Dr Mahmoud Ibrahim Also known as Rossendale Valley Medical Practice

Updated 19 December 2017

Dr.Mahmoud Ibrahim provides care and treatment to 2629 patients of all ages, based on a General Medical Services (GMS) contract. The practice is part of the NHS East Lancashire clinical commissioning group (CCG) and provides care and treatment to patients living in the Rossendale area. The practice serves an area where deprivation is rated as five on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). Male and female life expectancy in the practice geographical area is 77 years for males and 82 years for females both of which are slightly below the England average of 79 years and 83 years respectively. The numbers of patients in the different age groups on the GP practice register are similar to the average GP practice in England.

The practice provides services from the following location:

• Haslingden Health Centre, Manchester Road, Rossendale. BB4 5SL

We did not visit the practice during this desk top review.

The practice is located in a refurbished health centre which provides patients with fully accessible treatment and consultation rooms. The service is provided by a single handed GP (male). The practice also employs a practice manager, one female practice nurse, an advanced nurse practitioner as well as a team of reception and administrative staff.

The practice is open 8am to 6.30pm on Mondays, 8am to 1:15pm on Tuesdays, 8am to 6.30pm Wednesdays and 6.30am to 6.30pm on Thursdays and Fridays. When the surgery is closed every Tuesday afternoon from 1:15pm, a GP remains on-call for emergencies until 6:30pm. All surgeries are accessed by appointment.

When the practice is closed patients can access out-of-hours care via the East Lancs Medical Service (ELMS) and the NHS 111 service.

Updated 19 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on Dr. Mahmoud Ibrahim on 22 June 2017. The overall rating for the practice was good, although the practice was rated as requires improvement for safety. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Dr. Mahmoud Ibrahim on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 14 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach identified in the requirement notice.

The practice is now rated as good for safe services, and overall the practice is rated as good.

Our key findings were as follows:

• The practice had taken action to address the concerns raised at the CQC inspection in June 2017. They had put measures in place to ensure they were compliant with regulations.
• Appropriate arrangements were now in place for monitoring the supply of emergency drugs.
• The practice had improved arrangements to ensure that vaccines were stored at consistently safe temperatures.
• Recommendations made at the previous inspection, such as updated training in the Mental Capacity Act (2005) and reviewing the recruitment policy had been actioned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 August 2017

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.
• The practice completed a health check on all newly registering patients which helped to identify any long term conditions early in the relationship with the practice.
• The GP and practice nurse had recently attended training to run an insulin initiation service which was planned to launch in September 2017. Specialist clinics were held in the practice for patients with heart disease, diabetes, chronic obstructive pulmonary disease (COPD) and asthma. Performance for diabetes related indicators was lower or comparable to the national average. For example the percentage of patients with diabetes, on the register, in whom the last blood pressure reading was 140/80 mmHg or less in the period April 2015 to March 2016 was 65%. (CCG average 82% National average 78%).
• Patients with COPD were seen regularly. This was also an opportunity to provide flu and pneumonia vaccination and issue patients with rescue packs including antibiotics for respiratory conditions.
• A smoking cessation service was offered onsite by an external agency.
• Longer appointments and home visits were available when needed.
• All these patients had 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 11 August 2017

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

• There were comprehensive 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 and those who did not attend secondary care appointments.

• Immunisation rates for all standard childhood immunisation programmes achieved up to 86.5% in 2015/16, which was comparable with the clinical commissioning group (CCG) average. However uptake rates for the vaccines for two year olds achieved (65%) against a national target of over 90%.These were provided both at immunisation clinics and by appointment.

• 78% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compared to a CCG average of 82% and a national average of 81%.

• All children discharged from hospital after an asthma attack were followed up within 48 hrs by a clinician.

• 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 and health visitors.

• All parents or guardians calling with concerns about a child under the age of 10 were offered a same day appointment.

• Young people were signposted or referred to appropriate services such as Child and Adolescent Mental Health.

• The practice offered appointments to discuss sexual health, undertook pregnancy testing and contraception was available.

Updated 11 August 2017

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 people in its population.

• The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments on the same day. Health checks were available for the over 75 years at a monthly clinic when information and advice was provided by a local agency.

• Patients had been identified who were on the Avoiding Unplanned Admissions register all of whom had a care plan.

• The practice was providing an enhanced service in shingle and pneumococcal vaccination to this group of patients. The practice proactively identified patients who were entitled to this vaccination and then contacted them. There were leaflets available at the reception regarding shingles vaccination.

• There was an Advanced Nurse Practitioner employed by the CCG to work within nursing and residential homes in the locality.

• Staff signposted older patients who were at risk of social isolation to a befriending service run by a voluntary sector agency.

Updated 11 August 2017

The practice is rated as Good for the care of working age people.

• 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. This included pre-bookable appointments from 6.30am and an on-call doctor available until 6.30pm.

• The practice was proactive in offering online services including repeat prescriptions as well as a full range of health promotion and screening that reflected the needs for this age group.

• Health checks were available for patients aged between 40-74years.

• Telephone consultations were offered daily. There was flexible timing for telephone call backs from the GP. If appointments were not available to see clinicians at the practice patients were directed to Pharmacy first, NHS 111, or the local walk in centre.

• Smoking cessation advice was available at the surgery delivered by a voluntary agency.

• Staff referred patients to the Exercise on Prescription service.

Updated 11 August 2017

The practice is rated as Good for the care of people experiencing poor mental health.

• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record in the preceding 12 months. This was above the clinical commissioning group average of 88% and the national average of 88%.

• 76% of patients with mental health conditions had their alcohol consumption recorded in the preceding 12 months. This was lower than the CCG average of 90% and the national average of 89%.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations such as alcohol and drug services who have a clinic onsite and patients were given contact details for the crisis team, single point of access.

• Daily appointments were offered from 06.30am two days each week for people with anxiety or social phobia who were unable to wait in a full waiting room.

Updated 11 August 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. Alerts for direct access to GPs or nursing staff were added to records of these patients.

• The practice undertook health checks for patients with learning disabilities at an extended appointment when a nurse and a GP wrote an individual care plan.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients including hospice staff, palliative care nurses and district nurses. This included multidisciplinary integrated care meetings to ensure patients received safe, effective and responsive care.

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

• Carers were identified during appointments with practice staff who carers were offered health checks and flu vaccination.

• Home visits were available if the patient could not attend appointments at the surgery.

• There were interpreter services available which could be booked for specific appointments for patients who did not speak English as a first language.