Queen Square Medical Practice

Updated 7 January 2016

Queen Square Medical Practice is part of the NHS Lancashire North Clinical Commissioning Group (CCG). Services are provided under a personal medical service (PMS) contract with NHS England. The practice confirmed they had 13577 patients on their register.

Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male and female life expectancy in the practice geographical area is below the England average for males at 78 years and 82 years for females (England average 79 and 83 respectively).

The patient numbers in the different age groups were reflective of national averages; however patients who were in paid work or full time education was 58% compared to the Clinical Commissioning Group (CCG) average of 62.2% and England average 61%. There were also a higher number of patients unemployed at 7.2% (CCG average 3.3% and England average 5.5%).

The practice has ten GP partners (seven male and three female), and two associate GPs (one male and one female). The practice employs a practice director, practice manager and finance manager, a nurse practitioner, seven practice nurses (including research nurses) five healthcare assistants and 21 reception and administrative staff .In addition, the practice has the support of a part time pharmacist who is jointly employed by the CCG.

The practice is a training practice for qualified doctors who are training to be a GP.

The GP practice provides services from one registered location at Queen Square Medical Practice in Lancaster. In addition to this, the practice provides services from the Healthhub, which is next door to Queen Square Surgery and is used to provide Tier 2 services such as sexual health, infertility and dermatology and from the Caton branch surgery at Caton Health Centre, Hornby Road, Caton. The Caton branch surgery provides GP appointments, nurse led health screening clinics and a weekly baby clinic. We did not visit this branch surgery. Patients can request appointments at either the main surgery or the branch surgery.

The Queen Square Medical Practice is open Monday and Tuesday from 7.30am to 6.30pm, Wednesday 8am to 8pm, Thursday 8am to 6.30pm, Friday 9.30am to 6.30pm (between 8am and 9.30am a GP triage service is available for urgent calls) and the second Saturday every month from 8.30am to midday.

The Caton branch surgery is open 8.30am to 1pm then 3pm to 6pm on Mondays and Thursdays, 8.30am to 1pm on Tuesdays, 8.30am to 5.30pm on Wednesdays and 9.45am to 1pm and 3pm to 6pm on Fridays.

Out of Hours services are provided by Bay Urgent Care, and contacted by ringing NHS 111.

The practice provides online patient access that allows patients to book appointments and order prescriptions and review some of their medical records.

The practice buildings have been adapted so they are accessible to people with disabilities.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queen Square Medical Practice on 18 November 2015. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed. Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. The practice offered a telephone call back service.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. The practice had a strong commitment to supporting staff training and development.
• Feedback from patients about their care was consistently and strongly positive. Patients described the GP practice as excellent; staff were described as caring and professional.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met people’s needs.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 practice was a research practice, employed a team of nurses specifically for this role, and was actively involved in a range of different research studies. The aim of these studies was to identify new or to improve current treatments.

We saw areas of outstanding practice:

• Working closely with specialists from University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) the practice provided an enhance fertility service for all NHS patients registered in the Lancashire North Clinical Commissioning Group (CCG) geographical area. This enabled patients living in the area to have local monitoring and treatment without having to travel for four hours or more to and from Manchester. Patients were taught how to self-inject hormone treatments as required.
• The practice also provided rooms free of charge to a local charity A.C.E. to support young people with their mental health and wellbeing needs.
• The practice registered and treated all the students who had complex health care needs such as cerebral palsy and associated health conditions and who lived at a local residential further education college. This enabled the practice and the college to have effective working relationships, and reassured parents of the students. Students benefited from continuity of care.

The areas where the provider should make improvements are:

• Ensure that the practice policies and protocols are reviewed, kept up to date and if required strengthened to provide clarity for staff and consistency in approach to patient services. For example, the receipt of test results protocol, the use of Choose and Book service and the monitoring of medicines held in GP bags.
• Develop practice policies for the duty of candour and the receipt and storage of prescription paper.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

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

• The practice had a large team of practice nurses and health care assistants to meet the needs of the patients. Nursing staff had lead roles in chronic disease management. They were supported by GPs who were leads at the practice.

• The practice maintained and monitored registers of patients with long term conditions including cardiovascular disease, diabetes, asthma and chronic obstructive pulmonary disease. These registers enabled the practice to monitor and review patient conditions effectively and patients at risk of hospital admission were identified as a priority

• The number of patients registered with the practice with a long term condition was similar to both the Clinical Commissioning Group (CCG) and national averages.

• Longer appointments and home visits were available when needed. The practice offered early morning or later evening appointments to people with a long-term condition and those who worked through the day.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 January 2016

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

• There were systems in place 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 A&E attendances.

• The practice provided Tier 2 services for gynaecology, incontinence, infertility and sexual health or genitourinary medicine (GUM).

• The practice registered all students with complex health care needs and who lived at a residential further education college. The practice provided rooms to a local charity that supported young people with mental health and emotional issues.

• Immunisation rates (2014/15) were higher than the Clinical Commissioning Group (CCG) rates for all but one of the standard childhood immunisations.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice implemented a policy for patients over the age of 13 to access online appointments.

• Evidence of joint working with midwives, health visitors and community nurse was available.

Updated 7 January 2016

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.

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

• Those patients on the palliative care registered had a first and second named GP to ensure consistency in care,

• Care plans were in place for those patients considered at risk of unplanned admission to hospital.

Updated 7 January 2016

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. For example, the practice offered appointments from 7.30am on Monday and Tuesdays and late evening appointments on Wednesday, as well as one Saturday morning each month.

• Appointments were available to patients at either their main surgery or the branch surgery.

• Telephone consultations were available.

• 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 7 January 2016

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

• The practice had 170 patients on their mental health register, data supplied by the practice (not yet verified), confirmed that they met all the Quality and Outcomes Framework (QOF) targets for 2014/15.

• 8.9% of the practice population had a diagnosis of depression. This was higher than the Clinical Commissioning Group (CCG) 8.4% and the England average 6.5%. (QOF data 2013/14).

• 1% of the practice population had a diagnosis of dementia, which was also higher than the CCG at 0.8%, and the England average of 0.6%. (QOF data 2013/14).

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

Updated 7 January 2016

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, those with a learning disability.

• The practice registered all students with complex health care needs (including learning disabilities) and who lived at a residential further education college.

• A team of three named GPs supported patients’ resident at a drug and alcohol rehabilitation service. The practice also provided consultation rooms (free of charge) for the shared care, drug and alcohol service to see patients from any local practice.

• The practice provided rooms for group work for the shared care drug and alcohol service.

• A first and second named GP was linked on patients’ electronic records whose needs identified them as vulnerable and requiring continuity of approach and care.

• The practice offered longer appointments for patients who were vulnerable or with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice told vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.