Stonebridge Surgery

Updated 12 September 2016

Stonebridge Surgery is located on Preston Road in Longridge village, Lancashire. The large modern medical centre is near to the centre of the village. There is easy access to the building and disabled facilities are provided. There is a car park on the site. There are five GPs working at the practice, all of whom are partners. Two of the partners are male and three female. There is also one locum GP working six sessions each week and one GP in training working nine sessions each week. There is a total of five whole time equivalent GPs available. There are five nurses, all part time and all female. There is a full time practice manager, a prescriptions clerk and a team of administrative staff.

The practice opening times are 8am until 6.30pm Monday to Thursday, 8am until 6pm Friday and 8am until 11am Saturday. Appointments are available 8.10am to 11.50am and 2.30pm to 5.50pm Monday to Friday and 8.10 until 10.40am Saturday.

Patients requiring a GP outside of normal working hours are advised to call the 111 service who will transfer them to Preston Primary Care Centre, an out of hours service, call an ambulance or suggest they attend Accident and Emergency. There are 7637 patients on the practice list. The majority of patients are white British with a high number of elderly patients and patients with chronic disease prevalence. On the Index of Multiple Deprivation the practice is in the second least deprived decile with a score of nine. The practice holds a GMS contract with NHS England and forms part of Greater Preston Clinical Commissioning Group.

This practice has been accredited as a GP training practice and has qualified doctors attached to it training to specialise in general practice and also offers placements to medical students.

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stonebridge Surgery on 7th July 2016. 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about the services provided and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements :

• Ensure the staff recruitment policy and procedure is revised and followed to include take up of written references and police (DBS) checks.Current DBS which were ongoing should be completed.
• Ensure that significant events are logged in order to facilitate analysis and identification of trends.
• Establish a Patient Reference Group to participate in practice feedback and improvements
• Consider providing an update for reception staff in mental health problems and how to manage concerns about appointments

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2016

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.

• Performance for diabetes related indicators was better than the national average.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

• The practice provided a blood pressure self-monitoring machine within the surgery.

• The practice rated highly on appropriate anticoagulation in atrial fibrillation, treating fragility fractures and recording smoking status in chronic disease.

• One of the GP partners had a special interest in dermatology and another had extensive secondary care experience in respiratory medicine and they provided regular teaching and updates for staff and reviewed patients.

Updated 12 September 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 and those who did not attend secondary care appointments.

• Immunisation rates were relatively high for all standard childhood immunisation programmes achieving up to 96.5% on 2014/15 compared to a CCG maximum of 95%. These were provided both at immunisation clinics and by appointment.

• 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.

• 84% of women aged 25-64 are recorded as having had a cervical screening test in the preceding 5 years. This compared well to a CCG average of 80% and a national average of 82%.

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

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

• All parents/guardians calling with concern about a child under the age of 10 were offered a same day appointment.

Updated 12 September 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Practice staff visited seven care homes in the area to provide ward rounds, confer with staff and managers and provide advice on medicine management. The residential and nursing home specialist nurse based at the practice worked closely with the Community Matron in the locality and ensured good continuity of care.
• Patients could be admitted from secondary care or home to the community hospital allowing extended rehabilitation, close monitoring and palliative care.
• Warfarin initiation and prescribing was offered so that the rural community need not travel into Preston.

Updated 12 September 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.

• The practice was proactive in offering online services including electronic prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice staggered appointments each day offering late afternoon appointments and running Saturday clinics to provide flexibility.

• The GP’s performed minor surgery and joint injections, reducing patient waiting times and local secondary care burden.

• One of the GP’s had significant experience in sports and musculoskeletal medicine, and was currently undertaking an MSc in this area and provided teaching, updates and clinical reviews so that patients need not travel to secondary care appointments.

Updated 12 September 2016

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

• 88% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This compared favourably with a CCG average of 86% and a national average of 88%.

• 91% of patients with mental health conditions had their alcohol consumption recorded in the preceding 12 months. This compared well with a national average of 89%.

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

• The practice carried out advance care planning for patients with dementia.

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

• 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.

The practice had a GP with extensive experience in mental health medicine and they looked after patients living at a specialist nursing home for people with complex mental health problems.

Updated 12 September 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 homeless people, travellers and those with a learning disability.Alerts for direct access to GPs or nursing staff were added to records of these patients.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients including hospice staff, Macmillan nurses and district nurses. This included multidisciplinary gold standard palliative care framework meetings to ensure our palliative care patients receive safe, effective and responsive care.

• The practice informed 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.

• Practice staff maintained a register of carers. A carer’s information board was maintained in the waiting room. All carers were offered the influenza vaccination.

• One of the partners had quarterly meetings with the local community drug and alcohol team to review joint patients and highlight areas of concern.