Fernbank Surgery Also known as Dr Ellwood and Partners

Updated 8 September 2016

Fernbank Surgery is located in Victoria Street, Lytham St Annes, Lancashire and has a branch practice in Freckleton, Lancashire. The team covers both practices and offers appointments at both, regardless of which surgery patients contacted.

This practice is located in a large medical centre near to the centre of the town. There is easy access to the building and disabled facilities are provided. There is a large car park serving all of the medical facilities on the site. There are six GPs working at the practice. Five GPs are partners, two male and three female and one female GP is salaried. There are five full time practice nurses, four female, one male, two part time health care assistants (both female) There is a full time practice manager, one assistant practice manager and a team of administrative staff.

Within the building there was one other general practice, a musculo-skeletal service, outpatient clinics and a café.

The practice opening times are 8am until 6.30pm Monday to Friday.

Patients requiring a GP outside of normal working hours are advised to call Fylde Coast Medical Services using the usual surgery number and the call will be re-directed to the out-of-hours service.

There are 10,121 patients on the practice list. The majority of patients are white British with a high number of elderly patients and patients with chronic disease prevalence. The practice are part of Fylde and Wyre Clinical Commissioning Group and deliver services under a General Medical Services contract.

Updated 8 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fernbank Surgery, Lytham St Annes on 7 April 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 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.

• Thorough recruitment procedures were carried out before staff were employed.

• 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 were two areas of outstanding practise:

• One of the GPs  chaired the local neighbourhood meeting. This included benchmarking referrals against other practices and reviewing all local data for trends and actions required.
• We looked at two clinical audits completed in the last two years. These were completed audits where the improvements made were implemented and monitored.Findings were used by the practice to improve services. For example, an audit of gestational diabetes led to a review of NICE guidance being followed in the practice and annual follow up reviews for patients.

The areas where the provider should make improvements :

• Consider producing easy to read information leaflets for people with learning disabilities

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 September 2016

The practice is rated as good for the care of people with long-term conditions.

• The practice has a robust chronic disease programme which included:

• A robust annual review call and recall programme was in place.

• The practice used up to date, evidence based practice guidelines for the management of chronic conditions

• Effective working relationships had been established with Clinical Nurse Specialists for a variety of long-term conditions. The practice offered specific clinics delivered by upskilled staff for Asthma, Diabetes and COPD patients. BP home monitoring, dietary advice, and referral to exercise/lifestyle management groups occurred.

• Patients with COPD were offered enhanced support to recognise advancing symptoms and how to manage these and were given individualised person held care plans known as Breathing Booklets.

• Longer appointments were offered for patients with multiple conditions.

• The clinical lead of the “Housebound Project” was one of the practice GP’s. This is delivered by the neighbourhood team so that patients unable to attend surgery for chronic disease clinics received an equitable service at home.

• Care plans were produced for all patients who required long-term care.

• 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.

• Post-hospital discharge care plan reviews were carried out with patients who attended A & E unnecessarily

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Updated 8 September 2016

The practice is rated as good for the care of families, children and young people.

• The practice had high achievement with their childhood immunisation programme achieving between 88.5% and 97% uptake for two year olds in 2014/15 as compared with the CCG average of 94%. There were systems in place to identify non- attenders for immunisations.
• The practice had six weekly meetings with the health visitors and school nurses to discuss children who might be at risk.
• There was an area in the waiting room for children to play.
• The practice offered a private room for breastfeeding and there were baby-changing facilities.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and younger patients who had a high number of A&E attendances.

• 64% of patients with asthma, on the practice register, have had an asthma review in the preceding 12 months that included an assessment of asthma control using the three RCP questions. This compared to a national average of 75%.

• 82% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years.This compared to a national average of 82%.

• Urgent appointments were offered for children who were acutely unwell, including appointments outside school hours.

• There was an adolescent friendly culture in the Practice with staff flexible to their needs, understanding confidentiality and safeguarding issues. Staff had received training on consent in young people.

• The practice signposted young people to voluntary sector services including Connect

Updated 8 September 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 patients including booking well in advance so that families or carers could attend and transport could be arranged if necessary.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• Care plans and health checks were provided as needed with regular medicine reviews carried out.
• Two of the GP’s were involved in delivering the “Extensive Care” service which provided holistic care for those with two or more chronic diseases. A team of nurses and a consultant in elderly medicine made up the team.

• Care plans were produced for many patient’s on the register in particular those who had been discharged from hospital or those in residential homes.

• The practice offered longer appointments available for those patients who needed them. There was a named GP for all patients.

• Practice staff worked with voluntary organisations including Age UK, Stroke Association and Lancashire Wellbeing Service.

Updated 8 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice promoted online services and text messaging to make it easier for patients who work to access services outside of practice hours.
• NHS health checks were routinely encouraged.

• Text messaging had been introduced as a reminder for patients to keep their appointments.

• The practice offered early morning access from 8am and late appointments until 6.30pm.

• Saturday morning and weekday evening flu clinics were available throughout the season.

• Same day appointments were available and patients could book appointments online and An Electronic Prescription Service meant that patients did not have to go into the Practice to order or collect prescriptions .

• The practice had introduced innovative FEV6 screening for patients with COPD (a screening tool used in the diagnosis of airway obstruction).

• Flexible consulting was offered including working in partnership with patients to offer patients access to results to enable them to self-manage long-term conditions such as diabetes management plans, BP monitoring advice sheets, and “my breathing book”.

• A Smoking Cessation service was run at the other location at Freckleton.

Updated 8 September 2016

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

• The practice had a dedicated area in the waiting room with information regarding dementia and a mental health helpline.
• All patients on the mental health register were invited for an annual review of their mental and physical health and medication.

• 87% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their records, in the preceding 12 months.This compared to a national average of 88%.

• 79 % of patients diagnosed with dementia had their care reviewed in a face-to-face review in the preceding 12 months. This compared to a national average of 84%. Staff were Dementia Friends trained.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. This included joint visits with community mental health teams.

• The practice is currently piloting a scheme where patients may have their depo injection at home.

• Self-help and signposting took place to non-pharmacological therapies including Big White Wall, online resources, exercise on prescription, Richmond Fellowship and Minds Matter.

Updated 8 September 2016

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

• The practice had a register of vulnerable adults and children.

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• Clinical staff were trained in the Mental Capacity Act. There were procedures in place for identifying patients with a Deprivation of Liberty Safeguard in place.

• The practice regularly worked with multi-disciplinary teams in the case management of patients deemed to be vulnerable.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. The practice used the Gold Standard Framework to support patients who were at the end of their life.

• Checks were offered to patients with a learning disability with dedicated, longer appointments scheduled at more accommodating times.

• The practice supported a Vanguard project (the practice is a chosen site taking the lead on the development of a new care model) for patients with complex needs which involved referral into a dedicated service.

• Non-clinical and clinical staff worked flexibly to accommodate those with conditions that involved chaotic or unplanned behaviour for example alcohol abuse and severe and enduring mental health conditions.