Archived: McIlvride Medical Practice

Updated 2 November 2016

The practice delivers commissioned services under the Personal Medical Services (PMS) contract. The clinical team is made up of three partner GPs, a salaried GP, an advanced nurse practitioner, a nurse clinician, two practice nurses and a healthcare assistant. A locum GP is also regularly available. A practice manager, assistant practice manager and a team of 16 administration and reception staff provide support. There is a mix of male and female GPs and each individual leads in a specialist clinical area, such as diabetes or reproductive health.

The practice has been fully refurbished with input from the patient participation group. There is level access from the car park into the building and disabled toilet facilities.

Appointments are from 8am to 6.30pm Monday to Friday with some appointments also available from 7.30am to 8am and from 6.30pm to 7pm. Saturday flu clinics run in the winter.

The practice serves a list of 6244 patients in an area of low deprivation.

Fifty nine per cent of patients are of working age, compared to the England average of 67%. The practice has a higher number of patients with a long-standing health conditiont (61%) compared with a national average (54%).

We had not previously carried out an inspection at this practice.

Updated 2 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at McIlvride Medical Practice on 19 May 2016. 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice an established part of the local community and had good links with care homes, the district nursing team and care coordinators.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had undergone a period of change in the previous 12 months, with the appointment of a new practice manager and two new GP partners. 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• There was a consistent focus on multidisciplinary working with multiple community and specialist teams. For example, patients had access to a physiotherapist without the need for a referral through a local practice partnership. Staff had spent a day in local pharmacies through a ‘Walking in the shoes of’ project. This helped staff in all roles to understand pharmacy processes and how to reduce medicine errors.
• The practice IT lead had piloted and implemented social media as a communication tool. This was used to communicate urgent messages such as a power failure to the practice as well as to direct patients at risk of social isolation to community social events such as a tea dance.
• A care coordinator provided dedicated support to patients with long term conditions and particularly those who had attended hospital as an inpatient. This meant patients had rapid access to community services including occupational health and counselling.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 November 2016

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

• The practice had more patients than the national average with a long term condition; 61% compared with the national average of 54%.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• A GP and nurse led a diabetes clinic that included treatment initiation, maintenance and an annual review.
• 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 a consistent focus on improving care and services for people in this group, including a pilot project to provide tailored care for patients with chronic obstructive pulmonary disease.
• Staff attended and minuted multidisciplinary meetings to ensure patients with long term complex conditions received the most appropriate care.
• Patients had access to a care administrator who acted as a single point of contact for patients who needed extra support to manage a long-term condition.

Updated 2 November 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.
• 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 had established links with community mental health teams that provided care for young people.
• 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. 

Updated 2 November 2016

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

• The practice had the highest number of patients over the age of 85 in North West England and staff had adapted aspects of the service to meet their needs. This included holistic needs assessments and care planning.
• 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.
• Each GP had a designated care home. This meant they provided consistent care to patients and got to know them well.
• Staff had established good working links with a frailty team, which helped to provide patients with appropriate specialist care.
• During the winter, weekend flu clinics were offered as part of a health promotion programme.

Updated 2 November 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 maintained a number of embargoed appointments outside of the Monday to Friday 9am to 5pm working week to help such patients get appointments without disrupting their work.
• 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. This included secure e-mail and text messaging for follow-ups and online prescriptions ordering and appointment booking.

Updated 2 November 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 their care reviewed in a face to face meeting in the last 12 months, which is worse than the national average. The practice was addressing this by working with care home staff to improve understanding of the signs of dementia and ensuring patients discharged from hospital were followed up and seen by a GP.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• 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. Staff had training in the Deprivation of Liberty Safeguards (DoLS) and the use of independent mental capacity advocates.
• An in-house cognitive behavioural therapist was available and patients could self-refer to talking therapies services.

Updated 2 November 2016

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. The practice was able to register homeless patients, travellers, migrant workers and sex workers? and staff had received appropriate training to support them.
• 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. This included a monthly multidisciplinary meeting with community nurses and matrons and collaboration with drug and alcohol teams.
• 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.
• There was a designated safeguarding lead in place for adults and for children.