Irwell Medical Practice

Updated 5 January 2018

Irwell Medical Practice (Irwell Mill, Bacup, OL13, 9NR) provides services to around 14,300 patients in the Bacup area of East Lancashire, under a General Medical Services (GMS) contract. In 2005, three former practices in the East Rossendale Valley merged to become Irwell Medical Practice, moving into a purpose built building with other community health services. The premises are owned by Community Health Partnerships and have a local building manager. The practice is located on the ground and first floors of the building. Health visitors, district nurses and audiology clinics are located the ground and second floors. The practice also runs a vasectomy clinic in Burnley for patients living within East Lancashire under a local incentive scheme commissioned by East Lancashire CCG.

The practice has six female and three male GPs, a nursing team comprising two advanced nurse practitioners (ANP), four nurses and a health care assistant (HCA). They are supported by a strategic manager, an operations manager and a team of 17 support staff. The practice is a training practice for medical students and GP trainees and also employs and supervises a local care home Advanced Nursing Practitioner (ANP) team.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 11.30am every morning and 3pm to 6pm daily. Extended hours are offered on Monday and Tuesday evenings between 6.30 and 8.15pm.

The practice has a predominantly British White population, with slightly above average population aged 0 to 9 and between 50 and 69 year olds than the average for England. There are less people aged 25 to 39 than the England average. There has been an increase in patients from Eastern Europe in recent years.

Practice data shows significantly more patients than average with a long-standing health condition (65%), compared to the national average of 53%. Male life expectancy is below the national average at 77 years, while female life expectancy falls in line with the England average at 83 years (national average male 79, female 83). Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). East Lancashire has a higher prevalence of COPD, smoking and smoking related ill-health, cancer, mental health and dementia than national averages.

When the practice is closed, out of hours care is provided by East Lancashire Medical Services Ltd through a contract with East Lancashire CCG.

Updated 5 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection January 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those retired and students) – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at Irwell Medical Practice on 22 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice was open and transparent, and had systems in place to adhere to the Duty of Candour. When things went wrong, we saw that the practice offered patients and apology and an explanation.

• Quality improvement was embedded into practice. There was a programme of clinical audit in place that was routinely monitored and changes made to practice resulted in measurable improvements to patient care. The practice was proactive in identifying new ways of working to streamline services and improve patient experience.

• The practice had developed and implemented an advance nurse practitioner (ANP) service for the locality which was funded by East Lancashire CCG. This team provide additional clinical care for patients living in 19 nursing and residential homes in Rossendale to reduce avoidable admissions.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Feedback from both patients and staff was proactively sought and used to shape the delivery of high quality care.

• The practice was strongly committed to multidisciplinary working and could evidence how this had a positive impact on patient care.

• Patients found it easy to use the appointment system and reported that they were able to access care when they needed it. We saw that the practice proactively monitored access via regular demand and capacity audits which were used to inform rota planning.

• Reception staff knew that if patients wanted to discuss sensitive issues or appeared distressed they could offer them a private room to discuss their needs. A yellow card scheme was in place in reception. If a patient wished to speak in private, the yellow cards were available on each reception desk. They did not have to say anything, but instead hand a yellow card to the receptionist who would arrange a confidential room for the patient to speak to staff.

• Staff told us they felt valued and well supported.

• There was a strong focus on continuous learning and improvement at all levels of the organisation. The partners and management team were keen to contribute to and add value to the local healthcare economy and the practice frequently participated in pilot schemes and disseminated learning to other practices in the locality.

We saw a number of areas of outstanding practice:

• The practice had recently registered 34 patients who were asylum seekers. The practice had developed a ‘welcome pack’ for asylum seekers containing useful local information. This welcome pack had since been shared with other local practices. The practice also worked closely with an asylum seeker support worker from a local charity.

• The practice had recognised the lengthy wait patients experienced when referred to the memory clinic. They had commenced working with Alzheimer’s Connect; patients were referred to Alzheimer’s Connect while waiting to access assessment at the memory clinic. This ensured they received timely advice and support. A total of 28 patients had been referred to Alzheimer’s Connect since the end of July 2017. All practice staff accessed training delivered by Alzheimer’s Connect in October 2017 to raise their awareness of how best to support dementia patients and of the services offered by the organisation.

• The practice had identified 687 patients as carers (4.8% of the practice list). The practice ensured the various services supporting carers were coordinated and effective. Carers of patients with dementia were offered a health check appointment to coincide with the dementia health review for their relative.

• PPG members supported the practice by designing and conducting surveys as well as helping the practice improve patient care through involvement in training and acting as “mystery callers” to monitor and improve customer service. PPG members had supported medical students on placement both at this practice and others in the locality, by acting as patients for mock practical exams to allow them to prepare.

The areas where the provider should make improvements are:

• Complaints documentation should make clear that complainants have been informed how to escalate their concerns should they be unhappy with the practice’s final response.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 January 2018

Updated 5 January 2018

Updated 5 January 2018

Updated 5 January 2018

Updated 5 January 2018

Updated 5 January 2018