Glenroyd Medical

Updated 19 July 2016

Glenroyd Medical main surgery is housed on the first floor of the Moor Park health and leisure centre in the Bispham area of Blackpool. There is also a branch surgery nearer to central Blackpool which is situated in a large purpose built health centre. We did not visit the practice branch site during this inspection.

There is onsite parking available at both sites and the practice is close to public transport. Patient services at the main surgery are all located on one floor with administration rooms on the second floor. The practice provides services to 15577 patients.

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 three male and two female GP partners. The practice also employs a clinical nurse manager, an advanced nurse practitioner, two nurse practitioners, a specialist nurse, four practice nurses, an assistant practitioner, two health care assistants, two phlebotomists and two clinical pharmacists. Non-clinical staff consists of a practice manager and 24 administrative and reception staff who support the practice, as well as a fitness instructor. The practice is a training practice for medical students and GP trainees at different stages of their learning.

The practice is open between 8am and 7pm Monday to Friday. 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 111.

The practice has a larger proportion of patients aged over 45 years of age compared to the national average and fewer patients aged less than 45 years of age.

Information published by Public Health England rates the level of deprivation within the practice population group as three 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 larger proportion of patients experiencing a long-standing health condition (69% compared to the local average of 63% and national average of 54%). The proportion of patients who are in paid work or full time education is higher (58%) than the CCG average of 52% and lower than the national average of 62% and unemployment figures are lower, 5% compared to the CCG average of 7% and the same as the national average.

The practice provides level access for patients to the building with automated entry doors and is adapted to assist people with mobility problems. The building has three floors, and the practice reception, consulting and treatment rooms are all on the first floor. Patients can access the practice by using the stairs and there are two lifts for those patients who need it.

Updated 19 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Glenroyd Medical on 14 June 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.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, they had initiated, piloted and developed a project to give same day access to community matron assessment services.
• Opportunities for service development were identified and positively supported, for example in the provision of a pulmonary rehabilitation service.
• 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 (PPG).
• The practice had worked on identifying patients with possible underlying chronic disease who had not previously been given a diagnosis and had identified a total of 999 patients across all chronic disease areas. The practice reviewed these patients, calling them into the practice where necessary and identified those patients needing diagnosis and treatment for their long term condition.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had identified that there was a need to improve access for patients with hearing difficulties and two of the practice staff had trained in basic sign language.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result. They shared and discussed complaints in an open manner with the PPG.
• 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 strong and visible clinical and managerial leadership and governance arrangements. Staff were proud of the practice and were constantly involved in developing and supporting new ways of providing treatment.

We saw several areas of outstanding practice including:

• The practice was proactive in developing a practice team that offered an optimum skill mix to support the GPs. The numbers of clinical staff and the wide range of nursing skills improved patient access to appointments.
• The practice had recognised that patients referred for community assessment using a Doppler machine were having a lengthy wait to be seen. (Doppler assessments look at blood flow in the major arteries and veins in the limbs). The practice had arranged training in the use of the Doppler machine for one of its nurses with the vascular nurse practitioners at the hospital. This shortened waiting times for those patients needing assessment.
• One of the practice nurses and the practice fitness instructor provided a pulmonary rehabilitation service for all patients in the clinical commissioning group (CCG).
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, one of the practice pharmacists had identified a common theme in incidents reported to the clinical commissioning group (CCG) and highlighted this to them. The CCG then asked the other 22 practices in the area to address this issue.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 July 2016

The practice was rated as outstanding for responsive and well-led and good for safe, effective and caring. The issues identified as outstanding overall affected all patients including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice had supported a health care assistant to become an assistant practitioner trained in the management of some long-term conditions.
• As a result of an audit of the practice electronic clinical system, 25 patients were identified who had been undiagnosed with atrial fibrillation (a heart condition). A total of 73 patients with the condition were also identified and treated with an appropriate, recommended medication to reduce their risk of stroke.
• Three of the practice nurses were trained to initiate insulin which meant that only the most complex patients needed to be referred to the hospital services for diabetic patients.
• Blood measurements for diabetic patients showed that 87% of patients had well controlled cholesterol levels compared with the national average of 81%.
• Longer appointments and home visits were available when needed.
• Responding to low figures for diabetic patient foot screening, the practice trained a health care assistant to carry out foot checks for housebound diabetic patients for their annual diabetic review. We saw evidence that in 2014-2015 there were 672 patients screened in this way and in 2015-2016 there were 790 patients screened.
• One of the practice nurses and the practice fitness instructor provided a pulmonary rehabilitation service for all patients in the clinical commissioning group (CCG).
• The practice had recognised that the community nursing service was under pressure and that patients referred for assessments using a Doppler machine were having a lengthy wait to be seen. (Doppler assessments look at blood flow in the major arteries and veins in the limbs). In order to address this problem, the practice had arranged training in the use of the Doppler machine for one of its nurses with the vascular nurse practitioners at the hospital. This enabled patients to be assessed in the practice and patient waiting times were reduced.
• 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.

Updated 19 July 2016

The practice was rated as outstanding for responsive and well-led and good for safe, effective and caring. The issues identified as outstanding overall affected all patients including this population group.

• 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 higher than local and national averages for all standard childhood immunisations. The practice arranged clinics for times when patients could attend and increased clinics in school holidays.

• 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 practice’s uptake for the cervical screening programme was 87% which was higher than the CCG average of 81% and the national average of 82%.
• 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, health visitors and school nurses. New mothers experiencing problems with low mood were referred to a special health visiting service.

Updated 19 July 2016

The practice was rated as outstanding for responsive and well-led and good for safe, effective and caring. The issues identified as outstanding overall affected all patients including this population group.

• 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 and urgent appointments for those with enhanced needs.
• One of the nurses at the practice was trained in the management of leg ulcers and could treat patients in an emergency.
• A podiatry service was available on the premises as well as a hearing assessment service.
• The practice encouraged patients to attend national screening programmes. The percentage of patients attending screening for breast cancer was 72% compared to the CCG average of 66% and the percentage of patients screened for bowel cancer was 56% compared to the CCG average of 53%.
• Members of a national charitable organisation visited the practice to provide clinics giving social care advice.
• The practice had produced notices with yellow backgrounds for those patients with impaired vision and had changed the background colour on the patient television screen to yellow.
• The practice held its own database on the computer system showing a summary of all of the patients who were resident in care and nursing homes. This contained numbers of home visits provided as well as information about care planning, resuscitation status and whether there were any deprivation of liberty arrangements in place. The database was reviewed and updated by the practice advanced nurse practitioner and was used by staff in conjunction with the practice clinical records system as a summary for each patient to aid care and treatment.
• The practice had initiated, piloted and developed a project to give same day access to community matron assessment services. This provided increased, timely support for patients with complex needs and contributed to reduced accident and emergency service attendances and emergency admissions to hospital for patients. We saw evidence that the practice was classified as “significantly low” in the CCG for these two areas.

Updated 19 July 2016

The practice was rated as outstanding for responsive and well-led and good for safe, effective and caring. The issues identified as outstanding overall affected all patients including this population group.

• 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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• When the practice was giving influenza vaccinations they arranged clinics on Saturdays and after 6.30pm to enable working people to attend.
• The practice was open every day from Monday to Friday from 8am to 7pm.

Updated 19 July 2016

The practice was rated as outstanding for responsive and well-led and good for safe, effective and caring. The issues identified as outstanding overall affected all patients including this population group.

• 92% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record which was comparable to the local average of 93% and higher than the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice promoted patient screening for memory loss and held regular screening clinics at the practice. The practice open day which was attended by more than 200 patients also offered memory screening for patients.
• 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.
• 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.

Updated 19 July 2016

The practice was rated as outstanding for responsive and well-led and good for safe, effective and caring. The issues identified as outstanding overall affected all patients including this population group.

• 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 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 practice received electronic notifications of vulnerable adults from other outside agencies.
• The practice had identified that there was a need to improve access for patients with hearing difficulties and two of the practice staff had trained in basic sign language.
• The practice had recently been awarded the new quality mark award by the Lancashire society for lesbian, gay, bisexual and transgender (LGBT) people in recognition of its LGBT-friendly policies and procedures.
• There was designated member of staff who communicated with patients with learning difficulties to offer health assessments each year. This aided patient communication and encouraged attendance at the reviews.