Layton Medical Centre

Updated 26 August 2016

Layton Medical Centre is housed in a purpose-built single storey building in the Layton district area of Blackpool. The building was constructed in 1990 and has been extended to include a pharmacy and additional rooms. At the time of the inspection, there was extensive building work in progress to extend the surgery further and reconfigure the existing premises. The planned development will provide onsite parking and the practice is close to public transport. The practice provides services to 6,418 patients.

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

There are two female GP partners and two long term male locum GPs. The practice also employs an advanced nurse practitioner, four practice nurses, a health care assistant and a clinical pharmacist. Two of the practice nurses are employed solely in order to conduct clinical research with selected practice patients. The non-clinical team consists of a practice manager and 10 administrative and reception staff who support the practice.

The practice is open between 8am and 8pm on Monday and Thursday and 8am and 6.30pm on Tuesday, Wednesday and Friday. When the practice is closed, patients are able to access out of hours services offered locally by the provider Fylde Coast Medical Services by telephoning 111.

The practice population is similar to the national average with slightly more patients aged over 65 years of age, 20%, compared to the national average of 17%.

Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice caters for a larger proportion of patients experiencing a long-standing health condition than average practices (67% compared to the national average of 54%). The proportion of patients who are in paid work or full time education is higher (55%) than the CCG average of 52% and lower than the national average of 62% and unemployment figures are higher, 14% compared to the CCG average of 7% and the national average of 5%.

The practice provides level access for patients to the building with automated entry doors and is adapted to assist people with mobility problems.

Updated 26 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Layton Medical Centre on 26 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 generally assessed and well managed, however, the practice lacked risk assessments relating to some blind pull cords and the storage of adrenalin for emergency use.
• 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 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.
• The practice assessed service delivery regularly with the use of audit, however, they did not always formally document these audits.
• 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 and had a duty of candour policy in place.

We saw two areas of outstanding practice:

• The practice told us that the overarching approach of the practice was one of integrating health and social care, recognising that the two were closely linked. The practice had identified a need for support for socially isolated patients and had started hosting a monthly coffee morning for those people to meet.
• The practice participated in research which involved about 4% of its patients. This research provided positive outcomes for patients with some chronic diseases and informed the clinical practice of the GPs and clinical staff. The practice had won two recent awards for research.

The areas where the provider should make improvement are:

• Carry out risk assessments to identify risks associated with loose pull cords on blinds and the storage of adrenalin for emergency use.
• Document audit activity and formalise the recording of quality improvement work to improve governance arrangements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 August 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.
• Outcomes of treatment for patients with long-term conditions were consistently above national averages. For example, the percentage of diabetic patients who had their blood sugar levels well-controlled was 88% compared to the national average of 78% and the percentage of diabetic patients with blood pressure readings within recommended levels was 91% compared to the national average of 78%.
• 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.
• One of the practice nurses could initiate insulin for diabetic patients ensuring that only those patients with the most complex needs were referred to hospital.
• The practice worked with the clinical commissioning group and other neighbouring practices to redesign community services.
• The practice participated in research which involved about 4% of its patients. This research provided positive outcomes for patients with some chronic diseases and informed the clinical practice of the GPs and clinical staff. The practice had won two recent awards for research.

Updated 26 August 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 high for all standard childhood immunisations. The practice continued to check babies at seven to nine months of age after this check had been dropped from the national programme to encourage immunisation uptake.
• The practice invited all pregnant women into the practice for an antenatal appointment with a GP. The GP encouraged the uptake of the vaccination against pertussis (whooping cough) and administered this to the patients themselves.
• 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 94% which was much higher than the clinical commissioning group (CCG) average of 81% and 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.
• The practice sponsored a local children’s football team. They told us that this allowed them to forge links with the community and promote healthy living through exercise.

Updated 26 August 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. We saw evidence that care plans were in place for 99% of all patients aged over 65 years of age.
• 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 been part of the clinical commissioning group (CCG) pilot project to test a mobile electronic patient record system which was used on patient home visits.
• The practice allocated a named GP to care for patients in the final stages of life. Both GP partners had experienced six months’ work in a hospice as part of their medical training.

Updated 26 August 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 offered a ‘Commuter’s Clinic’ on Monday and Thursday evening until 8pm for working patients who could not attend during normal opening hours.
• From the national GP patient survey, 82% of patients were satisfied with the practice’s opening hours compared to the national average of 78%.
• 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 26 August 2016

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

• 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.
• 95% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the 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 piloted a mental health wellbeing service. They employed a counsellor to see patients in the practice and also set up a separate group for patients experiencing problems with anxiety and another for working-age patients that ran in the evenings.
• 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 26 August 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 offered longer appointments for patients with a learning disability and those with complex needs.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had arranged for the local carers’ support organisation to attend the practice weekly at the same time as a member of social services was visiting to give advice to patients. The practice had been named as the local carers’ support organisation practice of the year in 2015.
• 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.
• The practice had received a complaint from a vulnerable patient and had met with the patient to discuss the problem. Practice staff discovered that there were other social issues that were affecting the patient and acted as the patient’s advocate to resolve them.
• Practice staff assisted patients in booking an appointment when they were referred to other services. They aimed to provide appointments for patients before they left the practice after their consultation, particularly for vulnerable patients.
• The practice had arranged a drop-in clinic with the local society for the blind and planned further sessions in the future.
• The practice had identified a need for support for socially isolated patients and had started and hosted a monthly coffee morning for those people to meet.