Archived: The Village Surgery Lostock Hall

Updated 30 September 2016

Dr Karim Mashayekhy’s practice otherwise known as The Village Surgery is housed in a purpose-built two storey building in the Lostock Hall area of Preston at 1 William Street, Lostock Hall, Preston, PR5 5RZ. The building was constructed in 1997 and provides patient facilities of a waiting area, treatment room and two consulting rooms on the ground floor with a minor surgery room on the first floor. The practice provides level access for patients to the building with widened entry doors. Access to first floor rooms is by using stairs. The practice offers a minor surgery clinic to patients every week on the first floor of the building. This is changed to a downstairs room if patients are unable to use the stairs.

There is parking provided for the practice in the adjoining public car park and the practice is close to public transport. There is an independent pharmacy nearby.

The practice is part of the Chorley and South Ribble Clinical Commissioning Group (CCG) and services are provided under a General Medical Services Contract (GMS).

There is one male GP partner and one practice nurse who provides clinical services and practice management support to the practice. Three administrative and reception staff also support the practice.

The practice is open from 8am to 6.30pm every day from Monday to Friday and appointments are offered every day from 9am to 10.50am and from 4pm to 5.30pm except Thursdays when the surgery is open but there is no bookable afternoon surgery. When the practice is closed, patients are able to access out of hours services offered locally by the provider Chorley Medics by telephoning 111.

The practice provides services to 1,368 patients. There are higher numbers of patients aged between 45 and 60 years of age (26%) than the national average (20%) and fewer numbers of patients aged under 15 years of age (15%) than the national average (17%).

Information published by Public Health England rates the level of deprivation within the practice population group as eight on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Both male and female life expectancy is comparable to the local and national average, 82 years for females compared to 83 years nationally and 79 years for males compared to 79 years nationally.

The practice has a higher proportion of patients experiencing a long-standing health condition than average practices (63% compared to the national average of 54%). The proportion of patients who are in paid work or full time education is higher (66%) than the CCG and national average of 62% and unemployment figures are lower, 2% compared to the CCG average of 3% and national average of 5%.

Updated 30 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Karim Mashayekhy also known as The Village Surgery on 26 August 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 generally assessed and well managed. However, the practice had not carried our regular fire drills and fire extinguishers were not being checked annually by a recognised fire safety service, although the practice arranged for this following our visit. There was no current building electrical safety certificate and only clinical items of equipment had been electrically tested to ensure they were safe to use. The practice made arrangements for this to be completed following our inspection and we saw evidence of this.
• 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.
• The practice had adequate arrangements in place to respond to emergencies and major incidents. However, they had no supplies of emergency medication used to treat suspected meningitis and had not assessed the associated risks. Following our inspection we saw evidence that the practice purchased this medication.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Staff sought consent from patients in the majority of instances in line with legislation and guidance, however, written consent was not recorded for minor surgery as would be expected. We saw evidence following the inspection that surgery policy had been changed to obtain written consent for minor surgery.
• Information about services 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 the 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 improvement are:

• Maintain the new arrangements for checking fire extinguishers and undertake regular fire drills.
• Provide a current building electrical safety certificate and undertake regular testing for non-clinical equipment for electrical safety.
• Obtain and record written patient consent for minor surgery in line with current guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 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.
• The percentage of diabetic patients who had their blood sugar levels well-controlled was 73% compared to the local average of 80% and national average of 78%. The percentage of diabetic patients with blood pressure readings within recommended levels was 87% compared to the local average of 80% and national average of 78%.
• Longer appointments and home visits were available when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 30 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. Immunisation rates were relatively high for all standard childhood immunisations.
• 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.
• The practice’s uptake for the cervical screening programme was 84%, which was comparable to the local average of 85% and higher than the 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. A midwife visited the practice every other week to provide services.

Updated 30 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.
• The GP telephoned all patients discharged from hospital and usually visited them to ensure that their needs were met.
• A podiatrist visited the practice each month to provide a clinic for patients.

Updated 30 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 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.
• From the national GP patient survey, 83% of patients were satisfied with the practice’s opening hours compared to the local average of 79% and national average of 78%.
• Patients could order repeat prescriptions online as well as by telephoning the practice.

Updated 30 September 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face-to-face review compared to the local average of 88% and national average of 84%.
• 100% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the local average of 93% and national average of 88%.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 30 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 those receiving end of life care and those with a learning disability.
• 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. The practice was aware of all those patients who were receiving end of life care and provided personalised and timely support.
• 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.