The Castle Medical Group

Updated 10 March 2016

The Castle Medical Group is housed in Clitheroe Health Centre, a purpose built building. This accommodation is shared with a neighbouring GP practice. It is a dispensing practice, meaning that it is a practice authorised to dispense drugs, and the dispensary in the health centre is run jointly by the two practices. The practice dispenses medicine to approximately a third of its patient list.

Another GP practice (Pendleside Medical Practice), a Treatment Room provided and staffed by East Lancashire Hospital Trust as well as other healthcare services such as podiatry and community nursing teams are also located within the same building.

The building is accessible to people with disabilities.

The practice is part of the NHS East Lancashire Clinical Commissioning Group (CCG) and provides services to a patient list of 14,316 people under a General Medical Services contract with NHS England. The average life expectancy of the practice population is in line with the national average and above that of the CCG for both males and females. The practice population contains a higher proportion (21.6%) of people over the age of 65 than the national average of 16.7%. The percentage of the practice’s patients resident in nursing homes is 0.9%, which is higher than the national average of 0.5%. The practice also has a higher percentage of patients suffering with a long standing health condition; 57.1% compared to the national average of 54%.

Information published by Public Health England rates the level of deprivation within the practice population group as eight 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 eight GP partners (four female and four male) and four salaried GPs (three female and one male). The GPs are supported by five practice nurses, an assistant practitioner and two healthcare assistants (HCAs). Clinical staff are supported by a managing partner, a practice manager and an admin manager. The practice employes 22 admin and reception staff, as well as eight staff who work in the dispensary.

Castle Medical Group is a training practice and four of the GP partners are qualified as trainers. Placements are offered at the practice for both foundation year doctors and specialist trainees.

The practice is open Monday to Friday between the hours of 8am and 6:30pm. Appointments are offered from 8:30am onwards. In addition, the practice offers extended hours appointments between 6:30 and 8pm on a Monday evening and 7:15 until 8am on Tuesday and Wednesday morning. Outside normal surgery hours, patients are advised to contact the Out of hours service, offered locally by the provider East Lancashire Medical Services.

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Castle medical Group on 21 January 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.

• Feedback from patients about their care was consistently and strongly positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example it had reviewed it’s appointment system following patient feedback to offer more pre-bookable appointments. The practice engaged in ongoing monitoring of its appointment availability to ensure patients were able to access services in a timely way.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from its staff, which it acted upon.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality improvement and patient care as its top priorities. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. Governance in place to ensure the delivery of this vision and strategy was well organised.

We saw one area of outstanding practice:

• The practice worked closely with the other GP practice and the other healthcare professionals located within the building to develop local clinical pathways. A clinical pathway for guidance and management of atrial fibrillation had been agreed and was being implemented. This ensured patients living in the locality received consistent, evidence based care and treatment for atrial fibrillation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

The practice is rated as outstanding 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.

• Two practice nurses were trained to deliver an education programme to patients on diabetes and and also delivered training to residential and nursing home staff.

• The nurses were trained to offer insulin initiation for diabetic patients. Three practice nurses were also trained in anticoagulant management and held clinics to monitor patients blood to determine the correct dose of anti-coagulant medicine. This prevented the need for patients to make frequent hospital visits.

• Performance for diabetes related indicators was either better than or in line with the national average.

• 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 10 March 2016

The practice is rated as outstanding 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.

• The practice’s uptake for the cervical screening programme was 80.7%, which was higher than the CCG average of 74.2% and the national average of 74.3%.

• 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.

• A confidential sexual health clinic was offered for young people each week by one of the practice nurses.

• Two surgeries a week were offered by the GPs at a local independent boarding school to cater for the health needs of the pupils resident there, and the GPs had taken on the responsibility of appraising the school’s nursing staff so that they could maintain clinical competence.

Updated 10 March 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. For example one health care assistant was specifically employed to carry out reviews of patients over the age of 75 years. Close working relationships were established with the Community matron for people over the age of 75 with complex healthcare needs.

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

• Monthly palliative care meeting were held and community health care professionals attended these. Patients had a care plan in place.

• Care plans were in place for those patients considered at risk of unplanned admission to hospital.

• The practice worked closely with the locality advanced nurse practitioner who visited older people resident in care homes.

Updated 10 March 2016

The practice is rated as outstanding 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.

• Extended hours appointments were offered on a Monday evening as well as a Tuesday and Wednesday morning. Telephone consultations were also available.

Updated 10 March 2016

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

• 78.69% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
• Performance for mental health related indicators was either above or broadly in line with the national average. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record in the preceding 12 months was 95.05% compared to the national average of 88.47%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The integrated Neighbourhood Team had an attached mental health worker.

• The practice offered an enhanced service to facilitate timely diagnosis of dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• One of the GPs took responsibility for the health needs of a number of patients at a local community rehabilitation centre for people recovering from mental health difficulties.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 March 2016

The practice is rated as outstanding 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 and those with caring responsibility.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• There was a shared care agreement with a substance misuse support agency, and GPs liased closely with them to support patients that had been referred to them and accessed appointments with a drug misuse support worker on the practice premises.

• 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.