Fishergate Hill Surgery

Updated 7 December 2016

Fishergate Hill Surgery is located approximately one mile from the centre of Preston, Lancashire on a busy junction of a residential and industrial unit area. The modern medical centre has been recently extended and refurbished and plans have been submitted for further extension of both the ground floor and first floor accommodation and the car park. There is access to the building through a single glass door leading to a small reception area and access for disabled patients is currently restricted into the waiting area. There are plans to improve this in response to patient feedback.

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

There are three GP partners and one part time salaried GP working at the practice. There are two male partners and one female partner. The salaried GP is female and works four sessions each week. There is a total of 2.8 whole time equivalent GPs available. There is one full time practice nurse, one part time triage nurse, one part time Health Care Assistant (HCA) and one full time Advanced Nurse practitioner who leads the nursing team. There is a full time practice manager, a part time clinical pharmacist, two medicines coordinators and a team of administrative staff.

The practice opening times are 8.15am until 6pm Monday, Tuesday, Thursday and Friday and 8.15am until 8pm on Wednesday. The practice is also open on two Saturdays per month 8.30am until 11.30am. Appointments are available 8.20am to 12.30am and 3pm to 6pm Monday to Friday and 8.30am to 11.30am on two Saturdays per month.

Patients requiring a GP outside of normal working hours are advised to call the 111 service who will transfer them to the Out of Hours provider Preston Primary Care.

There are 6200 patients on the practice list. The majority of patients are white British with a high number of people aged 15-64years. However there are significant numbers of white European (12%) and Asian (12%) patients. The practice population is in the fifth less deprived decile in England according to the Index of Multiple Deprivation.

This practice has been accredited as a GP training practice and has qualified doctors attached to it training to specialise in general practice.

Updated 7 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fishergate Hill Surgery on 2nd 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 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.

We found one area of outstanding practice:

• The practice had developed a credit card sized useful telephone numbers hand out for patients with mental health problems who were at risk of significant self harm which included contact numbers for the crisis team and Samaritans.

The areas where the provider should make improvements :

• Practice staff should establish a more robust system of clinical audits which demonstrate quality improvement over three completed cycles.
• The practice team should consider establishing more formalised meetings which minute discussions about serious events, complaint etc. The action points should be logged and brought forward for review.
• Continue to monitor the number of patients identified as carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 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 such as chronic obstructive pulmonary disease, chronic kidney disease, diabetes and chronic heart disease.

• Performance for diabetes related indicators was better than the national average. A diabetic foot screening clinic was held weekly by a podiatrist at the surgery and patients preferred to attend the surgery rather than the hospital as they felt it was a less stressful experience.

• 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.

• 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 physiotherapist, GPs, practice nurse, health care assistant (HCA) 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.

• The practice team had recently reviewed and revised the call and recall service to improve annual recalls of patients and made some multiple co-consultations into one appointment to reduce travel and inconvenience for patients.

• Specific clinics were held for patients on anti-coagulation medication. The HCA ran these and was overseen by a GP and this improved local access, monitoring and compliance. For some patients this was also done as a home visit.

• Hand held micro spirometry (a tool to assess lung function) was used to assess house bound patients with chronic obstructive pulmonary disease (COPD) more accurately. A pharmacist worked in the practice two days per weekand specialised in the management of chronic lung diseases.

Updated 7 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, when children and young people who had a high number of A&E attendances or failed to attend appointments a health visitor was informed.

• Immunisation rates were high for all standard childhood immunisations. Immunisation clinics were held at the surgery on Mondays with GP’s and nurses involved.

• 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.

• 88% 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, evenings or Saturday morning. The Lead Nurse reviewed all results and recalled patients accordingly.

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

• A post-natal clinic was run on Fridays led by the senior partner who discussed contraception during the appointment. The practice had adopted a template for oral contraception repeat prescription requests to improve accessibility to this service. These were reviewed by the prescribing doctor with the aim of reviewing the patient face to face annually. Long term contraception such as implants was provided by a regular locum GP.

• Ante natal assessment with a midwife was available once a week at the surgery which gave easy access and communication between the teams who provided care and support.

Updated 7 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, including blood tests being carried out at patient’s home by the health care assistant (HCA).

• A triage service allowed assessment of nursing home and residential home contact requests and assisted with the identification of the most appropriate response. Practice staff then visited care homes to provide health checks and reviews, confer with staff and managers and review medication.

• Patients were referred to the primary care team and palliative care teams including district nurses, community matrons, Lancashire Wellbeing and community physiotherapists. Monthly multi-disciplinary meetings were held to discuss patient needs.

• Extended hours were available for appointments in the evenings and on Saturdays. This improved access for people who worked and who also had caring responsibilities.

• All patients aged over 75 years were offered a health check at the surgery or in their own home and were referred for additional support dependent upon the findings.

Updated 7 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 and access to online appointments as well as a full range of health promotion and screening that reflected the needs of 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 extended hours and Saturday mornings. Telephone consultations were available as appropriate.

• Electronic prescribing assisted patients with collection of prescriptions direct from the pharmacist of their choice including pharmacies near their work place.

• Nurse offered a triage service for urgent appointments on the same day. The nurse assessed the patient and directed them to the most appropriate clinician or service.

• The surgery was open every second and fourth Saturday morning and until 8pm Wednesday, to assist people during a working week. There were also early morning pre-bookable appointments at 8.20 a.m. Patients could book appointments three months in advance.

• When patients had exceptional difficulties with attending for blood tests the HCA would see them outside normal clinic times.

Updated 7 December 2016

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

• 91% 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 to a national average of 88%.

• 95% of patients with physical and/or mental health conditions had their smoking status recorded in the preceding 12 months. This compared to a national average of 94%.

• 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 such as reduced duration prescribing for people at risk of overdose or addiction.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. They had developed a credit card sized useful telephone numbers hand out including the crisis team and Samaritans for people with significant self-harm risk.

• 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.

• Urgent appointments were offered if patients felt unable to cope including telephone consultations. After discharge from hospital patients were reviewed regularly until the staff felt they were stable. Appointments were arranged at quiet times for patients who were anxious.

Updated 7 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. These patients were reviewed annually by the GP and staff liaised with the community learning disability team.

• 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.

• 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 and the patient was visited at home and assessed in their own environment to ensure that necessary support was provided.

• Immediate triage was offered to patients requesting same day appointments. The nurse assessed and directed the patient to the appropriate service.

• These patients had a care plan and were identified as appropriate for same day reviews. Prompts and alerts on patient records were used to highlight this.

• The practice maintained a log of all children on the list for safeguarding and maintained a list of vulnerable adults on a Deprivation of Liberty Safeguard (DoLS) and they were reviewed regularly and records updated. (DoLS a set of checks that aims to make sure that any care that restricts a person’s liberty is both appropriate and in their best interests).

• The practice involved an Independent Mental Capacity Advocate (IMCA) in meetings to discuss the best interests of patients.

• For people with hearing impairment and sight impairment extra time was given and appropriate support provided including written or computer based consultations. There was a hearing loop available on the reception desk.

• Practice staff had access to and regularly used language line interpreting services to aid communication.