Archived: Town Centre GP Surgery

Updated 17 January 2017

Town Centre GP Surgery is part of the NHS England and Luton Clinical Commissioning Group (CCG).

The practice is registered with the CQC to provide the following activities:

• Diagnostic and screening procedures

• Treatment of disease, disorder or injury

• Maternity and midwifery services

• Surgical procedures

• Family planning

Services are provided under the auspices of an Alternative Provider Medical Services (APMS) contract. The contract allows for provision of GP services and also includes delivery of the services of a Walk-in-Centre. (an APMS contract is agreed under directions of the Secretary of State for Health and provides the opportunity for locally negotiated contracts.) The Walk-in-Centre is available to NHS patients who require urgent medical attention for minor illness or injury.

All services are provided from one registered location;

• 14-16 Chapel Street, Luton, LU1 2SE.

The practice has approximately 7,676 registered patients. The age range of patients at the practice differs significantly from the national demographic. For example, approximately 1.3% of the practice population is over 65 years of age, compared to 15% in the local CCG and the England average of 17%. The practice had approximately 50% of its patients in the 20 - 39 years age range, where the national average was approximately 12%.

According to national data the area falls in the ‘second most deprived decile’ and is one of the more deprived areas. People living in deprived areas tend to have greater need for health services. The unemployment level for the area covered by the practice was 18%, this compared to the CCG average of 9% and the national average of 5%.

Average life expectancy for people living in the area is lower than both the local CCG and the England national averages. Male life expectancy, at 76 years compared to CCG average of 78 years and the national average of 79 years. Female life expectancy for the area was 81 years, which was again lower than both the local CCG average of 82 years and national average of 83 years.

The purpose built building has good facilities for patients, including access arrangements, with automatic doors and easy access toilets for the less mobile and baby changing facilities.

The ground floor reception and waiting area is bright and equipped with an electronic patient arrival registration screen. Consultation and treatments rooms are located on the ground floor and first floors. A lift was provided for access to the first floor for those people who preferred not to use the stairs. The administration staff occupy the upper floors.

The practice is located in Luton town centre and is provided with public transport linking the practice to surrounding housing and major roads. Limited on street car parking is available in adjacent roads, with commercially provided car parks otherwise accessible.

The practice has five GPs, (four male and one female), two minor illness nurses and two practices nurses and a health care assistant (all nursing staff were female). Administration and management is provided by the practice manager and a team of administrators and reception staff.

The practice offers appointments and services to meet the requirements of its patients as follows;

• The practice is open daily from 8am to 8pm everyday Monday to Friday.

The practice has patients who work away from the area, with many commuting to and from London. Early and later appointments are offered for patients who may not be able to attend during conventional opening times. Urgent and emergency appointments are available on the same day and patients are advised consultations may be with a duty doctor rather than their preferred, or usual, GP.

When the practice is closed, out-of-hours services are provided by the 111 service. Advice on how to access the out-of-hours service is clearly displayed on noticeboards throughout the public spaces in the waiting and reception area, on the practice website and telephone message when the surgery is closed.

The Walk-in-Centre was open from 8am to 8pm 365 days a year.

Updated 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Town Centre GP Surgery on 14 June 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.
• Feedback from patients was positive. They 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. 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.
• Outcomes from national patient surveys showed the practice was performing broadly in line with local and national averages in most areas.
• 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 sought feedback from staff and patients, which it acted on.
• There was a positive culture and learning environment, with a clear emphasis on learning in a blame free environment.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review the process for new patient health checks to ensure they include appropriate clinical testing and consideration as appropriate.
• Continue work to identify and support those patients who are carers.
• Continue patient engagement initiatives to raise awareness and support patients to attend for cancer screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 January 2017

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 patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 79%, compared to the local CCG average of 89% and national average of 88%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review was offered 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.
• Effective re-call procedures were in place for monitoring and to ensure attendance at reviews.
• Care plans were agreed for COPD (chronic obstructive pulmonary disease) patients.

Updated 17 January 2017

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.
• There was a clinical safeguarding lead and all staff were trained appropriate to their role.
• Immunisation rates were higher than local and national averages 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 percentage of women aged 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years was 73%, compared to the local CCG average of 80% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw examples of joint working with midwives, health visitors and school nurses.

Updated 17 January 2017

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 practice had 28 patients aged over 75; all these patients had a named GP and dedicated, personalised care packages in place.

Updated 17 January 2017

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 as well as a full range of health promotion and screening that reflects the needs for this age group.
• Telephone consultations and extended hours offered evening appointments.
• Early morning and late evening appointments with nurses and other clinics were readily available.
• On-line services introduced including appointment booking and ordering prescriptions.
• The practice’s uptake for the cervical screening programme was 73%, which was lower than the CCG average of 80% and national average of 82%. The practice had a higher than average exception rate of 15%, compared to a CCG average of 9% and a national average of 6 %.
• 44% of female patients aged between 50 and 70 years had been screened for breast cancer in the last 36 months, which was lower than the CCG average of 71% and the national average of 72 %.
• 37% of patients aged between 60 and 69 years had been screened for bowel cancer in the last 30 months, which was lower than the CCG average of 51% and the national average of 58%.

Updated 17 January 2017

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

• 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.
• 67% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months (01/04/2014 to 31/03/2015), compared to the local average of 81% and the national average of 84%.
• The practice worked closely with support groups and voluntary organisations that assisted patients experiencing poor mental health.
• The practice had a system in place to follow up patients who had attended A&E 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 17 January 2017

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 33 homeless people 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 informed vulnerable patients about how to access 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.
• Bereavement support was in place where needed with visits to recently bereaved patients.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 10 patients as carers, which was less than 1% of the practice list.