Archived: Eaves Lane Surgery

Updated 14 August 2017

Eaves Lane Surgery is situated at 311 Eaves Lane, Chorley, Lancashire PR6 0DR. It is housed in a small Victorian terraced house and disabled access is enabled by a ramp to the front door. There is one treatment room on the first floor which can only be accessed by a steep flight of stairs. Staff ensure that all patients unable to manage the stairs can be seen in a room downstairs.

The practice is situated on a busy main road with on-street parking available and easy access to public transport.

The practice is part of the NHS Chorley and South Ribble Clinical Commissioning Group (CCG) and services are provided under a general medical service (GMS) contract with NHS England.

From September 2016 the practice became part of a wider group of practices including Buckshaw Village surgery and Adlington Medical Centre, both in the East suburbs of Chorley. Services at Eaves Lane are provided by the principal male GP assisted by one male salaried GP and one male locum GP. There is a practice nurse and a health care assistant based at the surgery and administration is provided by a practice manager, an office co-ordinator and three members of reception and administration staff. Staff working at other practices in the group assist the surgery when needed including both clinical and non-clinical staff. There is a business director for the group, one other practice manager and a medicines co-ordinator, all of whom assist the surgery.

The surgery is open to patients between 8am and 6.30pm on weekdays and appointments are offered from 9.45am to 12.05pm and 3.30pm to 5.50pm on Monday, Tuesday and Thursday, and from 8.15am to 12.20pm and 3.30pm to 5.20pm on Wednesday and Friday. Patients are also able to attend extended hours appointments at Buckshaw Village surgery on a Monday evening from 6.30pm to 7.50pm and on some Saturdays from 8.30am to 2.20pm. In addition to these appointments, patients are also able to access walk-in clinics at Buckshaw Village surgery from 8am to 11am and 3pm to 5pm on weekdays. When the practice is closed, patients are able to access out of hours services offered locally by the provider GotoDoc by telephoning NHS 111.

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 provides services to 2091 registered patients and all patients are able to visit any of the practices in the group. There are lower numbers of patients aged over 65 years of age (11%) than the national average (17%) and higher numbers of patients aged under 18 years of age (23%) than the national average (21%). The practice also has noticeably more male patients aged between 25 and 54 years of age (26%) than the national average of 21%.

Information published by Public Health England, rates the level of deprivation within the practice population group as four on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Life expectancy is the same for males as the national figure, 77 years of age, and slightly lower for females, 82 compared to 83 years of age. There are 47% of patients with a long-standing health condition compared to the national average of 53%. A total of 9% of patients are unemployed compared to the national average of 4%.

Updated 14 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eaves lane Surgery on 4 July 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance and had been trained to provide them with the skills and knowledge to deliver effective care and treatment. Clinical education events were run at the practice’s sister surgery every two months for any local clinicians who wanted to attend.
• Patients we spoke to and comment cards that we received said that they felt the practice offered an excellent service and that staff were helpful, caring and treated them with dignity and respect. They also indicated improvements in the service since the new GPs had taken over.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day. Patients were able to access appointments at three different surgery sites including daily walk-in clinics and Saturday appointments.
• The practice was aware of the limitations of the surgery premises and was looking to relocate to a new surgery site that it was planning to have built in the locality.
• 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice had undergone a period of change which had resulted in improved services for patients. The practice had a strong vision, which focused on working with patients to ensure high quality care and treatment as its top priority.
• The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 August 2017

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

• Nursing staff were trained in the management of patient long term conditions and patients at risk of hospital admission were identified as a priority.
• The practice offered a daily point of care service for blood monitoring for patients who were taking blood-thinning medications for heart conditions.
• Quality and Outcomes Framework (QOF) for 2015/16 for diabetic indicators showed the practice performed below that of the local and national averages. However this data reflected the service provided by the previous registered GP practice. We were shown unverified data for 2016/17 that showed that performance for diabetic indicators had increased from 75% overall to 97%.
• 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.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• There was a comprehensive system in place to recall patients for 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.

Updated 14 August 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccinations given in 2015/16 were generally lower than national averages, however, the practice told us that they expected these figures to improve with increased nursing provision and better patient recall systems in place.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice’s uptake for the cervical screening programme was 86%, which was higher than the local average of 84% and the national average of 81%.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 14 August 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population. Patients had access to a nurse practitioner based at a sister practice who was responsible for co-ordinating care for all patients aged over 75 years of age.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. They used a mobile computer system to inform care and treatment during home visits.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice shared information with the out of hours service regarding patients nearing the end of their lives. This included when a do not attempt cardiopulmonary resuscitation (DNACPR) order was in place.

• The practice followed up on vulnerable older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services including the out of hours service.
• The practice first floor treatment room was accessed by a steep set of stairs. Staff were aware of patients who were unable to use these stairs and offered a consultation in the ground floor room if necessary.

Updated 14 August 2017

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

• 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 until 8pm on Monday and Saturday appointments which were available at the practice sister surgery.
• 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.
• Patients were able to receive travel vaccinations available on the NHS as well as those only available privately.
• Telephone appointments with clinicians were available in addition to face-to-face appointments.

Updated 14 August 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than local and national averages.
• Patients experiencing mental health problems were able to be referred directly to a local mental health service.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 93% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the local average of 92% and national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• 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.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 14 August 2017

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 homeless people, travellers and those with a learning disability. They had developed policies for the recognition and care of patients who were military veterans and for homeless patients.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability and with complex needs.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had developed a new comprehensive process for care planning for vulnerable patients which was led by a nurse practitioner.
• 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, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.