Rosegrove Surgery

Updated 4 February 2016

Rosegrove Surgery is part of the NHS East Lancashire Clinical Commissioning Group (CCG). Services are provided under a personal medical service (PMS) contract with NHS England. The practice has 4489 patients on their list. The practice is located in a residential area of Burnley, Lancashire.

Information published by Public Health England rates the level of deprivation within the area the practice is located in as two on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male and female life expectancy in the practice geographical area is below the England average for males at 77 years and 82 years for females (England average 79 and 83 years respectively).

The practice population groups are largely in line with England averages. The patient population aged 65 years and over is 14% and is lower than the England average of 16.7%. The percentage of patients aged 75 years is also lower at 5.8% when compared to the England average of 7.6%. However, the percentage of patients aged less than 18 years is higher than the England average at 15.7% compared to 14.8%.

The practice has two GP partners (both male). The practice employs a practice manager, two practice nurses, two healthcare assistants (HCA) and five reception and administrative staff. One HCA is part-time and also undertakes the role of an additional administrator on a part-time basis.

The practice is a training practice for qualified doctors who are training to be a GP.

The practice reception is open Monday to Friday between 8.15am – 6.30pm with the exception of Thursday when the practices closes at 12.30pm and patients are provided with an emergency number to call if they have an urgent need on a Thursday afternoon. Extended hours for patients who, due to work circumstances, are unable to attend during normal surgery hours, are offered until 8pm on Mondays and from 7.30am on Tuesdays.

Out of Hours services are provided by the Urgent Care Centre located at Burnley General Hospital and contacted by telephoning NHS 111.

The practice provides online access for patients to book appointments and order prescriptions.

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rosegrove Surgery on 15 December 2015. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it was generally 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 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 practice proactively sought feedback from staff and patients, which it acted on.

We saw two areas of outstanding practice:

• The practice had well established links with a local refuge and provided healthcare support to individuals and families accessing refuge services.The refuge provided a safe and confidential place to stay for women and children to help them escape and overcome the effects of domestic abuse.As a result of practice activity, that included visiting the refuge to explain practice services at ‘in house’ meetings, residents were assisted to register and access person centred healthcare in a timely and appropriate manner.

• The practice had a shared service policy with a local drug recovery service provider to provide care to those with drug addiction problems.The practice was proactive in its approach to working with the drug recovery service and assisted them to hold fortnightly clinics in the practice that were accessible to patients from other practices.The lead practice GP for the shared service who had undertaken specific training associated with helping those with a drug addiction undertook regular joint review appointments every 6-9 months with a shared care worker and individual patients.

The areas where the provider should make improvement are:

• Ensure a programme of infection control audits is completed periodically to gain assurance associated activity is effective or identify areas for improvement.

• The need for additional role specific training should be assessed for individuals allocated lead responsibility for infection control.

• Review and maintain policies to ensure they are accurate and specific to the practice.

• Provide staff with additional training and enforce compliance with policy to reduce information security risks associated with the use of IT smart-cards.

• Maintain records of individuals that have completed chaperone training.

• Develop and implement a policy to support the consistent completion and recording of medication reviews.

• Ensure systems are implemented to monitor expiration dates of single use equipment.

• Maintain a record of checks of fire detection systems and carry out regular fire drills.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 February 2016

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

• The practice had a team of nurses and health care assistants to meet the needs of the patients.Nursing staff had lead roles in chronic disease management and they were supported by the practice GPs.

• The number of patients registered with the practice with a long-term condition was similar to the national average.

• Patients diagnosed with a chronic condition were included on a specific register and were invited for an annual review of their condition.An individual care plan tailored to their specific needs was offered to each patient.

• All patients with a long-term condition were offered an annual influenza vaccination.

• The practice opportunistically screened patients at risk of Dementia.

• Practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Longer appointments and home visits were available when needed.

Updated 4 February 2016

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

• The practice provided same day appointments for all children under the age of three years regardless of appointment availability and staff told us they would they would work outside of normal surgery times to meet the needs of patients.

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

• Cervical screening uptake data from 2014/15 for women aged 25-64 years was 81.88%, which was comparable to the national average of 81.83%.

• Immunisation rates were generally similar to CCG averages for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 59.3% to 88.9% and five year olds from 44.1% to 96.6%.

• Infants were offered routine health checks at regular intervals.The practice told us they recognised a first check of this type was undertaken in hospital but they offered the same check within practice to provide ongoing support for young mothers and families.

Updated 4 February 2016

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 and urgent appointments for those with enhanced needs.

• There was a good uptake of influenza vaccinations for patients aged 65 and older at 74.02% which was higher than the national average of 73.24% and all patients over 75 years of age were offered a full health needs assessment or review every 12 months.

• The practice offered same day appointments to adults aged over 75 years of age.

• In conjunction with other practices in the local area Rosegrove Surgery worked with the Clinical Commissioning Group (CCG) to enable Specialist Nurse Practitioners (SNPs) to be employed to work with care, residential, nursing homes and patients aged over 75 in their own homes.

Updated 4 February 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.

• Extended hours were available until 8pm each Monday and from 7.30am 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.

• Patients aged between 40-74 years were offered an NHS Health Check.

Updated 4 February 2016

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

• 90% people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.

• Data showed the practice achieved a higher percentage than the national averages for mental health related indicators detailed within the Quality Outcomes Framework.For example, 94.29% having a comprehensive care plan compared to 88.47% nationally.

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

• Regular reviews were offered for patients experiencing poor mental health, and the practice undertook opportunistic screening of at risk patients when they attended an appointment for a different reason.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

Updated 4 February 2016

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

• The practice worked proactively with a local drug recovery service under a shared care policy to ensure that carers and other family members as well as service users were offered appropriate help and support.The practice assisted the service to hold fortnightly clinics in the practice and these were accessible to patients from other practices.The lead practice GP for the shared service who had undertaken specific training associated with helping those with a drug addiction also undertook regular joint review appointments every 6-9 months with a shared care worker and individual patients.A representative of the local drug recovery service told us they found the practice extremely approachable and was able to describe to us a situation where a practice GP took action when it was identified that a service user was not engaging with the service or attending any appointments.As a result of the action taken by the GP we were told the service user has not missed any further appointments with the drug recovery service.

• The practice provided care to patients of a local women’s refuge that accommodated approximately 200 families each year and was the preferred provider of healthcare services as it was identified by the refuge as being very supportive and appreciative of the needs of refuge residents.Residents of the refuge were able to access appointments within hours of moving to the refuge.Staff from the practice have also attended meetings within the refuge to explain practice services to residents.

• The practice regularly worked with and signposted individuals to other service providers and voluntary organisations when additional support needs were identified.This includes individuals whose quality of life is assessed as poor and as a result has impacted upon their health and wellbeing or those who are suffering from conditions related to previous military service.

• 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.