Ash Tree House Surgery

Updated 6 September 2016

Ash Tree House Surgery is located in Church Street Kirkham, Preston, Lancashire. The practice is located in a large house in the centre of the town. There is easy access to the building and disabled facilities are provided. There is a car park behind the practice. There are seven GPs working at the practice. Six GPs are partners, four male and two female and one female GP is salaried. There are five part time practice nurses, one part time trainee nurse practitioner, two part time health care assistants (all female) and one part time phlebotomist. There is a full time practice manager, two assistant practice managers and a team of administrative staff.

The practice opening times are Monday 8am until 8.30pm and Tuesday to Friday 8am to 6.30pm. The practice appointment times are;

Monday: 8am to 8.30pm

Tuesday to Friday: 8am to 6.30pm

Patients requiring a GP outside of normal working hours are advised to call Preston Primary Care using the usual surgery number and the call will be re-directed to the out-of-hours service.

There are 10,779 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. The practice is part of Fylde and Wyre Clinical Commissioning Group and provides primary medical services under a General Medical Services contract with NHS England .

This practice has been accredited as a GP Training Practice and has qualified Doctors attached to it training to specialise in General Practice. It also offers placements to nursing students.

Updated 6 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ash Tree House Surgery, Kirkham, Preston on 5 April 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 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 services and how to complain was available and easy to understand.

• Thorough recruitment procedures were carried out before staff were employed.

• 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 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 September 2016

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

• The practice has a robust chronic disease programme which included:

• A robust annual review call and recall programme was in place.

• There were effective systems for ensuring patients were followed up with an interim review if indicated.

• An annual medication review was offered to all patients on repeat medication, with robust procedures for non-compliant patients.

• Home visits were carried out by GPs, practice nurses and a health care assistant for house bound patients with chronic disease.

• There were weekly meetings with the practice based community pharmacist to identify improvements in prescribing and safety.
• There was a failsafe procedure to ensure abnormal tests were repeated.
• 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.

• Post-hospital discharge care plan reviews were carried out with patients who attended A&E unnecessarily.

• Nurses trained in long term care supported patients and there were long term care ‘Champions’ within the team.

• The practice offered specific clinics for Asthma, Diabetes and COPD.

• Longer appointments were offered for patients with multiple conditions.

• Care plans were produced for all patients who required long term care and a Care Plan Champion coordinated their needs.

• There was an insulin initiation service for Diabetic patients.

Updated 6 September 2016

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

• The practice had high achievement with their childhood immunisation programme achieving up to 98.5% uptake in 2014/15.
• There were systems in place to identify non- attenders for immunisations.
• The practice had links to the health visitor who is informed of all children who have joined or left the practice.
• The practice offered a private room for breastfeeding and there were baby changing facilities.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and younger patients who had a high number of A&E attendances.

• 74% of patients with asthma, on the practice register,had an asthma review in the preceding 12 months that included an assessment of asthma control using the 3 RCP questions. This data was unvalidated on the date of inspection.

• 76.5% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years.This data was unvalidated at the time of the inspection.

• The practice offered flexible baby clinics.

• A Family Liaison Co-ordinator acted as a point of contact to support families and ensured patients felt they had a dedicated person to help them.

• A bespoke clinic was provided at an outlying local army base with poor transport links to ensure children received appropriate vaccinations and healthcare .

• A Primary Health Care Team meeting ensured continuity of care.
• The practice participated in serious case reviews involving young patients to ensure full knowledge of their issues and appropriate support was given.

Updated 6 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 patients.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• Care plans and health checks were provided as needed with regular medicine reviews carried out.

• The practice supported five care homes in the locality with regular visits and phone calls.
• The practice offered flu, pneumonia and shingles vaccination programmes.
• There was a notice board in the waiting area which promoted dementia awareness and carer support.

• There were monthly multidisciplinary team meetings to discuss patients with complex needs.

• Referrals to other services were regularly made, for example the falls service and dietetic service. The practice contacted all patients leaving secondary care.

• Care plans were produced for all vulnerable people.

• There were longer appointments available for those patients who needed them.

• There was a named GP for all patients.

Updated 6 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice promoted online services and text messaging to make it easier for patients who work to access services outside of practice hours.
• Staff had received training on consent in young people. A leaflet about consent was in the waiting room.

• NHS health checks were routinely encouraged.

• Text messaging had been introduced as a reminder for patients to keep their appointments.

• The practice offered late opening until 8:30pm for working groups and early morning access from 8am.

• There was an all day GP and nurse triage and call back system.

• Same day appointments were available and patients could book appointments online.

• An Electronic Prescription Service meant that patients did not have to go into the Practice to order or collect prescriptions.

Updated 6 September 2016

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

• The practice had a dedicated area in the waiting room with information regarding dementia and carer information.
• All patients on the mental health register were invited for an annual review.

• 87% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their records, in the preceding 12 months.This compared to a national average of 88%.

• The mental health care plans were carried out with a specialist nurse.

• 95 % of patients diagnosed with dementia had their care reviewed in a face-to-face review in the preceding 12 months. This compared to a national average of 84%.

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

• Most of the practice staff were Dementia Friends trained.

• There was an in house Psychological Wellbeing Team for direct referrals.

• Educational updates were provided for clinical staff by the psychological wellbeing team

• Helpline phone numbers were given to patients and were available in all GP rooms and on notice boards in the waiting room.

Updated 6 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• All staff and doctors had regular training in child and adult safeguarding. The practice had clear procedures regarding safeguarding.
• The practice had a poster displayed in the waiting room to inform patients regarding safeguarding and how to raise concerns. There was also information on the website.
• The practice had a register of vulnerable adults and children and a review of these patients is undertaken every three months to identify any concerns that require further action.
• There was a newly introduced patient health form with a section for patients to record if they had a disability, medical condition or were a carer. These were passed to the practice manager who ensured this was clearly recorded on the record and will contact the patient to discuss their needs if indicated.
• Concerns regarding patients were discussed at practice meetings where indicated.
• The practice nurse and doctors identified vulnerable patients for discussion at MDT meetings.
• Clinical staff were trained in the Mental Capacity Act. There were procedures in place for identifying patients with a Deprivation of Liberty Safeguard in place.
• Staff had received training on consent and there is a patient information leaflet about consent.
• The practice regularly worked with multi-disciplinary teams in the case management of patients deemed to be vulnerable.
•  The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example the practice made referrals to the AQA project to support with wellbeing and daily life and to foodbanks where appropriate