Abbey-Dale Medical Centre

Updated 5 April 2016

Abbey-Dale Medical Practice is housed in a purpose built building situated between Blackpool & Lytham St. Annes. The practice provides services to a patient list of 3633 people. The practice has been given planning approval to extend the building in the near future and plans are in place to amalgamate the practice services with those of another single-handed practice following this extension.

The practice is part of the NHS Blackpool Clinical Commissioning Group (CCG) and services are provided under a Personal Medical Services Contract (PMS). There are four GP partners (three male and one female). The practice also employs one practice nurse, one health care assistant and a pharmacist. There is also an additional health care assistant who is employed by the local hospital trust and works at the practice. Non-clinical staff consist of a practice manager, a practice manager assistant and eight administrative and reception staff.

The practice is open between 8am and 6.30pm Monday to Friday, with appointments offered between 8.30am and 5.40pm. Extended hours are offered between 6.30pm and 8.30pm on Monday evening with appointments available until 8.20pm. When the practice is closed, patients are able to access out of hours services offered locally by the provider Fylde Coast Medical Services by telephoning a local number or 111.

The practice has a higher proportion of patients over the age of 45 when compared with the England average. Figures show that the practice has 21.3% of patients aged 65 and over compared to the England average of 16.7%.

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 caters for a lower proportion of patients experiencing a long-standing health condition (52% compared to the national average of 54%). There are significantly more disability allowance claimants per 1000 (79) than the national average (50). The proportion of patients who are in paid work or full time education is slightly lower (59%) than the national average of 60% however those unemployed are significantly lower, 1% compared to the national average of 6%.

The practice provides level access to the building and is adapted to assist people with mobility problems. A stair lift provides access to one consulting room on the first floor if needed.

Updated 5 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Abbey-Dale Medical Centre on 17 February 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 the skills, knowledge and experience to deliver effective care and treatment.

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

• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 saw several areas of outstanding practice:

• The practice, together with the health visitor, carried out health checks for babies aged between seven and nine months even though this was no longer funded for the child health screening programme. This ensured continuity of care and improved the uptake of child vaccinations and immunisations.

• The practice was the preferred provider of care for transgender patients with the local lesbian, gay, bisexual and transgender forum. The practice was commended by the forum for its care and sensitivity and provided care for transgender patients. NHS England supported the practice to provide services for one transgender patient who was outside the practice catchment area.

• The practice ran monthly memory clinics and patients were able to self-refer to these clinics as required.

The areas where the provider should make improvement are:

• Carry out regular audit to inform quality of care and review actions taken as a result of significant event analysis to assess their effectiveness.

• Ensure that potential staff chaperones have a DBS check or risk assessment in place before they act as a chaperone (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

• Ensure additional training and guidance is sought for GPs in relation to Deprivation of Liberty Safeguards.
• Update the Patient Specific Directions to ensure the administration of vaccinations is patient specific , as authorised by a GP.
• Undertake a Legionella assessment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 April 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had up to date training in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice achieved 98.2% of available points via the Quality and Outcomes Framework (QOF) in 2014-15. Key achievements for diabetes included 88% of patients with diabetes whose blood pressure readings were equal to or below maximum recommended levels. This was 10% above 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. Nursing staff offered home visits to patients who were unable to visit the practice for condition reviews. The practice pharmacist also offered appointments to review patient medications.

Updated 5 April 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. Immunisation rates were relatively high for all standard childhood immunisations ranging from 84% to 100% and the practice had a robust process to follow up on non-attenders.

• 91% of patients diagnosed with asthma had received an annual review in the preceding 12 months which was above the national average of 75%.

• Cervical screening for women aged 25 to 64 was 72%, which was comparable with the CCG average.

• 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. The practice health visitor had been in post for over 20 years. Together with the GP, the practice continued to offer checks to seven to nine month old babies even though funding for this had been removed nationally. This helped provide a continuing relationship with the practice and encouraged further attendance for baby health checks and immunisations.

Updated 5 April 2016

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

• The practice offered proactive, personalised care to meet the needs of older people in its population.

• A GP was given protected time to work with the practice pharmacist, nursing staff and patients to produce care plans for those patients at risk of emergency admission to hospital or who might need care when the surgery was closed. These plans were reviewed regularly. If a patient was admitted to hospital, the GP reviewed the care plan and the patient was contacted. A home visit or surgery appointment was made when needed.

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

• The practice offered a monthly memory-screening clinic that patients could self-refer to if they wished to. If needed, patients were then referred to local memory services.

• Members of the hospital bowel screening team visited the practice every six months to encourage patients to take up this service. This improved uptake among the patient population from 176 patients during 2014-2015 to 183 patients during the same period in 2015-2016.

• The practice had robust systems in place to follow up patients who did not collect their repeat prescriptions or failed to attend appointments at the practice or hospital.

Updated 5 April 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.

• Appointments were offered on a Monday evening up to 8.20pm.

• 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.

Updated 5 April 2016

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

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  The practice had recorded an agreed care plan for 100% of patients with a recognised mental health problem compared to the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 5 April 2016

The practice is rated as good for the care of people who 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.

• We were told that the travelling community recognised the practice as providing exceptional care and there were a large number of patients on the list for this population group. This was also confirmed by the Health Visitor.

• The practice offered longer appointments for patients with a learning disability. When referrals to other services were needed, patients were asked to wait so that the referral process could be explained and the relevant paperwork given to them before they left the practice.

• The practice was recommended by the local lesbian, gay, bisexual and transgender forum as the first choice practice for transgender patients.It commended the practice on its website for its care and sensitivity. NHS England supported the practice to provide services for one transgender patient who was outside the practice catchment area.

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

• 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. The safeguarding GP lead for the practice was also the safeguarding lead for the CCG and delivered extra in house training to staff.