Parkgate Surgery

Updated 11 April 2016

Parkgate Surgery is situated on a main road close to the town centre of the semirural town of Ormskirk. The practice occupies a converted Victorian building and has a patient list size of 6313. The practice is part of the NHS West Lancashire Clinical Commissioning Group (CCG) and services are delivered to patients under a General Medical Services (GMS) contract with NHS England.

The average life expectancy of the practice population is above local averages for both males and females, with males on average living to 80 years and females to 83 years (CCG average being 79 and 82 respectively, national averages being 79 and 83 years). The practice’s patient population consists of a higher proportion of older people, with 27% being over the age of 65 (CCG average 20.4%, national average 17.1%), 12.9% being over the age of 75 (CCG average 8.9%, national average 7.8%) and 3.7% being over the age of 85 (CCG and national averages both 2.3%). The practice also caters for a higher proportion of patients with a long-standing health condition at 64%, compared to the CCG average of 55.5% and national average of 54%.

Information published by Public Health England rates the level of deprivation within the practice population group as nine 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 three GP partners (two female and one male). The GPs are supported by two practice nurses (both female). The clinical staff are supported by a practice manager, assistant practice manager and nine administration and reception staff.

The practice is open Monday to Friday between the hours of 8am and 6:30pm. Appointments are offered from 8:30am until 11:30am in the morning, and between 2pm and 6pm in the afternoon (with some slight variation in these times depending on the day of the week). Outside normal surgery hours, patients are advised to contact the out of hours service, offered locally by the provider OWLS CIC Ltd.

Updated 11 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parkgate Surgery on 11 February 2016. Overall the practice is rated as outstanding.

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

• The practice delivered services to a higher than average proportion of older patients and had good working relationships with the 15 care homes contained within the practice boundary.

• The practice demonstrated a thorough awareness of the needs of its patient population and had put measures in place to improve outcomes for patients identified as being at risk. This was particularly evident in the work undertaken around provision for older patients and those at risk of hospital admission. The practice closely monitored its quality improvement work to ensure a comprehensive understanding of the impact it had on patient outcomes.

• The practice had implemented additional nursing time specifically to facilitate home visits to over 75 year olds, housebound and frail patients. The practice also employed a care coordinator who oversaw administration tasks relating to those patients at risk of hospital admission.

• The practice had produced a branded folder in which patients could store their hand held personalised care plan. This made it easily identifiable and so facilitated information sharing with other professionals and gave patients an increased sense of ownership of their care.

• 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. The practice logged and categorised incidents in order to monitor trends and allow them to better predict where problems may arise.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example they carried out opportunistic screening for atrial fibrillation during a weekend flu vaccination clinic which resulted in three new diagnosis.

• Feedback from patients about their care was consistently and strongly positive. Patients told us that they felt valued and were always made to feel like a priority by staff.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. Multidisciplinary team meetings were held in the practice on a weekly basis, and care plans for complex patients drawn up jointly with other professionals to ensure the best care was provided.

• 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 the telephone system had been updated following patient feedback that it could be difficult to get through to the practice by phone.
• 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 and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw several areas of outstanding practice including:

• The practice was engaged in a comprehensive programme of clinical audit which allowed them to clearly demonstrate quality improvement and how this improvement had been achieved. This allowed the practice to have a robust understanding of its performance. Key areas of improvement included a significant reduction in emergency admissions, an increased prevelance of atrial fibrillation and reduction in prescribing of hypnotics. For example the practice could demonstrate how emergency admissions into hospital had been reduced by 95% over an 18 month period, and attendance at other secondary care services reduced by 50%.

• The practice was proactive in identifying clinical risks, and then taking rapid action to address and mitigate these risks. Once identified they were discussed at the next weekly clinical meeting, assigned to a nominated GP lead as well as having administration time identified to support the resulting work undertaken to make improvements.

• Staff had received carer awareness training to give them the skills to screen and identify those patients with caring responsibility.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 April 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.

• The practice employed a care coordinator who oversaw administration tasks relating to those patients at risk of hospital admission.

• Patients on the admissions avoidance register were provided with a hand held personalised care plan which was easily identifiable as it was in a branded practice folder. This facilitated information sharing with other professionals and gave patients an increased sense of ownership of their care.

• The practice demonstrated that improvements to services had resulted in a reduction of emergency admissions to hospital of 95%, and a reduction of 50% in patients presenting to other secondary care services.

• 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. Multidisciplinary meetings were held on a weekly basis.

• Of all patients on four or more medications, 92% had attended a medication review appointment in the last year, while 83% of patients on repeat medication had had their medicines reviewed.

• The practice offered an ECG telehealth service, where results were analysed instantly and feedback offered by a consultant cardiologist.

• The practice had recognised an underdiagnosis of atrial fibrillation, and had taken action resulting in an increased prevelance from 137 to 193 patients.

Updated 11 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.

• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months that included an assessment of asthma control using the three RCP questions was 79.44%, compared to the national average of 75.35%.

• 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 82.53%, which was in line with the national average of 81.83%. The practice had carried out audit activity to address repeated failures to attend for cervical smear appointments. Following targeted intervention the practice was able to demonstrate a 12% increased uptake in smear appointments amongst this patient cohort.

• 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.

Updated 11 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 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.

• The practice delivered services to a higher than average proportion of older patients and had good working relationships with the 15 care homes contained within the practice boundary.

• The practice had implemented additional nursing time specifically to facilitate home visits to over 75 year olds, housebound and frail patients. In the year 2014/15 the practice completed a total of 453 health checks for patients over the age of 75 (this was compared to just three the previous year before the additional nursing time had been sourced).

• The nurse had a ringfenced session each week to carry out home visits for this population group.

• The practice regularly audited the services it provided for older people, and could demonstrate that emergency admissions from patients residing in care homes had reduced by 33% as a direct result of improvements to care pathways.

Updated 11 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.

• 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.

• Telephone consultations were offered for those patients requiring medical advice who were unable to make it into the surgery.

Updated 11 April 2016

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 89.04% compared to the national average of 84.01%.

• Performance for mental health related indicators was consistently higher than 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 90.32% compared to the national average of 88.47%. The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 89.04% compared to the national average of 84.01% and the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 94.12% compared to the national average of 89.55%.

• 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. Reception staff had received training to raise their awareness of issues around dementia.

Updated 11 April 2016

The practice is rated as outstanding for the care of people who circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• 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.

• 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.

• Staff had received carer awareness training to give them the skills to screen and identify those patients with caring responsibility.

• Reception staff had attended training around how to appropriately register migrants in anticipation of an influx of this population group to the area in the near future.