The Olive Family Practice Ltd

Updated 15 July 2016

The Olive Family Practice Ltd is based in a large health centre on a main road approximately half a mile from the centre of Bolton. The practice is at ground floor level and is fully accessible to patients with disabilities. There is a car park at the rear of the practice.

The Olive Family Practice Ltd is an organisation and the lead GP is the director of the company. The practice is overseen by NHS Bolton Clinical Commissioning Group (CCG) and it delivers commissioned services under an Alternative Provider Medical Services contract. At the time of our inspection there were 3221 patients registered with the practice.

There are three GPs (two male and one female, 2.2 working time equivalent) and a regular female locum GP. There is also a practice nurse, a healthcare assistant, a practice manager and administrative and reception staff.

The practice is open daily from 8am until 6.30pm, with extended hours opening every Tuesday until 8pm. There were no set surgery times as these were flexible to meet the needs of patients.

Patients at the practice are from over 30 nationalities and over 20 languages were spoken by patients. Some of the languages spoken were not available on the telephone translation service. There is a higher than average number of patients in the 0 to 35 age group, especially in the age groups 0 to 4 and 25 to 29. There is a lower than average number of patients aged over 40, and a much lower than average number of patients aged over 65.

The practice is in the most deprived decile and patients have a lower than average life expectancy. The number of patients with a long term health condition is almost 20% less than the CCG and national average.

There is an out of hours service available provided by a registered provider, Bury and Rochdale Doctors on Call (BARDOC).

Updated 15 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Olive Family Practice Ltd on 27 May 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.

• The practice used innovative and proactive methods to improve patient outcomes. For example, they did not have set appointment times and instead had devised a system using units of activity. This worked well due to the diverse needs of the patients, where interpreters were often required and often patients had complex needs.

• 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 there was close contact with the local mosques.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to.
• 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.

We saw several areas of outstanding practice including:

• The practice had good links with the local mosques.

• GPs usually looked after the palliative care needs of their patients, and where it was anticipated they would be away from the practice another GP in the area was introduced to the family in advance to ensure continuity of care. GPs were contacted by religious leaders or families when a death occurred and they attended in a timely manner to issue death certificates so a funeral could be arranged according to the patient’s religious beliefs.

• Information within the practice was available in a variety of languages and staff also spoke several languages. The practice had established links with a nearby community centre that could provide translation services as some of the languages spoken by patients were not covered by the telephone translation service. For example, volunteers translated for the Oromo language. There were over 20 languages spoken by patients at the practice and a high proportion did not speak English as a first language so interpreters were required daily.

• The practice had a flexible appointments system, so instead of having set appointments they had units of activity in five minute blocks. They found this met the needs of the diverse practice population and reception staff had been well trained in how to determine the appropriate number of units of activity to allocate to a patient. For example, if translation services were required a patient was usually allocated 20 minutes, and five minutes was allocated to a telephone appointment. We saw an example of a non-English speaking patient with post-traumatic stress disorder being allocated 50 minutes.

• In response to demand during the winter months the practice had a walk-in surgery for a short time in the afternoons. They still directed patients to the pharmacy if this was appropriate but they found the open surgery was the most effective way of managing the needs of the patients and the time of the clinical and reception staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 July 2016

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

• The appointment system supported patients with varying needs so their long term condition reviews were allocated an appropriate amount of GP time.

• Care plans were in place for patients at risk of an unplanned hospital admission. We saw these were discussed at weekly practice meetings and at monthly multi-disciplinary team meetings. Care plans were also in place for all patients with a long term condition.

• GPs looks holistically at patients conditions to ensure they received the best outcome. They found patients often had multiple unmet needs and found taking extra time speaking to them during appointments identified issues relating to the patient as a whole.

• Performance for diabetes related indicators was 93.1%. This was better than the local average of 88.7% and the national average of 89.2%.

Updated 15 July 2016

The practice is rated as outstanding 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 attended A&E. GPs followed up all children who had not attended a pre-booked appointment.

• 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.

• Appointments were available outside of school hours and the premises were suitable for children and babies. During the winter months when mothers made more demands on GPs the practice put on open surgeries in the late afternoon. They found this effectively met the demand while reducing pressure on the reception staff.

• We saw positive examples of joint working with midwives, health visitors and school nurses. A multi-disciplinary team attended meetings at the practice monthly.

• The GPs treated families in a holistic way. For example, they encouraged  childhood immunisations by explaining the impact not having the immunisations could have on older members of the family.

Updated 15 July 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. They recognised that a lot of older patients lived with their extended families so they involved carers where appropriate.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. They kept a record of housebound patients so visits could be easily arranged.

• Annual health checks were offered to patients over the age of 75. The practice had a low number of these patients and the majority had had a health check in the past year.

• GPs provided continuity of care to patients at the end of their lives, and if they had holidays planned they introduced new GPs to the families before they went.

Updated 15 July 2016

The practice is rated as outstanding 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 was open until 8pm one day a week. Telephone appointments were also available.

• 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.

• The practice invited patients over the age of 30 for the NHS health checks usually aimed at over 40s. They told us the high number of BME patients meant they were at greater risk of developing diseases such as diabetes, and they used this opportunity to diagnose earlier, stop signs of any deterioration in health and provide education to patients.

Updated 15 July 2016

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

• 94.74%of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG average of 86.14% and the national average of 84.01%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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 15 July 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability. We saw examples of homeless patients being registered at the practice and the practice manager told us they sought advice from the CCG if patients without an address requested they became a patient.

• The practice offered longer appointments for patients with a learning disability, and reception staff knew how long to allocate for appointments using their units of activity system.

• The practice had good safeguarding processes in places and we saw examples of close working with other agencies including the police while securing positive outcomes for patients.