care skills of the individual and increase community support and resilience. Self-Care Facilitators supported patients to develop independence and positive coping strategies and utilise these skills volunteering and engaging with community resources. Initial analysis in July 2014 suggests that 84% of those who access ASC experienced an improvement in their quality of life, 71% felt more confident in managing their own condition and there was a 15% increase of people in employment.

Updated 3 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.

• Childhood immunisation rates were high. Drop in Baby Clinics were held with practice nurses, health visitors and GPs. Health visitors met with the GP’s after the clinic to discuss any safeguarding concerns.

• The practice had offered very flexible care to meet the needs of its local population for example offering family planning to young mothers attending the baby clinic. This had impacted on numbers of under-age mothers on the practice register

• 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.

• 81% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compared to the national average of 82%. These appointments were available early in the morning and evenings..

• Appointment times were flexible around school attendance such as same day urgent appointments that were bookable after 3pm.

• The practice hosted a Child & Adolescent Mental Health Service (CAMHS) pilot.

• There was a Speech and Language Clinic run within the surgery.

• The Practice was working together with the Healthy Living Centre and Peoples Health Trust to engage with local communities over the longer term, so that people in the community can determine how and when the money is best spent within their local area, to make it a better place to grow, live, work and age.

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Updated 3 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. Home visits were carried out by Practice Nurses for annual reviews, flu vaccinations and ear irrigation for housebound patients. Follow up appointments were carried out by telephone if the patient was immobile or when there was a severe weather warning.

• Older patients were referred to the Enhanced Integrated Community Services which provided a hospital at home service including intravenous drugs.

• Practice staff visited care homes to provide health checks and reviews, confer with staff and managers and review medication. Staff referred patients to the primary care team and palliative care teams including District Nurses, palliative care nurses and Community matrons. Monthly multi-disciplinary meetings were held to discuss patient needs.

• Appointments were available until 6pm or until 7.45pm via the local Federation. This improved access for people who worked and who also had caring responsibilities.

• Patients on the admission avoidance register were discussed with the GP and a management plan was put in place.

• The practice referred patients to Here to Help (H2H) Project (Age UK)was an enhanced Integrated Service jointly funded by Age UK England and the local CCG to run initially for 12 months with a co-ordinator in each locality.This service aimed to work proactively with GPs to identify patients in need of support, share their knowledge of services available in the community and help at risk patients before they required a GP appointment.The service targeted patients aged 65 and over who had had two or more emergency hospital admissions in the last twelve months and had two or more long term health conditions

• There was a podiatry clinic run at the surgery.

• Practice staff referred to the Friends for Life over 50’s group to support social inclusion.

Updated 3 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 including access to online appointments as well as a full range of health promotion and screening that reflects the needs for this age group..

• A repeat prescription scheme was available which helped working age people, who found it difficult to contact the surgery during working hours.

• A wide range of appointment times were available including appointments at the surgery until 6pm and appointments within the Blackburn with Darwen Federation until 7.45pm.Telephone consultations were available as appropriate and contact with the GP’s and nurses could be made by E mail.

• All patients over 40 years were offered an NHS Health Check at the surgery.

• An agency offering advice on financial matters ran drop in sessions at the surgery.

• There was a sexual health, family planning and womens service available within the surgery.

• Staff signposted patients to the Healthy Living in the Community scheme and a community gym.

Updated 3 January 2017

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

• 93% 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 well to a national average of 88%.

• 97% of patients with mental health conditions had their smoking status recorded in the preceding 12 months. This compared well to a national average of 93%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and provided personalised medicine management.

• There was a memory assessment service provided on site.

• The practice hosted a Child & Adolescent Mental Health Services pilot.

• A Primary Care Mental Health Worker was to be based at the surgery as part of a two year pilot to commence in the autumn of 2016.

• The Practice nurses review and provide home visits where needed for patients with agoraphobia following bereavement.

• Patients are referred to Minds Matters, counselling, self care facilitation and Dementia Friends for support.

Updated 3 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 homeless people, travellers and those with a learning disability.

• People with a learning disability were reviewed annually by the GP and Practice Nurse during an extended appointment and staff liaised with the community learning disability team. A pictorial or easy read letter was used where necessary. Alerts were placed on notes to structure care around needs for example when a vulnerable patient was attending the surgery a longer amount of time was allocated for their appointment. GPs and practice nurses carried out home visits for people with learning disabilities who required cervical smears. The practice had suggested to the Locality Group that ultrasound scanning could be offered to patients who required mammograms.

• 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.

• 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.

• Vulnerable patients who repeatedly did not attend appointments were reviewed at practice meetings.

• There was a Drug and Alcohol Clinic run on site by a local voluntary agency.

• Carers of patients with long term conditions were signposted to a Carers Support Group.

• Patients with hearing impairment were given extended appointments to enable time for any communication barriers to be overcome. A signing service was used if required and patients received appointments by text.