Archived: The Ivy Medical Group

Updated 4 November 2016

The Ivy Medical Group provides medical services to approximately 3,800 patients through a primary medical services contract (PMS). The catchment area for registered patients includes Burton Joyce, Lowdham and surrounding villages.

The practice has two GP surgeries with Lambley lane surgery, in Burton Joyce as the main surgery and Medical centre, in Lowdham as the branch site. We visited both locations as part of our inspection. A dispensary service is offered from the Medical centre, Lowdham and about a third of the practice population access this service.

The level of deprivation within the practice population is significantly below the national average, with most of the practice population living in affluent villages / semi- rural areas.

The current clinical team comprises one full-time GP (male), a salaried GP (female), a practice nurse (female) and a part-time health care assistant (female). The clinicians are supported by an administration team comprising a full time practice manager, a lead receptionist, six part-time receptionists, two medical secretaries and a practice administrator. The dispensary staff includes a dispensing manager and a dispensing assistant.

The Ivy Medical Group is a GP training practice offering placements for students from the University of Nottingham medical school.

The practice opens from 8.15am to 1pm and 2pm to 6.30pm Monday to Friday with the exception of Thursday when the practice closes at 12.30pm.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Nottingham Emergency Medical Service (NEMS).

Updated 4 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Ivy Medical Group on 18 July 2016. The practice was rated as requires improvement overall.

We then carried out an unannounced focused inspection of The Ivy Medical Group on 30 August 2016. This inspection was undertaken to follow up a Warning Notice we issued as a result of our inspection of 18 July 2016, as the practice had failed to comply with the regulations in respect of providing safe care and treatment for patients. This inspection cannot change the ratings. There will be a full re-inspection within six months of the publication date of the initial report.

Our finding across the areas we inspected was as follows:

• Detailed records were kept to evidence the receipt of and actions taken in respect of nationally available patient safety information including Medicines Health and Regulatory Authority (MHRA) alerts to ensure medicines were prescribed safely.

• The practice had reviewed the activities undertaken within the dispensary, consulted staff and produced updated standard operating procedures (SOPs are written instructions about how to safely dispense medicines) which reflected current practice.

• The arrangements for managing medicines in the practice kept patients safe and risks to patients were well managed. Specifically: effective systems were in place for shared care arrangements with secondary care to ensure adequate monitoring and follow up of patients on high risk medicines; repeat prescriptions dispensed at Lowdham medical centre were signed before the medicines were given to patients; and medicines were securely kept within the dispensary.

• Regular clinical meetings and staff bulletin updates were facilitated to promote learning from patient safety alerts and medicines related issues.

• The practice had purchased defibrillators for both sites (Lambley lane surgery, in Burton Joyce and Medical centre, in Lowdham) and staff had received relevant training for dealing with medical emergencies.

We found that the practice had complied with the Warning Notice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 October 2016

The provider was rated as inadequate for the safe domain and requires improvement for the well led domain. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• Data reviewed showed outcomes for patients were at or above local and national averages.

• Clinical staff worked closely with community specialist nurses to manage the care of patients with complex health needs. This included facilitating monthly multidisciplinary meetings attended by the community respiratory nurse, district nurses and the community matron.

• Patients at risk of hospital admission were identified as a priority and their care was kept under review to ensure they received integrated care in the community.

• Longer appointments and home visits were available when needed.

• Patients were offered a structured annual review to check their health and medicines needs were being met. The reviews were planned around the patients’ date of birth and patients who did not attend scheduled appointments were monitored.

Updated 20 October 2016

The provider was rated as inadequate for the safe domain and requires improvement for the well led domain. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• Appointments were available outside of school hours and all children aged under five were seen on the day if medically assessed as necessary.

• There were systems in place to identify and follow up children living in disadvantaged circumstances including those at risk of abuse or deteriorating health.

• Records reviewed showed positive examples of joint working with midwives, health visitors and school nurses. For example, the health visitor provided child developmental checks and took part in safeguarding meetings.

• Uptake rates for all standard childhood immunisations were relatively high and in line with the local averages.

• The practice provided baby changing facilities and a private room for breastfeeding mothers if requested.

Updated 20 October 2016

The provider was rated as inadequate for the safe domain and requires improvement for the well led domain. The issues identified affected all patients including this population group. There were, however, examples of good practice.

The practice population comprised of higher numbers of older people (about 11.5% were aged 75 and over) and services were tailored to meet their needs. For example:

• The GP could refer patients for a social care needs assessment through their links with a named social worker and a community care officer.

• The health needs and care plans for older people at risk of hospital admission or deteriorating health was discussed at monthly multi-disciplinary meetings, to ensure they received appropriate care.

• Home visits and urgent appointments for patients with enhanced needs were offered where possible. This included a named GP visiting patients residing in care homes.

• The practice provided a medicines delivery service to housebound patients who had their medicines dispensed at the Medical centre, Lowdham.

Updated 20 October 2016

The provider was rated as inadequate for the safe domain and requires improvement for the well led domain. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• 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 for appointment booking, prescription requests and news/facebook/twitter feeds.

• The practice website had been upgraded to include health promotion information and an iPhone application was being trialled to improve access to the service for patients.

• Health promotion for this age group included advice and support with weight management, smoking and alcohol cessation.

• The practice promoted cancer screening programmes and uptake rates were marginally above the local and national averages. For example, 83% of females aged between 25 and 64 years had a record of cervical screening within the target period compared to a local average of 81% and national average of 74%.

• The practice used a text messaging service to remind patients of appointment bookings.

Updated 20 October 2016

The provider was rated as inadequate for the safe domain and requires improvement for the well led domain. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• The practice regularly worked with multi-disciplinary teams in the case management of patients to ensure they received continuity of care. This included advance care planning for patients with dementia and liaison with the local community mental health teams/psychiatric services.

• Systems were in place to follow up patients at risk of hospital admission and those who had attended accident and emergency.

• Patients were signposted and encouraged to self-refer for psychotherapy services and counselling to improve their mental well-being where appropriate.

• Information about how to access various support groups and voluntary organisations was available to patients.

Published data showed:

• 79% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was below the local average of 88% and the national average of 84%. The overall exception reporting rate for dementia related indicators was 9% and this was in line with the local and national averages.

• 100% of patients with a mental health condition had a documented care plan in the last 12 months which was above the local average of 86% and the national average of 88%. The overall exception reporting rate for mental indicators was 24% compared to the local average of 15% and national average of 11%.

Updated 20 October 2016

The provider was rated as inadequate for the safe domain and requires improvement for the well led domain. The issues identified affected all patients including this population group. There were, however, examples of good practice.

• The practice offered longer appointments for patients with a learning disability and most of these patients had received an annual health check and care plan review.

• The practice regularly worked with other health and social care professionals in the case management of vulnerable patients. This included patients receiving end of life care and carers. Patients were also informed about how to access various support groups and voluntary organisations.

• The practice adopted a co-ordinated approach to care planning in collaboration with other professionals, which ensured key information was shared with other providers such as the out of hours service.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. They 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.