Archived: Dalton Square Practice

Updated 17 December 2015

Dalton Square Practice is housed in a 200 year old Georgian building in the centre of Lancaster. The practice provides services to a patient list of approximately 12,800 people. The demographic area served by the practice contains a higher proportion of people aged between 18-24 due to the close proximity of local universities.

Information published by Public Health England rates the level of deprivation within the practice population group as six 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 similar proportion of patients experiencing a long-standing health condition (55.3% compared to the national average of 54%) but for a lower proportion of patients with caring responsibilities (12.8% compared to the national average of 18.2%). The practice has slightly more disability allowance claimants per 1000 (51.3) than the national average (50.3). The proportion of patients who are in paid work or full time education (60.7%) is in line with the the national average of 60.2%.

The practice is part of the NHS Lancashire North Clinical Commissioning Group (CCG) and services are provided under a Personal Medical Services Contract (PMS). There are seven GP partners (six male and one female), as well as three female salaried GPs. The practice also employs three female practice nurses, four female health care assistants, and a pharmacist. Non-clinical staff consisted of a practice manager and assistant practice manager, two care coordinators and 12 administrative and reception staff. Dalton Square Practice is a training practice for GP registrars and medical students.

The practice is open between 8:00am until 18:30 Monday to Friday, with appointments offered between 8:30am and 5:50pm. Extended hours are offered between 6:30pm and 8:00pm on two evenings per week for pre booked appointments. The practice rotates the evenings these appointments are offered each week in order to maximise accessibility for patients.

When the practice is closed, patients are able to access out of hour’s services offered locally by the provider Bay Urgent Care.

Updated 17 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dalton Square Practice on 4/11/2015. Overall the practice is rated as good.

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

• The practice prioritised continuity of care for its patients. Patients said they found it easy to make appointments when they needed them.
• 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. The practice was consistently ranked highly compared to other local feedback for patient satisfaction.Feedback to questions relating to patient access was particularly strong.

• 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.
• 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 altering shift patterns of reception staff to better manage busy periods of the day.
• The practice facilities meant it 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.

We saw several areas of outstanding practice:

• Every patient had a named GP and 65% of all consultations offered were with a patient’s named GP.

• The practice accepted registrations from patients who were resident outside the geographic boundaries of the surgery, as long as it was clinically safe to do so.This allowed for greater flexibility for patients who, perhaps due to work commitments, would find it easier to attend appointments in Lancaster.

• The practice ran a weekly sexual health clinic during university term time. It was not necessary to be registered as a patient with the practice in order to access this service.

The areas where the provider should make improvement are:

• Consider maintaining an asset register to safeguard against equipment being overlooked for maintaininace, calibration and testing.

• Ensure appropriate electrical safety cetification is sought for the premises.

• Ensure the formalised systems in place for monitoring emergency medicines and equipment include all medicines held on site.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 December 2015

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.

• Performance for diabetes related indicators was better than the national average. For example, the percentage of patients with diabetes on the register who had a record of an albumin:creatinine ratio test in the preceding 12 months was 91.9%, compared to the national average of 85.94%.

• Longer appointments and home visits were available when needed.

• All these patients had a structured annual review to check that their health and medicines needs were being met. Care was coordinated so that patients were only required to attend for one review appointment, regardless of how many disease registers they were on.

Updated 17 December 2015

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 practice’s uptake for the cervical screening programme was 78.77%, which was comparable to the CCG average of 75.5% and the national average of 76.9%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw good examples of joint working with midwives, health visitors and school nurses. Midwives held ante-natal clinics on two afternoons per week at the practice.

Updated 17 December 2015

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.

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

• 85.58% of over 65s had received influenza vaccine compared to the national average of 73.24%.

• The practice participated in the Gold Standard Framework in order to optimise the coordination and quality of care offered to patients in the final year of their life.

Updated 17 December 2015

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.

• Evening appointments were offered until 8:00pm on 2 nights per week catering for those patients who worked through the day.The evenings these session were offered rotated each week in order to maximise patient choice.

• 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 17 December 2015

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

• 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 94.19% compared to the national average of 86.04%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 97.67% compared to the national average of 88.61%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• It offered enhanced services for patients with dementia, facilitating timely diagnosis.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 17 December 2015

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 those with caring responsibility and those with a learning disability.

• It offered longer appointments for people with a learning disability.

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

• It had told 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.