Archived: Lisle Court Medical Centre

Updated 8 November 2017

Lisle Court Medical Centre provides GP services to a diverse population of over 4,600 patients living in the heart of Royal Leamington Spa. One third of the practice’s consultations are conducted in languages other than English and the patient list has seen an increasing prevalence of young families and students. There are pockets of high and low deprivation within the practice catchment area resulting in a patient list with a broad variety of needs. The practice premises are converted from former flats and there is a small adjoining car park and on-street parking available. Facilities for people with disabilities were available at the practice including parking, step free access to consultation rooms and a hearing loop.

The clinical team consists of one male and one female GP, a female regular sessional GP, a nurse practitioner and three practice nurses, a healthcare assistant and a phlebotomist (person who takes blood). The team is supported by a practice manager, a finance manager, an assistant practice manager, an interpreter, a head receptionist, two administrators and four reception staff.

The practice is open between 8.30am and 6pm from Monday to Friday, closing for an hour daily between 12.30 and 1.30pm. At the times between 8am and 6.30pm and lunchtimes when the practice reception was closed the telephone system diverted to the duty GP’s mobile telephone so that any urgent patient needs could be dealt with.

Appointments are available from 9.20am to 12.10pm and 2.30pm to 5.10pm daily. Additional appointments are also available on selected days from 8.30am, from 2pm and until 5.40pm. Extended hours appointments are offered with a GP from 6.30pm to 8pm on Tuesday each week, and with a GP and a nurse from 9am to 11am on one Saturday morning per month. A nurse practitioner is available on one Tuesday evening per quarter. There are arrangements to direct patients to the NHS 111 out of hours service from 6.30pm to 8am.

Home visits are also available for patients who are too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book routine GP appointments.

We previously carried out an announced comprehensive inspection at Lisle Court Medical Centre on 14 July 2016. The practice was rated as requires improvement in safe, caring and well-led with good in effective and responsive; with an overall rating for the practice of requires improvement.

This inspection was an announced focused inspection carried out on 21 September 2017 to confirm that the practice had carried out their plan to address the areas requiring improvement that we identified in our inspection in July 2016. This report covers our findings in relation to the requirements and improvements made since our last inspection.

We found the practice had carried out a detailed analysis of the previous inspection findings and taken action to address areas where improvements were needed. The practice had made extensive changes which had resulted in significant improvements. Practice staff had taken responsibility for embedding and maintaining these improvements and we saw a positive approach to performance and improvement throughout.

Updated 8 November 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Lisle Court Medical Centre on 14 July 2016. As a result of our inspection the practice was rated as requires improvement in safe, caring and well-led with good in effective and responsive; with an overall rating for the practice of requires improvement. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Lisle Court Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 21 September 2017 to confirm that the practice had carried out their plan to address the areas requiring improvement that we identified in our inspection in July 2016. This report covers our findings in relation to the requirements and improvements made since our last inspection.

We found the practice had carried out a detailed analysis of the previous inspection findings and taken action to address areas where improvements were needed. The practice had made extensive changes which had resulted in significant improvements. Practice staff had taken responsibility for embedding and maintaining these improvements themselves and we saw a positive approach to performance and improvement throughout.

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

• Staff knew how to document significant events and escalate concerns. There was a system for dealing with incidents and learning was shared with staff at team meetings. Records showed that changes implemented when lessons were learned were kept under regular review to ensure that these had been fully embedded.
• Risks to patients were assessed and well managed. The system for recording and monitoring GP training had been improved and showed that training in infection control and fire safety was up to date.
• Data showed patient outcomes were rated in line with the local and national averages. A programme of continuous audit evidenced improvement to patient outcomes.
• Although the National GP Patient Survey results published in July 2017 showed that overall patients’ experience of the practice and the satisfaction scores were lower than local and national averages, there had been improvements in some areas.
• The practice had a diverse population with a large number of Punjabi speaking patients. An interpreter was employed to accommodate this group and conducted approximately one third of consultations in languages other than English.
• Policies were specific to the practice and easily accessible to all staff.
• The management of medicines and emergency equipment had been improved with revised procedures which were regularly monitored to ensure they were followed.
• The process for updating Patient Group Directions (PGDs) had been revised and ensured that PDGs were signed before they were acted upon.
• The practice monitored and encouraged uptake of childhood immunisations to improve health outcomes. Unpublished data showed results had increased and were now in line with local and national averages.
• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening, but uptake for both was lower than local and national averages. Staff followed an established recall protocol to encourage patients to take up screening opportunities.

There were some areas where improvements should be made:

• Continue to encourage patients to engage in screening programmes.
• Take action to improve patient satisfaction particularly in the area of GP/patient interaction.

The practice is now rated as good for providing safe, effective, caring, responsive services, and for being well-led. The overall rating for the practice is now good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 November 2017

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

• The practice nurses had lead roles in chronic disease management such as diabetes, Chronic Obstructive Pulmonary Disease (COPD) and asthma.
• Performance for diabetes related indicators was similar to the national average range. 81% of patients with diabetes’ last blood pressure reading within an acceptable range which was in line with the CCG and national averages of 81% and 78%; 90% of patients on the register had received a foot examination and risk classification in the previous 12 months, which was in line with the CCG average of 92% and above the national average of 88%.
• The practice recalled patients with a long term condition annually for review which included a blood test.
• Flu vaccinations were available annually during pre-bookable clinics in practice hours and drop-in weekend clinics.
• Longer appointments and home visits were available for patients with long term conditions.

• The practice discussed care for patients with long term conditions during multidisciplinary team meetings.

Updated 8 November 2017

The practice is rated as good for the care of families, children and young people.

• One of the GPs was the practice’s safeguarding lead who engaged with local health visitors. Staff were trained to child safeguarding level three.
• Childhood immunisation rates for the vaccinations given to children under 12 months old were comparable to CCG averages. Immunisation rates for those given to children between 12 months and five years were mixed; with some significantly lower than the CCG average. The practice told us they were aware of this and made frequent contact with families who did not attend to discuss the benefits of child immunisations with them and encourage uptake. Unpublished results for the last two quarters showed that results were improving, with averages of 90% achieved.
• Staff told us that they recognised children and young people as individuals and tailored their treatment suitably to their age.
• There were appointments available outside of school hours.
• The practice offered flu vaccinations to children and made flexible appointments available for these.
• The practice had installed a children’s play area in the patient waiting room, and facilities at the premises were suitable for children and babies.
• The practice’s uptake for the cervical screening programme was similar to local and national averages.

Updated 8 November 2017

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 patients in its population. Home visits, longer appointments and priority appointments were offered.
• The practice provided care to a small number of older patients living in a local care home. The care home staff said that the practice provided the support to meet patients’ needs.
• The practice offered comprehensive health checks to patients aged over 75 and collaborated care with other agencies such as Age UK to support their needs.
• The practice held regular multidisciplinary team meetings to discuss the needs of older patients.
• The practice directed older people to appropriate support services.

Updated 8 November 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice held extended hours appointments with a GP from 6.30pm to 8pm on Tuesday each week, and with a GP and a nurse from 9am to 11am on one Saturday morning per month to assist patients who worked during the day. A nurse practitioner was additionally available one Tuesday evening per quarter.
• Appointments could be booked up to 13 weeks in advance and the day before. Same day appointments were available for those who needed an urgent consultation. Online booking and repeat prescription ordering was available. Patients could also access telephone consultations.
• The practice offered NHS health checks to those patients aged 40 to 74.

• Appointments for blood tests were pre-bookable and urgent blood tests were prioritised immediately following consultation where possible to prevent patients having to return to the practice.

• The practice offered flu vaccination during extended hours and held drop-in clinics on Saturday mornings which helped working age patients.

Updated 8 November 2017

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

• The practice contacted patients on its mental health register annually to offer them a review. The practice used both written and telephone communication to encourage these patients to engage with them.
• Patients experiencing poor mental health (including those with dementia) were placed on a register, had a care plan in place and were invited to see a GP for a comprehensive review at least once a year.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was in line with or above local and national averages.
• Longer appointments were available to patients experiencing poor mental health.
• The GPs and the practice nurses understood the importance of considering patients’ ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.
• The practice had given patients experiencing poor mental health information about how to access various support groups and voluntary organisations.

Updated 8 November 2017

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

• The practice held registers of patients whose circumstances may make them vulnerable such as carers and those with a learning disability. Potentially vulnerable patients were identified via health checks, consultations and interactions with staff.
• Longer appointments were available for patients who needed them.
• Staff we spoke with knew how to recognise signs of abuse in vulnerable adults and children and they were aware of their responsibility to escalate any concerns.
• The practice had appointed a lead for homeless patients, who were registered by the practice using the local Salvation Army address. Homeless patients were advised to attend to see the GP when they needed to and wait for an appointment the same day.
• The practice worked closely with a local probation hostel to tailor services as required for the patients who were resident. For example, there was an arrangement for any prescriptions for this group of patients to be sent directly to a specific pharmacy for collection.
• The practice employed an interpreter specifically to accommodate the practice’s large Punjabi speaking population. Approximately one third of the practice’s consultations were conducted in languages other than English. External translation services were available for speakers of other languages. The entrance to the practice displayed a welcome sign and information on the repeat prescription box in a variety of languages.