Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection January 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those retired and students) – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at Irwell Medical Practice on 22 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice was open and transparent, and had systems in place to adhere to the Duty of Candour. When things went wrong, we saw that the practice offered patients and apology and an explanation.

• Quality improvement was embedded into practice. There was a programme of clinical audit in place that was routinely monitored and changes made to practice resulted in measurable improvements to patient care. The practice was proactive in identifying new ways of working to streamline services and improve patient experience.

• The practice had developed and implemented an advance nurse practitioner (ANP) service for the locality which was funded by East Lancashire CCG. This team provide additional clinical care for patients living in 19 nursing and residential homes in Rossendale to reduce avoidable admissions.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Feedback from both patients and staff was proactively sought and used to shape the delivery of high quality care.

• The practice was strongly committed to multidisciplinary working and could evidence how this had a positive impact on patient care.

• Patients found it easy to use the appointment system and reported that they were able to access care when they needed it. We saw that the practice proactively monitored access via regular demand and capacity audits which were used to inform rota planning.

• Reception staff knew that if patients wanted to discuss sensitive issues or appeared distressed they could offer them a private room to discuss their needs. A yellow card scheme was in place in reception. If a patient wished to speak in private, the yellow cards were available on each reception desk. They did not have to say anything, but instead hand a yellow card to the receptionist who would arrange a confidential room for the patient to speak to staff.

• Staff told us they felt valued and well supported.

• There was a strong focus on continuous learning and improvement at all levels of the organisation. The partners and management team were keen to contribute to and add value to the local healthcare economy and the practice frequently participated in pilot schemes and disseminated learning to other practices in the locality.

We saw a number of areas of outstanding practice:

• The practice had recently registered 34 patients who were asylum seekers. The practice had developed a ‘welcome pack’ for asylum seekers containing useful local information. This welcome pack had since been shared with other local practices. The practice also worked closely with an asylum seeker support worker from a local charity.

• The practice had recognised the lengthy wait patients experienced when referred to the memory clinic. They had commenced working with Alzheimer’s Connect; patients were referred to Alzheimer’s Connect while waiting to access assessment at the memory clinic. This ensured they received timely advice and support. A total of 28 patients had been referred to Alzheimer’s Connect since the end of July 2017. All practice staff accessed training delivered by Alzheimer’s Connect in October 2017 to raise their awareness of how best to support dementia patients and of the services offered by the organisation.

• The practice had identified 687 patients as carers (4.8% of the practice list). The practice ensured the various services supporting carers were coordinated and effective. Carers of patients with dementia were offered a health check appointment to coincide with the dementia health review for their relative.

• PPG members supported the practice by designing and conducting surveys as well as helping the practice improve patient care through involvement in training and acting as “mystery callers” to monitor and improve customer service. PPG members had supported medical students on placement both at this practice and others in the locality, by acting as patients for mock practical exams to allow them to prepare.

The areas where the provider should make improvements are:

• Complaints documentation should make clear that complainants have been informed how to escalate their concerns should they be unhappy with the practice’s final response.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Irwell Medical Practice on 26 January 2016. Overall the practice is rated as good

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised and shared with all staff at regular meetings.
• As a teaching practice, learning was embedded at all levels, along with a strong culture of reflective practice, teamwork and mutual support.
• Staff had the skills, knowledge and experience to deliver effective care and treatment and assessed patients’ needs in line with current evidence based guidance.
• Patients said that the practice treated them treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 worked closely with other organisations and the local community in planning service provision to ensure that they met people’s needs. For example, the practice was involved in the integrated neighbourhood team which ensured complex health and social care needs were identified and met through joint working.
• The patient participation group (PPG) was actively involved in supporting both the development of the practice and wider local health services through Clinical Commissioning Group (CCG) committees. The practice had made changes to the way it delivered services as a consequence of patient and PPG feedback.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand.
• The practice had a clear vision with patient care and safety as its top priority.
• Staff and patient representatives worked hand in hand to deliver and continuously improve the practice.
• There was a clear leadership structure and staff felt supported by visible and approachable management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice including:

• The long established PPG supported the practice by designing and conducting surveys as well as helping the practice improve patient care through involvement in training and acting as “mystery callers” to monitor and improve customer service. PPG representatives explained they had seen an improvement in customer service. The practice actively responded to PPG feedback and engaged with the PPG over practice developments.
• The practice had a “yellow card scheme” in the reception areas which meant that patients who wished to speak in private could pick up a card and hand to reception staff who would immediately arrange a quiet room for the patient to speak to staff.
• The practice had developed an advance nurse practitioner (ANP) service for the locality which was funded by East Lancashire CCG. This team provide additional clinical care for patients living in 27 nursing and residential homes in Rossendale to decrease avoidable admissions. The practice provided active management, training and support to the team. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice