The Tarleton Group Practice

Updated 25 November 2016

The Tarleton Group Practice is located in Tarleton Health Centre which is in the centre of Tarleton village, a semi-rural area of the south of Preston, in Lancashire. The large modern health centre is owned and managed by NHS Property Services and patients can also access many other clinics and services on the site such as podiatry, district nursing and health visitors. There is easy access to the building and disabled facilities are provided. There is an onsite car park serving all of the medical facilities on the site.

There are six GPs working at the practice. All of the GPs are partners, three male and three female and there is one male GP registrar. There is a total of 4.00 whole time equivalent GPs available. There are two female nurses, both part- time and two part- time female health care assistants. There is a full time practice manager, a medicines management coordinator, and a team of administrative staff.

The practice holds a General Medical Services contract with NHS England. It forms part of West Lancashire Clinical Commissioning Group.

The practice opening times are 8.30am until 6pm Monday to Friday. Appointments are available 8.40am to 11.00am and 3.00pm to 5.30pm each day.

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 GP Service for West Lancashire (OWLS).There are 8113 patients on the practice list. The majority of patients are white British with a small community of East European and Portuguese patients. There are a proportionately high number of elderly patients and patients with chronic disease prevalence.On the Index of Multiple Deprivation the practice is in the least deprived decile.

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

Updated 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Tarleton Group Practice on 25th 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 did not always find it easy to make an appointment with a named GP however 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:

• Parents of patients with a learning disability were encouraged to plan for the future and staff had helped them to find several patients sheltered living arrangements.

• Staff had received training from a local transgender group and ensured that they received appropriate care and support.

• The practice involves staff comprehensively to develop and improve patient care. A staff working group representing clinicians and administrative staff had been set up to develop the one stop shop approach to supporting people with long term conditions. Consultation with staff had led to emergency packs to treat patients in anaphylactic shock in each treatment room. QOF results from the previous year were reviewed and a plan to improve them in the subsequent year was drawn up. Action included adjusting appointment times for nurses, annual reviews for patients with dementia, changes to coding particularly to identify house- bound patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 November 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. Staff aimed for a one-stop shop approach to reduce disruption for patients and save appointments.
• 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 including the community matron to deliver a multidisciplinary package of care.
• Practice staff made referrals to the local smoking cessation service.
• Blood monitoring was performed for patients with rheumatology and inflammatory bowel disease and staff liaised with specialist nurses. Staff gave injections for joint pain and hormone stabilisation.
• Blister packs and rescue packs for patients with chronic obstructive pulmonary disease COPD) were available where needed.These helped patients to take their medication on the correct day and gave them immediate access to antibiotics and advice if they developed a chest infection.

Updated 25 November 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. These were provided both at immunisation clinics, by appointment or via drop in.

• 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.

• 82% of women aged 25-64 are recorded as having had a cervical screening test in the preceding 5 years. This compared to a CCG average of 81% and a national average of 81%.

• 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 texting service was used to encourage teenagers to engage with stopping smoking and asthma clinic attendance.

• The practice offered access to a comprehensive family planning services including coil fitting.

• The practice website carried a message explaining confidentiality and there was a notice in the waiting-room.

Updated 25 November 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.

• A health care assistant (HCA) had been appointed to offer over-75 checks, either in surgery or at home where appropriate. This had allowed the practice to address new diagnoses of diabetes, deafness and depression. Additionally carers were identified, health improvements made, vaccinations offered and support provided such as signposting to relevant agencies. Three monthly reviews were offered where needed and the HCA remained the point of contact.

• Practice staff visited two local care homes to provide ward rounds, confer with staff and managers and provide advice on medicine management. A medicines optimisation review had recently taken place supported by the Clinical Commissioning Group (CCG).

• Staff referred patients to a primary care team based in the same building including District Nurses and Community matrons so that patients could receive a seamless service to meet their needs..

• The practice had a register of housebound patients.Home visits were available from nurses for these patients.

• Medicines management pharmacists attended the practice to rationalise prescribing. There was liaison with local pharmacists where blister packs were needed.

• Practice staff signposted to other services such as University of the Third Age (U3A) and Silver Surfers for social support.

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Updated 25 November 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 appointment booking and prescription ordering.
• The practice referred patients for physiotherapy and exercise on prescription.
• Surgeries began at 8.40am and appointments could be booked until 5.30pm. Appointments were also available at lunchtime.
• Urgent appointments were offered from 11am and there was an on-call doctor in the afternoons with 12 appointments only released after lunch. The duty doctor was available till 6.30pm.
• The practice was involved in proposals for a pilot scheme for seven day access.
• Two of the GP’s had attended training on the use of fit notes to encourage patients returning to work.
• Joint injections were offered to provide immediate treatment close to home, avoiding unnecessary referrals and travel.

Updated 25 November 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 CCG average of 91% and a national average of 88%.

• 96% of patients with mental health conditions had their alcohol consumption recorded in the preceding 12 months. This compared to a CCG average of 92% and the national average of 89%.

• 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 including daily prescriptions if needed.

• Dementia screening was done by HCAs in a variety of situations including home visits and advance care planning took place.

• 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 attended dementia training and identified patients to clinical staff where appropriate. They also received training on the Mental Capacity Act and carer awareness training. It was seen that there was well documented liaison with social services to provide holistic care for these patients.

• Blister packs were used to aid compliance with medication. They might be issued only one week at a time if memory problems were an issue.

• Reviews encouraged healthy lifestyles and led to referrals to exercise on prescription, dieticians and smoking cessation services.

• Staff liaised with a primary care mental health worker who offered cognitive behavioural therapy.

• The practice had increasing numbers of young patients with eating disorders and liaised closely with the child and adolescent mental health service.A template was used to capture relevant information and monitor any changes in the person’s condition. GP continuity was strongly encouraged by booking the next appointments face-to-face with the doctor.

Updated 25 November 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.

• The practice offered longer appointments for patients with a learning disability including physical checks. A patient--held booklet, “My Health Action Plan” was used to ensure multi-agency understanding of the patients care plan.There was a register of patients and a range of “easy-read” leaflets. Parents of patients with a learning disability were encouraged to plan for the future and staff had helped them to find several patients sheltered living arrangements.

• 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. These patients had comprehensive, personalised care plans which had been developed within the practice and included an alert if the patient had any safeguarding concerns.

• 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.

• Homeless people had the facility to register with a ‘practice address’ and put a plan in place to make future contact.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Practice staff had actively sought out 85 carers with alerts placed on patient records. A carer’s information board was maintained in the waiting room and there were two carers champions who took referrals to provide support, advice and signposted to agencies such as Age UK and Lancashire Carers. A practice leaflet had been produced “Do you look after someone?” which provided information for both adult and young carers.

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

• Screen alerts flagged up patients with communication problems such as those with visual or hearing loss, or reading difficulties. Staff had recently completed the Accessible Information Standard training.

• The practice ensured that the named GP liaised with social services to keep people in their own home as long as possible.

• There was a considerable immigrant population, many from Madeira, whose social problems can be compounded by the rural area and its transport links. Language line was used by staff when necessary. A receptionist who spoke Portuguese had recently been appointed.

• There were a small number of transgender patients whose care could be complex. Practice staff had tried hard to ensure their rights were upheld and that they received appropriate care and support. Staff had received training on how to support these patients from a local transgender group.

• Regular Gold Standard Framework meetings were held with the palliative care team and district nurses to support patients identified as being at the end of their life. After bereavement, next-of-kin were contacted by the appropriate doctor to offer condolences.