Archived: Ilex View Medical Practice

Updated 22 June 2016

Ilex View Medical Practice provides services to around 7,308 patients in the Rossendale Valley in East Lancashire. The practice provides services under a General Medical Services (GMS) contract with NHS England. The local clinical commissioning group (CCG) is East Lancashire CCG and the practice is based in a shared health centre building managed by East Lancashire Hospitals NHS Trust. The practice moved into this building in 2011.

Other services in the building include: another GP practice; the local hospice; physiotherapy; community services and diagnostic screening such as x-ray and ultrasound.

The practice has three GP partners, one male and two females as well as one female salaried GP and one regular locum who was previously a GP partner. The nursing team comprises a nurse practitioner, two nurses and a nursing assistant. The clinical team are supported by a practice manager and team of nine administrative staff.

The practice is open between 8am and 6.30pm Monday, Thursday and Friday, and 8am until 8pm on Tuesdays and Wednesdays. Appointments are from 8.30am to 11.30am every morning and 3pm to 6pm each afternoon. Extended hours surgeries are offered from 6.30pm until 8.pm on Tuesdays and Wednesdays.

Around 23% of the population are White Pakistani or Bengali, although most speak English. The practice has below average patients who are aged 45 and older. The practice informed us that their list size had grown by 1,000 patients in the last six years.

Male and female life expectancy is just below East Lancashire Clinical Commissioning Group (CCG) and national averages (male: practice 77 years, England 79; female: practice 81 years, England 83).

Information published by Public Health England rates the level of deprivation within the practice population as five on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). East Lancashire has a higher prevalence of Chronic Obstructive Pulmonary Disease (COPD, a disease of the lungs), smoking and smoking related ill-health, cancer, mental health and dementia than national averages.

Out of hours treatment is provided by East Lancashire Medical Services Ltd.

Updated 22 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ilex View Medical Practice on 12 and 20 May 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows

• The practice actively worked with East Lancashire Clinical Commissioning Group to identify vulnerable patient groups and introduce additional clinical care, such as the Rossendale long term conditions nurse, the advanced nurse practitioner team for local care homes and a paediatric community nursing team pilot.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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.
• Practice staff were passionate about their local community and proud to share details of a range of fund raising activities they had taken part in recently.
• Information about services and how to complain was available and easy to understand.
• 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.

There was one area of outstanding practice:

The practice was proactive at working with the local Clinical Commissioning Group to identify specific patient groups where additional care or services were required and helping introduce them. Specific service improvements included:

• Designing a “Common Childhood Illnesses” booklet which had been rolled out throughout East Lancashire and supporting the development of the community paediatric team.
• Helping set up and oversee a local long-term conditions team.
• The practice had conducted a frailty project, working with the University of Central Lancashire to identify elderly patients who were frail and assess them against nationally recognised criteria and identify appropriate clinical or social care needs.

The areas where the provider should make improvement are:

• Review the process for acting on safety alerts to ensure there is an audit trail of actions taken.
• Follow up on reference requests to ensure recruitment checks are completed for all staff.
• Review the complaints procedure and keep records of verbal communication as well as formal written complaints responses.
• Fulfil employer responsibilities relating to health and safety (including working with building management) to:
  • Review the process for portable appliance testing (PAT) to ensure all equipment is tested in line with the schedule.
  • Ensure actions required in the building fire risk assessment are carried out.
  • Complete actions identified in the risk assessment carried out by the Medical Defence Union and review local health and safety policy to include risk assessments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 June 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. One GP partner worked with East Lancashire CCG to develop a support service for patients with long-term conditions.
• A nurse contacted patients who missed long-term condition reviews by phone.
• Longer appointments and home visits were available when needed.
• The practice was generally performing in line with tor above other practices in the management of long-term conditions. For example, four out of five indicators for diabetes management were above the national averages. 92% of patients with diabetes had a recent blood pressure reading which was within a normal range, higher than the national average of 78%. 99% of patients with diabetes had an influenza immunisation in the preceding flu season, again above the national average of 94%.
• 92% of patients with chronic obstructive pulmonary disease (COPD, a lung condition) had a review in the last 12 months, in line with the national average of 90%.
• 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.

Updated 22 June 2016

The practice is rated as good for the care of families, children and young people, and outstanding for well-led in this population group.

• 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. 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.

• 82% of eligible women had a record of a cervical screening test within the previous five years, in line with the national average of 82%.

• As well as a weekly drop in vaccinations clinic which was facilitated the same day the health visitors ran a clinic in the building, 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 had implemented a paediatric early warning signs assessment for unwell children and obtained infant pulse oximeters (these measure oxygen saturation levels) with support of the CCG.
• The practice had developed a paediatric minor illness booklet to support parents of babies and young children, this was later rolled out throughout East Lancashire.

Updated 22 June 2016

The practice is rated as good for the care of older people.

• The practice worked closely with a range of local services to meet the needs of the older people in its population. This included Age UK which offered a 12 week programme to support patients who were becoming socially isolated and a local befriending scheme.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• One GP had a special interest in care of the elderly and used this knowledge to develop additional assessment of and support for frail elderly patients.
• Patients aged over 85 years old were offered double appointments through funding from a local CCG incentive scheme.
• The practice had conducted a frailty project, working with the University of Central Lancashire to identify elderly patients who were frail and assess them against nationally recognised criteria and identify appropriate clinical or social care review accordingly.

Updated 22 June 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 as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice was open two evenings a week until 8pm, giving opportunity for people to attend outside normal working hours.
• The practice had increased the numbers of appointments available through the online boking system and over 40% of the practice population was registered for electronic prescribing. The practice also offered a prescription ordering e-mail system where requests were sent to a secure NHS e-mail address.

Updated 22 June 2016

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

• There was a helpful information display about Dementia on the notice board and the practice made “about me” cards available (these are cards which patients with Alzheimer’s can carry in case they get lost or confused and need help).82% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• 91% of patients with schizophrenia, bipolar affective disorder or other psychoses had a care plan agreed in the previous 12 months, above the national average of 88%.
• The practice had identified patients with dementia for many years, and did not have a gap in patients identified with dementia. The practice utilised the national enhanced service to increase numbers and identify carers of patients with dementia.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• Staff had completed Dementia awareness training and 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• Patients with mental health conditions were offered personally tailored care to suit their needs.

Updated 22 June 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• This included working with the integrated neighbourhood team for patients who needed additional health and social care.
• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered open access and longer appointments for patients who were particularly vulnerable or had learning disabilities.
• 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 worked closely with the local substance misuse support group for patients who had drug and alcohol issues.
• The practice was located in the same building as Rossendale hospice and the staff worked closely with the hospice to support patients who were terminally ill and their families.