Biddulph Valley Surgery

Updated 3 August 2017

Dr P J Lightfoot & Partners is registered with the Care Quality Commission (CQC) as a partnership provider. The practice holds a General Medical Services contract with NHS England and is located in Biddulph, Staffordshire. The practice is located in a new purpose built medical centre which is not owned by the practice. There is parking with some of the patients living within walking distance and there is access to public transport. There are 10,050 patients on the practice list. The practice scored four on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

The practice team comprises:

• 4 GP partners and a salaried GP who provide 3.23 whole time equivalent (WTE) hours
• 3 Nurse Practitioners who provide 2.43 WTE hours.
• 3 Practice Nurses who provide 2.26 WTE hours
• 2 Healthcare Assistants who provide 0.96 WTE hours.
• 1 Practice Manager who provides 0.94 WTE hours
• 1 Deputy Practice manager who provides 0.99 WTE hours
• 1 Clinical Services Manager who provides 0.83 WTE hours
• 1 Clinical Services Facilitator who provides 0.64 WTE hours
• 1 Workflow Administrator who provides 0.99 WTE hours
• 2 Secretarial staff who provide 1.5 WTE hours
• 8 reception and administration support staff who provide 5.94 WTE hours.

The practice works closely with the clinical commissioning group (CCG). The practice is a teaching practice and provides a placement for medical students. The practice is open from 8am to 6.30pm, four days a week and from 8am to 1pm on a Thursday. Appointments can be booked by walking into the practice, by the telephone and on line. Patients requiring a GP outside of normal working hours are advised to contact the NHS 111 GP out of hour’s service provided by Staffordshire Doctors Urgent Care. This is a service commissioned by North Staffordshire Clinical Commissioning Group.

Updated 3 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr P J Lightfoot & Partners on 11 January 2017. The overall rating for the practice was as ‘Good’ with requires improvement for providing a safe service. The full comprehensive report for the 11 January 2017 inspection can be found by selecting the ‘all reports’ link for Dr P J Lightfoot & Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 18 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation identified in our previous inspection on 11 January 2017. This report covers our findings in relation to those requirements.

Overall the practice is rated as Good.

Our key findings were as follows:

• The provider had ensured there were effective arrangements in place to ensure that vaccines and other medicines stored in the refrigerators are stored at the correct temperatures and appropriate records were maintained.

• The practice had implemented processes to improve the recruitment process prior to staff commencing work at the practice.

• The practice had improved training access for all staff in adult safeguarding and the Mental Capacity Act 2005.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2017

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. There was a joint approach in managing these patients with the practice matron, community and district nurses. The practice promoted self-management by using care plans for asthma and Chronic Obstructive Airways Disease (COPD).

• Patients with COPD, asthma and diabetes were managed by nurse led clinics and GPs. Nationally reported data for 2015/2016 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 85% compared to the national average of 80% and the CCG average of 81%.

• Longer appointments and home visits were available when needed. The practice Matron undertook most home visits for older people undertaking a comprehensive holistic assessment and offering follow up care.

• Patients with a long term condition had a named GP and a structured annual review to check their health and medicine needs were being met.

• The practice promoted self-management for some long term conditions and referred patients for ongoing support where required.

• The practice had dedicated reception staff to deal with queries and messages about and from palliative care patients and assist in access to timely care, these staff also attend the Gold Standards Framework (GSF) meeting.

Updated 17 March 2017

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

• Immunisation rates for 2015/2016 were comparable to or slightly below the local CCG and England average for all standard childhood immunisations. For example, immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 82% to 95% compared to 86% to 96% for the local CCG area and 81% to 95% for England.

• 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.

• Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 76% compared to the local CCG average of 82% and national average of 81%. We saw examples of systems in place to promote cervical screening to women throughout the practice.

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

• We saw positive examples of joint working with multidisciplinary teams, including midwives, health visitors and school nurses.

• The practice provided access to contraception and screening for sexually transmitted diseases (STDs).

• The practice offered six week post-delivery checks for mothers and babies.

Updated 17 March 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 people in its population.

• All patients over 75 had a named GP. At the end of each year the practice identified all patients over 75 years of age who have not been reviewed and sent them a specific invitation for a health review.

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

• The practice had appointed a Practice Matron to enhance and co-ordinate care for older people particularly those at risk of unplanned admissions.

• The practice Matron visited the nursing and residential homes in the practice area weekly developing personalised care plans and information packs for patients and carers.

• The practice had identified and reviewed the care of those patients at highest risk of admission to hospital. Those patients who had an unplanned admission or presented at Accident and Emergency (A&E) had their care plan reviewed. Care plans were regularly reviewed and discussed.

The GPs reviewed NHS 111 contacts and planned follow up care as necessary

Updated 17 March 2017

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 reflected the needs for this age group.

Updated 17 March 2017

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

• Nationally reported data from 2015/2016 showed 88% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the previous 12 months, compared to the local CCG average of 86% and the national average of 82%.

• Nationally reported data showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 98%, this was 9% above the local CCG and national average.

• The practice undertook regular patient reviews in their own home or in the surgery. Those patients who had not attended were followed up with an invitation letter or with a phone call.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health. The practice Matron undertook a monthly visits at the local nursing and residential care homes with the community psychiatric nurse (CPN).

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Patients suffering acute mental health issues were seen on the same day and had access to the local crisis team.

• 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.

• Patients on medicines requiring regular monitoring and where the practice shared their care with mental health services were monitored regularly.

Updated 17 March 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 and provided a supportive and non-judgemental approach. Examples of these patient groups were people with drug and alcohol problems and those living with a learning disability.

• The practice offered longer appointments for patients with a learning disability. Annual reviews for this group were monitored by the practice.

• The practice held regular Gold Standards Framework (GSF) palliative care meetings to discuss and agree care plans. This involved the practice working together as a team and with other professionals in hospitals, hospices and specialist teams to provide the highest standard of care possible for patients and their families.

• The practice had no patients whose first language was not English but had systems in place to meet the needs of this patient group. The practice had systems in place to deal with patients with sensory loss.