Cleveleys Group Practice

Updated 13 April 2016

Cleveleys Group Practice is housed in a purpose built building, Cleveleys Health Centre, situated in a residential area of Cleveleys. The building has been extended to accommodate a growing patient list. The practice provides services to a patient list of 10,965 people. The building is shared with one other GP practice and local community services. District nurses and health visitors have their own rooms within Cleveleys Group Practice.

The practice is part of the NHS Blackpool Clinical Commissioning Group (CCG) and services are provided under a Personal Medical Services Contract (PMS). There are four GP partners (two male and two female) and one female salaried GP. The practice also employs two nurse practitioners, a specialist nurse (a care co-ordinator nurse), three practice nurses, two treatment room nurses, one health care assistant and a pharmacist. The practice is supported by non-clinical staff consisting of a practice manager and fifteen administrative and reception staff.

The practice offers extended hours and is open between 7.30am and 7pm Monday to Friday and Saturday between 8am and 2pm. Appointments on weekdays are offered between 7.40am and 6.50pm and on Saturday between 8am and 1.50pm. When the practice is closed, patients are able to access out of hours services offered locally by the provider Fylde Coast Medical Services by telephoning a local number or 111.

The practice has a considerably higher proportion of patients over the age of 60 when compared to the England average. Figures for patients aged 65 and over show that these patients make up 31% of the practice list compared to the CCG average of 20% and the national average of 17%.

Information published by Public Health England rates the level of deprivation within the practice population group as five on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice caters for a higher proportion of patients experiencing a long-standing health condition (65% compared to the national average of 54%). The proportion of patients who are in paid work or full time education is lower (43%) than the CCG average of 52% and the national average of 62% however unemployed figures are significantly lower, 1% compared to the CCG average of 7% and the national average of 5%.

The practice provides level access to the building and is adapted to assist people with mobility problems. All patient consultations are carried out on the ground floor of the premises and there is a car park on site for patients.

Updated 13 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cleveleys Group Practice on 3 March 2016. Overall the practice is rated as outstanding.

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.

• 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.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice employed a qualified nurse as a care co-ordinator who contacted all patients who had been discharged from hospital, providing a home visit and full assessment if necessary. We were told that this model of care was to be adopted by the Clinical Commissioning Group (CCG) for other practices.

• Feedback from patients about their care was consistently and strongly positive. 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 with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice met with other practices in the neighbourhood for monthly meetings that included representatives from community services, the police, ambulance services, social services and health and wellbeing workers.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, following a patient complaint, the practice reduced the number of appointments that patients with more than one long-standing health condition attended. The practice provided additional training to staff and brought health checks together into one appointment to reduce patient visits to the practice. Longer appointments were provided for this.
• 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 which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had attained the Royal College of General Practitioners (RCGP) accreditation in 2014. (This award is to reward practice teams who have improved their organisational quality of care to best practice recommended levels). The practice had used the learning from this to produce a performance dashboard that, together with feedback from staff meetings, audit, significant events and patient complaints was used to inform a quality improvement plan. This plan was regularly reviewed and updated at practice meetings.

• There was a clear leadership structure and staff felt supported by 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 practice pharmacist had developed a risk-profiling tool to identify patients who were most in need of having their medications reviewed by the practice staff. The pharmacist continued to audit this work to ensure that risks were reduced and we saw evidence of this.

• One of the practice GPs received direct alerts from the police when they had a concern regarding a vulnerable patient. This enabled the GP to arrange an appointment or visit the patient. The practice was the pilot site for this project.

• A charity providing memory screening for patients attended every fortnight and patients were able to self-refer to these clinics as required. The practice also arranged for this charity to attend a flu clinic on a Saturday.

• The practice had purchased a light box to facilitate staff training and hand hygiene. (A light box enables staff to identify poor hand hygiene practices).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2016

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

• Nursing staff had lead roles in chronic disease management and the practice planned strategically to enable continuity of care for patients.
• The practice achieved 99.5% of available points via QOF in 2014-15. Key achievements for diabetes included 90% of patients with diabetes whose blood pressure readings were equal to or below recommended levels. This was 6% above the CCG average and 12% above the national average. The practice had reported 8.9% of diabetic patients as exceptions compared to the CCG average of 14.1% and the national average of 10.8%. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• Longer appointments and home visits were available when needed.
• All these 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. The practice had worked to streamline review appointments for patients with more than one long-term condition so that visits to the practice could be reduced.
• The practice pharmacist had developed a risk-profiling tool to identify patients who were most in need of having their medications reviewed by the practice staff. We saw evidence of reducing risk for these patients.

Updated 13 April 2016

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

• There were 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. Immunisation rates were relatively high for all standard childhood immunisations.
• Results from the QOF for 2014-2015 showed that 80% of patients with asthma who were on the practice register had had an asthma review within the previous 12 months compared to the national average of 75%.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The cervical screening uptake for women aged 25 to 64 was 80%, which was comparable with the CCG and national averages.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Children under the age of five were always seen or telephoned on the same day by a healthcare professional and under one year of age by a GP.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice ran baby clinics with the health visiting service. The GP, practice nurse and health visitor continued to offer checks to seven to nine month old babies even though funding for this had been removed nationally. This helped provide a continuing relationship with the practice and encouraged further attendance for baby health checks and immunisations. Concerned parents were encouraged to use the clinics as a drop-in service.

Updated 13 April 2016

The practice is rated as outstanding 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 employed a nurse to co-ordinate care for patients who have had an admission to hospital. On discharge, the nurse either contacted the patient by telephone or by visiting them at home. If appropriate, a full clinical assessment was undertaken, a care plan produced and further referral made to other services if needed.
• The practice acted as a pilot site for a new service that was introduced in 2015. This service offered care for patients at risk of admission to hospital and who would benefit from proactive management.
• A charity providing memory screening for patients attended every fortnight and patients were able to self-refer to these clinics as required. The practice also arranged for this service to attend a flu clinic on a Saturday.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had a robust system to follow up patients who did not collect their repeat prescription or failed to attend their appointment at the practice or hospital.
• The practice worked and communicated well with local nursing homes. GPs provided regular visits and conducted ward rounds with the nursing home staff. Care planning was provided for these patients including end of life planning. Patients’ families were involved wherever possible.
• Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.

Updated 13 April 2016

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

• 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.
• The practice offered appointments from Monday to Friday from 7.40am to 6.50pm and on Saturdays from 8am to 1.50pm.
• Telephone appointments were also available for patients who needed advice but were unable to attend the surgery.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. We saw that online appointments were available for all GPs.
• A 24-hour telephone prescription ordering service was available as well as online ordering.

Updated 13 April 2016

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

• 78% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
• The practice had recorded an agreed care plan for 91% of patients with a recognised mental health problem compared to the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• A mental health counsellor ran weekly clinics in the surgery and staff could refer patients to this service. A recent local initiative enabled patients to self-refer to these when appropriate.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia and all staff had undertaken dementia awareness training.
• The practice had a register of patients who were subject to a Deprivation of Liberty Safeguards (DoLS) and staff had a good understanding of DoLS.

Updated 13 April 2016

The practice is rated as outstanding for the care of people who 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.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. One of the practice GPs received direct alerts from the police when they had a concern regarding a vulnerable patient. This enabled the GP to arrange an appointment or visit the patient. The practice was the pilot site for this project.
• The practice attended monthly neighbourhood meetings with other practices, community services and external agencies including members of the community police Early Action team who discussed patients who were at risk.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.
• The surgery offered a shared-care service with the local drug and alcohol service.