Archived: Dr T Mackenzie and Partners

Updated 29 June 2017

Dr T Mackenzie and Partners is based in Haslingden and is part of the East Lancashire Clinical Commissioning Group (CCG). The practice has 10069 patients on their register and provides services under a General Medical Services contract.

Information published by Public Health England rates the level of deprivation within the practice population group as six 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 were similar to the average GP practice in England.

The practice had a higher percentage (63%) of its population in paid work or full time education than the England average (57%).

The service is provided by three GP partners (two male and one female). The practice also employs a practice manager, assistant practice manager, business manager, three practice nurses, two nurse practitioners as well as a number of reception/administrative staff who also cover other duties. The practice also regularly employs locum GPs and is a training practice with trainees at different stages of their learning in the practice.

The practice is based in a refurbished health centre, under contract with NHS East Lancashire, and offers a comprehensive range of services. It is fully equipped with facilities for the disabled including disabled parking at the rear of the building, access ramps, double doors, disabled toilet, hearing loops in the reception area and a lift.

The practice is open 8am to 6.30pm Monday to Friday with extended hours on Tuesdays from 7am to 8pm. The practice triages calls they receive and make appointments available on the same day in accordance with assessed need. There is also provision for ill children to be seen the same day.

When the practice is closed Out of Hours services are provided by East Lancashire Medical Services and contacted by telephoning NHS 111.

Updated 29 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr T Mackenzie and Partners on 3 February 2016. The overall rating for the practice was requires improvement, with ratings of requires improvement for the key questions of safety and leadership, and ratings of good for effective, caring and responsive. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Dr T Mackenzie and Partners on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 27 April 2017 and was undertaken in order to assess the improvements that the practice had told us they had implemented. Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. We saw that when risks were identified, mitigating actions were completed in a timely manner and reviewed for effectiveness.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a GP and 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 management responsibilities around key lead roles within the practice had been clarified. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

There were two areas where the provider should make improvements:

• Documentation relating to complaints received should be sufficiently detailed to demonstrate compliance with practice policy.

• Reviews of practice policy documents should be sufficiently thorough to ensure all are practice specific and contain up to date information and reference to external organisations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 June 2017

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

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

• Performance for diabetes indicators demonstrated patient outcomes were in line with or above local and national averages.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• All these patients had a named GP and there was a system to recall patients for 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 hosted a community phlebotomy service one evening each fortnight to facilitate ease of access to appointments for blood tests.

Updated 29 June 2017

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

• We found there were systems 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 accident and emergency (A&E) attendances.

• Recent data provided by the practice showed immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group.

• The percentage of patients with asthma on the register who had an asthma review in the preceding 12 months that included an appropriate assessment of asthma control was 80%, compared to the CCG average of 77% and national average of 76%.

• The practice’s uptake for the cervical screening programme was 85%, which was above the CCG average of 82% and the national average of 81%.

Updated 29 June 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• The practice worked closely with the clinical commissioning group (CCG) funded nursing staff who delivered care in the community to those patients resident in care homes.

Updated 29 June 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours appointments each Tuesday.

• 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.

Updated 29 June 2017

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

• The practice carried out advance care planning for patients living with dementia.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 81% compared to the CCG average of 85% and national average of 84%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

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

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 29 June 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 those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.