Latchford Medical Centre

Updated 19 September 2016

Latchford Medical Centre is located in Latchford, Warrington, Cheshire. The practice was providing a service to approximately 6,400 patients at the time of our inspection.

The practice is part of Warrington Commissioning Group (CCG) and is situated in an area with higher than average levels of deprivation when compared to other practices nationally. The practice population is made up of a higher than average percentage of patients aged 0-9 years and working age people aged 25-39 years. The practice has a lower than average elderly population. The percentage of patients with a long standing health conditions is lower than the local and national average.

The practice is run by three GP partners. There is an additional salaried GP (two male and two female). There are two practice nurses, one health care practitioner, one health care assistant, a practice manager and a team of reception/administrative staff.

The practice is open from 8am to 6.30pm Monday to Friday. The practice had signed up to providing longer surgery hours as part of the Government agenda to encourage greater patient access to GP services. Patients could access a GP at a Health and Wellbeing Centre in the centre of Warrington from 6.30pm until 8pm Monday to Friday and between 8am to 8pm Saturdays and Sunday mornings pre-booked appointment.

Outside of practice hours patients can access the Bridgewater Trust for primary medical services.

The practice is a training practice for trainee GPs and foundation year doctors.

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice has a Personal Medical Services (PMS) contract. The practice provides a range of enhanced services, for example: childhood vaccination and immunisations, checks for patients who have a learning disability and avoiding unplanned hospital admissions.

Updated 19 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Latchford Medical Centre on 20 July 2016. Overall the practice is rated as good. Our key findings across all the areas we inspected were as follows:

• Staff clearly understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Significant events had been investigated and the provider could clearly demonstrate that action had been taken as a result of the learning from events.

• Systems were in place to deal with medical emergencies and all staff were trained in basic life support.

• There were robust systems in place to reduce risks to patient safety. For example, infection control practices were good and there were regular checks on the environment and on equipment used.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical staff were well supported to keep up to date with changes to best practice and to share their learning.

• Feedback from patients about the care and treatment they received from clinicians was highly positive. Patients told us they were treated with dignity and respect and were involved in decisions about their care and treatment.

• Data showed that outcomes for patients at this practice were similar to or better than outcomes for patients locally and nationally.

• Staff felt well supported and they were kept up to date with appropriate training. Staff we spoke with told us they had the skills, knowledge and experience to fulfil their roles and responsibilities.

• The majority of patients we spoke with said they had no difficulty in making an appointment and they felt there had been improvements to the appointment system and their experience of reception staff over the past year.

• The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

• The provider actively sought feedback from patients and acted upon it to improve patients’ experiences of the service. This included the practice having and consulting with a patient participation group (PPG).

• Information about services and how to complain was available. Complaints had been investigated and responded to in a timely manner. Action had been taken to improve the service in response to complaints.

• The practice had a clear vision to provide a safe and high quality service.

• There was a clear leadership and staff structure and staff understood their roles and responsibilities.

• The practice provided a range of enhanced services to meet the needs of the local population.

We saw areas of outstanding practice:

• The provider demonstrated a high level of drive and commitment to learn from incidents, use information, data and feedback to drive improvements and provide high quality care and treatment.

• The practice had good protocols and practices in place to share information and promote the safeguarding of vulnerable children.

• The practice operated a policy whereby they called all patients who had not attended their appointment to ensure they were safe.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 September 2016

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

• The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required immunisations received these.

• Regular, structured health reviews were carried out for patients with long term conditions and in line with best practice guidance.

• Patients were provided with advice and guidance about prevention and management of their health and were signposted to support services.

• Data from 2014 to 2015 showed that the practice was performing in comparison with or better than other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. For example, the percentage of patients with diabetes, on the register, who had had an influenza immunisation was 97% compared to a national average of 94%.

• One of the practice nurses was the diabetes lead nurse with the CCG and one of the GPs held a post graduate qualification in Diabetes. Patients could be provided with insulin initiation by the practice nurse which reduced the need for referral to secondary care.

• Longer appointments and home visits were available for patients with long term conditions when these were required.

• One of the practice nurses was a ‘Cancer Champion’ who ensured that patients were involved in a plan of care following initial diagnosis. It was also the champion’s role to signpost patients to the right support services.

• The practice provided an in house phlebotomy service which was convenient for patients especially those requiring regular blood monitoring.

• The practice provided an enhanced service to prevent high risk patients from unplanned hospital admissions. This included these patients having a care plan, a review of their medicines and a named GP.

• The practice monitored unplanned hospital admissions.

• Regular clinical meetings were held to review the clinical care and treatment provided and ensure this was in line with best practice guidance.

Updated 19 September 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 those who were at risk, for example, children and young people who had a high number of A&E attendances.

• A GP was the designated lead for child protection. A designated member of staff was responsible for liaising with the local authority to ensure the practices’ register of vulnerable children was up to date. Another member of staff was responsible to ensuring the GPs provided reports for case conferences.

• Regular meetings had been introduced with midwifes and health visitors to discuss child protection concerns.

• Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures. They provided examples of when and how they had acted upon concerns.

• Family planning and contraceptive services were provided.

• Child health surveillance clinics were provided for 6-8 week olds.

• Child immunisation rates were comparable to the national average for all standard childhood immunisations. Opportunistic immunisations were given to encourage uptake. The practice monitored non-attendance of babies and children at vaccination clinics and reported any concerns appropriately.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 78% which was comparable to the national average of 81%.

• Babies and young children were offered an appointment as priority and appointments were available outside of school hours.

Updated 19 September 2016

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

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

• The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

• The practice provided a range of enhanced services, for example, the provision of care plans for patients over the age of 75 and the screening of patients for dementia.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or better than local and national averages. For example, the percentage of patients with COPD who had a review undertaken including an assessment of breathlessness was 96% compared to the national average of 89%.

• GPs carried out regular visits to local care homes to assess and review patients’ needs and to prevent unplanned hospital admissions.

• Home visits and urgent appointments were provided for patients with enhanced needs.

• The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.

• Practice staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.

Updated 19 September 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.

• Telephone consultations were provided and patients therefore did not always have to attend the practice in person

• The practice was part of a cluster of practices whose patients could access appointments at a local Health and Wellbeing Centre up until 8pm in the evenings Monday to Friday, and from 8am to 8pm Saturdays and Sunday mornings, through a pre-booked appointment system.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group. Screening uptake for people in this age range was lower than local and national averages. For example 69% of females aged 50-70 had been screened for breast cancer in the last three years compared to a national average of 72%. The practice was aware of the lower than average uptake rates and had actively contacted patients to improve this for bowel screening with the intent of rolling this out for breast screening.

• The practice was proactive in offering online services including the booking of appointments and requests for repeat prescriptions. Electronic prescribing was also provided.

Updated 19 September 2016

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

• The practice held a register of patients experiencing poor mental health and these patients were offered an annual review of their physical and mental health.

• The practice had a designated lead for mental capacity.

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were similar to or better than local and national averages. For example, data showed that 96% patients diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This compared to a national average of 84%.

• The practice provided an enhanced service to proactively offer assessment to patients at risk of dementia and to improve the quality and effectiveness of care provided to patients with dementia.

• Staff had been provided with training in dementia awareness to support them in supporting patients with dementia care needs.

• The practice referred patients to appropriate services such as psychiatry and counselling services and had shared care arrangements with psychiatric services for prescribing medicines.

• Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they were prescribed.

• A system was in place to follow up patients who had attended accident and emergency and this included where people had been experiencing poor mental health.

• Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations and the practice hosted a cognitive behavioural therapist.

Updated 19 September 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 in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these.

• The practice had a designated lead for patients with a learning disability.

• Staff were aware of their responsibilities with regards to child and adult protection including, information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice operated a policy whereby they called all patients who had not attended their appointment to ensure they were safe.

• The practice was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available.

• The practice hosted a range of support services on a regular basis. For example, dietician, smoking cessation, Citizens Advice Bureau (CAB). A dedicated assistant practitioner social worker was attached to the practice to offer support to vulnerable patients in the community and to signpost patients to appropriate services.

• Information and advice was available about how patients could access a range of support groups and voluntary organisations.