Archived: Daneshouse Medical Centre

Updated 8 June 2017

Daneshouse Medical Centre (Old Hall Street, Burnley, BB10 1LZ) is housed in purpose built, single story premises on the outskirts of Burnley. The practice has a small car park, with designated disabled spaces and a ramp to facilitate access for those patients experiencing mobility difficulties.

The practice is presently registered as a partnership, but the provider has recently submitted applications to CQC to update this registration to reflect that they are working as a single handed GP.

The practice delivers primary medical services to approximately 3400 patients through a personal medical services (PMS) contract with NHS England, and is part of the NHS East Lancashire Clinical Commissioning Group (CCG). At the time of our inspection the practice list was closed.

The average life expectancy of the practice population is below national but in line with CCG averages for females and below both the local and national averages for males (81 years for females, compared to CCG average of 81 and national average of 83. For males; 73 years compared to CCG average of 77 and national average of 79). The practice patient population contains a higher proportion of younger people when compared to local and national averages. For example, 9% are aged between 0 and 4 (CCG and national averages 6%), 25% aged between five and 14 years (CCG and national averages of 12%) and 39% aged under 18 (CCG average 22% and national average 21%). Conversely, only 5% of the practice’s patient population are aged over 65, compared to the CCG average of 18% and national average of 17%, while 2% are aged over 75 (CCG and national averages 8%).

A higher proportion of the practice’s patients are unemployed; 10% compared to the CCG average of 5% and national average of 4%. The practice caters for a lower proportion of patients with a long standing health condition (44% compared to the CCG average of 56% and national average of 53%).

Information published by Public Health England rates the level of deprivation within the practice population group as one 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 the lead GP (male), with two long term locum GPs (one male, one female) adding a further 0.4 whole time equivalent GP time each week. The practice employs a practice nurse for two days each week. The clinical team are supported by a practice manager, assistant practice manager and a team of three receptionists / administrative staff.

The practice telephone lines are staffed between 8am and 6.30pm each working day, apart from between 12.30pm and 2pm on a Monday. The practice premises are open from 9am until 6:30pm Monday to Friday, again apart from 12.30 until 2pm on a Monday afternoon. Appointments with the GP are available between 9:30am and 11:40am each morning and between 3.30pm and 5:50pm each afternoon, apart from Wednesday afternoon when appointments start at 4pm. Extended hours appointments are also available between 6:30pm and 7.15pm each Monday and Tuesday evening, although the practice website did not reflect this accurately. The website stated that extended hours appointments were available on Monday and Thursday evenings.

Outside normal surgery hours, patients are advised to contact the out of hour’s service, offered locally by the provider East Lancashire Medical Services.

The practice has previously been a teaching practice, but has not had a student placement for over a year. The practice is currently in discussions with other local universities to arrange future placements.

Updated 8 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Daneshouse Medical Centre on 5 April 2017. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not appropriately embedded to keep them safe. For example, patients did not have access to appropriately trained chaperones.

• Staff were not clear about reporting incidents, near misses and concerns and there was limited evidence of learning and consistent communication with staff. We found numerous examples of incidents that had not been recognised as significant events.

• Patient outcomes were lower than local and national averages and there was limited evidence of audits or quality improvement.

• Patients we spoke with were positive about their interactions with staff and said they were treated with compassion and dignity. However, results from the national GP patient survey showed patients rated the practice lower than others for many aspects of care.

• The appointment systems were not effective, with long waits to be seen, so patients did not receive timely care.

• The practice did not have a system in place to effectively manage any complaints received.

• The governance arrangements in place were insufficient to ensure quality care was delivered. Staff were not always fully aware of their roles and responsibilities.

• Policy guidance was inconsistent, with duplicate polices and guidance available which did not always reflect current best practice.

The areas where the provider must make improvements are:

• Introduce reliable processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Implement an appropriate system for logging and auditing the location of blank hand written prescription pads.

• Introduce systems for effectively identifying, recording and managing risks and implementing mitigating actions.

• Ensure the policies and guidance available to staff to support them in their roles accurately reflect the work undertaken in the practice and are up to date.

• Establish a comprehensive governance framework so as to allow the practice to effectively assess, monitor and improve the quality and safety of the services provided.

• Establish an accessible system for identifying, receiving, recording, handling and monitoring complaints.

The areas where the provider should make improvement are:

• Ensure all documentation relating to pre-employment checks, including interview notes, are maintained appropriately.
• Consider a more systematic approach to the managerial oversight of staff training.
• Consider implementing a planned programme of clinical audit to ensure completion of full audit cycles so that quality improvement is proactively monitored.
• Consider the use of alerts on the patient record system to notify staff if a patient is also a carer.
• Links should be re-established with the PPG to facilitate further collection of patient feedback. Staff feedback should also be proactively sought.
• Consider more frequent engagement with locality multidisciplinary team meetings.
• Review the appointment and telephone systems to ensure that patients are able to access appointments in a timely manner.
• The business continuity plan should contain more comprehensive information, such as emergency contact details for staff to facilitate the cascade of information.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 June 2017

The provider was rated as inadequate for safety, effectiveness, responsiveness and for well-led and requires improvement for caring. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as inadequate for the care of people with long-term conditions.

• Patient outcomes for those with long term conditions were consistently lower than local and national averages.

However:

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met.

Updated 8 June 2017

The provider was rated as inadequate for safety, effectiveness, responsiveness and for well-led and requires improvement for caring. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as inadequate for the care of families, children and young people.

• Immunisation rates were low for standard childhood immunisations.

However:

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• The practice worked with midwives, health visitors and school nurses to support this population group.

Updated 8 June 2017

The provider was rated as inadequate for safety, effectiveness, responsiveness and for well-led and requires improvement for caring. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as inadequate for the care of older people.

• The GP did not routinely attend multidisciplinary meetings to discuss those patients with complex needs or those approaching the end of life.

However:

• Patients over the age of 75 years were offered an annual review appointment to ensure their health needs were being met.

• Home visits and urgent appointments for those with enhanced needs were offered when required.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 8 June 2017

The provider was rated as inadequate for safety, effectiveness, responsiveness and for well-led and requires improvement for caring. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as inadequate for the care of working age people (including those recently retired and students). However:

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

• 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 8 June 2017

The provider was rated as inadequate for safety, effectiveness, responsiveness and for well-led and requires improvement for caring. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia).

• Patient outcomes for those experiencing poor mental health were lower than local and national averages for many clinical indicators.

However:

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 100% compared to the local average of 85% and national average of 84%.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

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

Updated 8 June 2017

The provider was rated as inadequate for safety, effectiveness, responsiveness and for well-led and requires improvement for caring. The issues identified as requiring improvement overall affected all patients including this population group. The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable.

• The practice could not demonstrate how it regularly worked with other health care professionals in the case management of vulnerable patients.

However:

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

• The practice had six patients registered who were service users at the neighbouring charity hostel for homeless people.

• The practice offered longer appointments for patients with a learning disability.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing and documentation of safeguarding concerns.