The Ivy Medical Group Also known as Lambley Lane Surgery

Updated 28 April 2021

The Ivy Medical Group is located at Lambley Lane Surgery, 6 Lambley Lane, Burton Joyce, Nottingham, Nottinghamshire, NG14 5BG. The practice is situated within the Gedling borough to the north-east of the city of Nottingham and serves patients predominantly in the Burton Joyce and Lowdham areas and the surrounding villages. The practice has three sites with the main surgery being located at Lambley Lane in Burton Joyce and branch sites at The Apple Tree Medical Practice in Burton Joyce and at The Lowdham Medical Centre in Lowdham.

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, maternity and midwifery services, family planning, surgical procedures and treatment of disease, disorder or injury.

The practice team is led by a single-handed GP. The GP employs four salaried and three locum GPs, a lead practice nurse, an advanced nurse practitioner, a practice nurse and a health care assistant. The clinicians are supported by a practice manager, operations manager, assistant practice manager and a team of reception and administrative staff. The dispensary staff includes a dispensing manager and a dispenser.

The Ivy Medical Group is situated within the NHS Nottingham and Nottinghamshire Clinical Commissioning Group (CCG) and provides services to approximately 7,000 patients. The National General Practice Profile states that 95.5% of the practice population is from a white background. Information published by Public Health England, rates the level of deprivation within the practice population group as 6722 out of maximum of 6900, indicating they are in a less deprived area.

The Lambley Lane surgery opens from 8.15am to 1pm (12.30pm at the Lowdham branch site) and 2pm to 6.30pm Monday to Friday apart from a Thursday when the Lambley Lane surgery and the Lowdham branch site close at 1pm. The Apple Tree Medical Practice branch site is open from 8.15am to 6.30pm Monday to Friday. The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Nottinghamshire Emergency Medical Services.

Updated 28 April 2021

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Ivy Medical Group on 11 April 2017. The overall rating for the practice was good with a rating of requires improvement for providing well-led services. The full comprehensive report form the April 2017 inspection can be found by selecting the ‘all reports’ link for The Ivy Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 11 April 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• Practice workforce arrangements had been reviewed and additional staff recruited to improve stability and continuity. This included management, administrative and clinical staff.
• There was evidence of continued review and monitoring of patient experience information. The practice considered that changes to the staffing arrangements had not yet impacted upon patient experience data.
• Arrangements to monitor and record training had been improved.
• There was evidence of the involvement of regular communication and engagement with established locum GPs.
• Staff appraisals had been undertaken and new staff were given performance reviews.

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

• Continue to review and improve patient experience in respect of continuity of care and access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 June 2017

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

• Clinical staff worked closely with community nursing teams, care staff and the voluntary sector to manage the care of patients with complex health needs. This included facilitating regular multidisciplinary meetings attended by the community respiratory nurse, district nurses, community matron, Macmillan nurse and Age UK.
• 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.
• The practice participated in the national diabetes prevention programme for patients in line with the NHS diabetes prevention programme. As part of this programme, patients identified at high risk of diabetes were referred onto an evidence-based behaviour change programme to help reduce their risk. This included education on healthy eating and lifestyle, help to lose weight and bespoke physical exercise programmes, which reduced the risk of developing the condition.
• The diabetes nurse specialist attended a joint monthly clinic with the practice nurse to review patients with diabetes to initiate insulin, or to review more complex problems.
• 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 actively monitored which ensured low levels of exception reporting.

Updated 2 June 2017

• Appointments were available outside of school hours and all children aged under five were seen on the day if medically assessed as necessary. Children under one year of age were booked as extras on the appointment list without the need for triage.

• 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 2 June 2017

• The practice had the fourth highest proportion of older patients across the 20 practices within the CCG. Approximately 11.5% of patients registered at the practice were aged 75 or over and services were tailored to meet their needs.

• 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 regular multi-disciplinary meetings, to ensure they received appropriate care.
• Home visits and longer appointments for patients with enhanced needs were available. The practice provided a home phlebotomy service to ensure older people received the care they needed to monitor their health needs, and had implemented a delivery service to housebound patients who had their medicines issued via the practice dispensary.
• The practice was a member of the ‘Primary Care Home’ pilot to improve services for older patients in the community to reduce their need to travel to hospital.
• The practice had recently commenced input to a local care home as part of the ‘one care home, one practice’ initiative. This helped with continuity and established a more proactive and responsive service for residents.
• The practice worked with Age UK and planned to set up tea mornings to help address social isolation, and to develop a further opportunity to identify their patients’ needs. 

Updated 2 June 2017

• The practice was proactive in offering online services and news/Facebook/twitter feeds. The practice had achieved a 27% sign up from patients to access online services including appointments and repeat prescriptions. This was significantly higher than the national target of 10%, and also exceeded uptake in other local practices.
• The practice website had been upgraded to include health promotion information and an iPhone application was used to improve access to information and services 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 in alignment with 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 86% and national average of 82%.
• The practice used a text messaging service to remind patients of appointment bookings.
• NHS health checks were being actively promoted and the practice had worked hard to increase uptake in the last six months through the use of computer prompts, and the provision of dedicated clinics. 

Updated 2 June 2017

• 2015-16 published QOF data showed that 87.5% of patients with a mental health condition had a documented care plan in the last 12 months which was in line with the local average of 87.8%, and the national average of 88.8%. However, overall exception reporting rates for mental indicators were higher than local and national averages. Practice provided data (subject to external verification) showed that achievement had increased to 100% in 2016-7 and exception reporting rates had reduced.
• 81.8% 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 88.5% and the national average of 83.8%. The practice’s own data for 2016-7 demonstrated an achievement of 78.1%, but with improved levels of exception reporting.
• 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.

Updated 2 June 2017

• The practice offered longer appointments for patients with a learning disability
• The practice had eight patients on their learning disability register, and 62.5% of these patients had received an annual health 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.