Background to this inspection
Updated
14 September 2018
Lancaster Medical Practice is registered with the Care Quality Commission to provide primary care services. The practice provides services to around 55,000 patients from seven sites in the city of Lancaster and the surrounding villages:
- Lancaster University Medical Centre, Lancaster University, Lancaster, LA1 4ZP
- King Street Surgery, 38 King Street, Lancaster, LA1 1RE
- Rosebank Surgery, Ashton Road, Lancaster, LA1 4JS
- Owen Road Surgery, 67 Owen Road, Lancaster, LA1 2LG
- Dalton Square Practice, 8 Dalton Square, Lancaster, LA1 1PN
- Galgate Surgery, Highland Brow, Galgate, Lancaster, LA2 0NB
- Scale Hall Surgery, 1 West Drive, Scale Hall, Lancaster, LA1 5BY
We visited all of these sites as part of the inspection.
The provider formed from the merger of four separate GP practices in April 2017. There are currently 167 members of staff; this includes the executive director (who is also a partner) and three other members of the management team (a Head of Quality and Performance, a Head of Patient Services and a Head of Corporate Services), 28 GP Partners, four salaried GPs, 33 nursing staff (comprising practice nurses, nurse practitioners and HCAs. One of the nurse practitioners is also a partner in the practice), four medicines managers, five practice pharmacists, 49 administrative staff (including team leads and managers), 37 reception staff, and three cleaners.
The practice is part of Morecambe Bay Clinical Commissioning Group (CCG). The patient population at the practice is varied due to the fact the practice covers all of the city of Lancaster and the surrounding rural areas and the list size accounts for slightly more than a third of the whole population of the Lancaster district. Information taken from Public Health England placed some of the areas in which the practice is located in the most deprived decile while others are in the least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. Life expectancy for both males and females in Lancaster is below national averages. There is also a wide variation within the local area, with life expectancy being 9.1 years lower for men and 8.6 years lower for women in the most deprived areas of the district than in the least deprived areas. One fifth of the practice list at Lancaster Medical Practice (11,000 patients) are university students.
The practice is located in a variety of purpose-built and converted buildings. Patient facilities are on the ground floor where possible. At premises where patient services are offered on the first floor, there is either a lift available or patients who are unable to use the stairs are offered an appointment in a room on the ground floor. At sites where there is no dedicated car park, on-street parking is available. All sites had a disabled WC and step-free access.
Opening hours are between 8am and 6.30pm Monday to Friday at all sites except Scale Hall, which closes at 12pm on Wednesdays. Patients can book appointments in person, on-line or by telephone. Extended hours are available at Rosebank from Monday to Thursday, 6.30pm to 8pm and Saturdays from 8am to 2.30pm, and at Owen Road Surgery some Mondays and Wednesdays from 6.30pm to 8pm.
The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.
The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and PDS Medical.
Updated
14 September 2018
This practice is rated as outstanding overall. (Whilst under their former providers, each of the four practices which now make up Lancaster Medical Practice were previously rated good overall with one domain or population group rated outstanding. Inspections of these practices took place between October 2014 and December 2015)
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Outstanding
Are services caring? – Good
Are services responsive? – Outstanding
Are services well-led? - Outstanding
We carried out an announced comprehensive inspection at Lancaster Medical Practice on 2 and 3 August 2018 as part of our inspection programme.
At this inspection we found:
- The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- All of the 167 staff at the practice had completed mandatory training and had received an appraisal in the past 12 months.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- The involvement of other organisations and the local community was integral to how services were planned and ensured services met people’s needs. The practice had lead roles in the integrated care community and worked closely with the university.
- Leaders had the capacity and skills to deliver high-quality, sustainable care. They had an inspiring shared purpose, strived to deliver and motivated staff to succeed.
- Staff told us they felt supported and engaged during and since the merger.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
We also saw several areas of outstanding practice:
- The practice used a cultural values assessment tool to understand the culture and values of staff at each of the four legacy practices and to determine the desired cultural values for the merged practice. Staff were given “cultural training” to try and further embed these shared values and encourage staff to think as one practice, rather than as four separate entities. Staff we spoke to told us that this exercise had been an important factor in ensuring the success of the merger.
- As well as public consultations at each of the sites, the practice set up a dedicated email address for patients to communicate with the practice about the merger. They released a range of informative material to keep people up-to-date, such as lists of frequently asked questions. They kept in touch with patients via letter, email and social media. The practice devised a methodology and key messages for engaging with patients, staff and external partners to ensure that the information they were giving was consistent and clear.
- The practice had developed a new role following the merger: Patient Care Administrators (PCAs). They performed an administrative and coordination role for the clinical teams. This reduced the workload of clinicians and gave them more time for appointments. As PCAs were assigned to particular teams they developed close links with both the patients and the clinicians.
- Group consultations had been trialled at the practice to assist patients following treatment for cancer. The nurse leading the consultations used the Macmillan concerns checklist to gauge patients’ wellbeing and found that each of the patients reported a more positive outlook following the intervention. The project won the Most Innovative Group Consultation award from Health Education England (HHE) in November 2017. The practice planned to use the same method to help patients with other long-term conditions, such as diabetes.
- A nurse at the practice was awarded a grant to establish a mental health support group for new students at the university. This was set up in response to a review that found 9% of the practice’s 11,000 student population had attended the practice within the past 12 months with concerns about their mental health. Feedback collected by the practice showed students found the programme beneficial.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.