Pendleside Medical Practice

Updated 3 March 2016

Pendleside Medical Practice is part of the NHS East Lancashire Clinical Commissioning Group (CCG). Services are provided under a General Medical Services (GMS) contract with NHS England. The practice confirmed they had 9850 patients on their register. The practice jointly provided with the neighbouring practice, a medicine dispensing service for patients that did not live near a pharmacy.

Information published by Public Health England rates the level of deprivation within the practice population group as eight 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 reflects the England average for males at 79 years and 83 years for females. These life expectancy ages are higher that other localities within the CCG area.

The patient numbers in the older age groups were higher than the CCG and England averages. For example data from Public Health England for 2015 showed that 21.5%% of the patient population was over the age of 65, 9.9% were over 75 and 3.2% were over 85 years. The CCG averages were 17.6%, 7.5% and 2.2% respectively and the England averages were 17.1%, 7.8% and 2.3% respectively. In addition data showed that the practice had a significantly higher number of nursing home patients 1.1% per GP registered population compared to the England practice average of 0.5%.

The practice has eight GP partners (five male and three female). The practice employs a practice manager, four practice nurses (including two nurse prescribers), two healthcare assistants and 12 reception and administrative staff. In addition, the practice jointly employs with the neighbouring GP practice staff for the dispensary. This includes a dispensary manager, a deputy manager and, eight dispensers and two delivery drivers.

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

The GP practice provides services from one registered location at Pendleside Medical Centre. However nursing services such as long term condition reviews are also provided from two consultation rooms located in another building (Quex), about 100 metres from the main building. In addition the practice provides GP cover Monday to Friday at Clitheroe Community Hospital.

The practice is open Monday to Friday 8am to 6.30pm. Wednesday and Thursdays early morning appointments are available from 7.15am and later evening appointments until 7.15pm are available on Tuesdays and Thursdays for pre-booked appointments.

Out of Hours services are provided by East Lancs Medical Services (ELMS), and contacted by ringing NHS 111.

The practice provides online patient access that allows patients to book appointments and order prescriptions and review some of their medical records.

Pendleside Medical Practice is located in Clitheroe Health Centre, a purpose built building. This accommodation is shared with a neighbouring GP practice. In addition a nurse led Treatment Room service is provided and staffed by East Lancashire Hospital Trust. Other healthcare services such as podiatry and community nursing teams are also located within the same building.

The building is accessible to people with disabilities.  

Updated 3 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pendleside Medical Practice on 27 January 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, working with other local providers to share best practice. Evidence of close working with the neighbouring GP practice and other community health service was productive and led to consistent standards of care for patients in the locality.
• Feedback from patients about their care was consistently and strongly positive. Patients described the GP practice as excellent; staff were described as caring and professional.
• 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 healthcare professionals told us of the supportive nature of the GP practice by responding quickly to concerns identified with patients.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example it had rearranged the seating in the waiting room to allow patients to sit more comfortably and had taken appropriate action to minimise potential impact on patient privacy as a result of this.
• The practice was had the facilities and was well equipped to treat patients and meet their needs. The practice provided a medicine dispensing service for patients that did not live near a pharmacy.
• Information about how to complain was available on the practice notice board and in their patient brochure.
• 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.

We saw several areas of outstanding practice including:

• The practice worked closely with the other GP practice and the other healthcare professionals located within the building to develop local clinical pathways. A clinical pathway for guidance and management of atrial fibrillation had been agreed and implemented. This ensured patients living in the locality received consistent, evidence based care and treatment for atrial fibrillation.
• Practice staff had the support of the GP partners to identify and review healthcare conditions not routinely reviewed or monitored. For example one practice nurse reviewed the treatment and support provided to patients with Coeliac disease. As a result patients with Coeliac disease were offered an annual review and received a planned consistent standard of treatment and support.

The areas where the provider should make improvement are:

• Review the management of the practice complaints policy and procedures so that complaints are responded to objectively and the policy aligns with recognised guidance and contractual obligations for GPs in England. Final letters to complaints should include the contact details for the Parliamentary and Health Service Ombudsman.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Two practice nurses were trained to deliver education packages to patients on how to manage their diabetes and to residential and nursing home staff.
• The practice performed better than the national average in all five of the diabetes indicators outlined in the Quality of Outcomes Framework (QOF). The practice carried out insulin initiation.
• Longer appointments and home visits were available when needed.
• Two practice nurses were trained in anticoagulant management and held clinics to monitor patients’ blood to determine the correct dose of anti-coagulant medicine. The nurses worked closely with health care professionals to ensure patients who required surgical procedures were closely monitored and treated to ensure the optimum anti-coagulation therapy both pre and post operatively.
• 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. 

Updated 3 March 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 a high number of A&E attendances. Immunisation rates were satisfactory for all standard childhood immunisations.
• Quality and Outcome Framework (QOF) data showed that the practice performed better that the national average with 84.06 % of patients with asthma, on the register, who had had an asthma review in the preceding 12 months (National data 75.35%).
• 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.
• Data showed that the practice performed better than the national average for the percentage of women aged 25-64 who had received a cervical screening test in the preceding five years (with 91.26% compared to the national average of 81.83%).
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Patients had access to weekly sexual health and contraceptive clinics.
• We saw positive examples of joint working with midwives, health visitors and community nurses.

Updated 3 March 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. For example one practice nurse was specifically employed to carry out reviews of patients over the age of 75 years. Close working relationships were established with the Community matron for people over the age of 75 with complex healthcare needs.
• GPs were allocated a specific care home and carried planned weekly visits to the home.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. GPs had admitting rights to the local community hospital should their patients need to extra support.
• Care plans were in place for those patients considered at risk of unplanned admission to hospital.
• Data supplied by the practice showed they had lower emergency hospital admissions for the over 65s for April to October 2015 with approximately 67 patients per 1000 of the population being admitted compared with the CCG of 105 patients per 1000.
• Monthly palliative care meeting were held and community health care professionals attended these. Patients had care plans in place.

Updated 3 March 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.
• Telephone consultations were available and lunchtime surgeries were 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 offered bi-annual reviews of patients with a cancer diagnosis and offered annual reviews to patients with Coeliac disease.
• The practice offered early morning (Wednesday and Thursday) and later evening appointments (Tuesday and Thursdays) for working patients and those patients who could not attend during normal opening hours.

Updated 3 March 2016

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

• 84.09% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
• 91.38% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months which was above the national average of 88.47%. We saw examples of these.
• The practice regularly worked with multi-disciplinary teams. The Integrated Neighbourhood Team had an attached mental health worker.
• 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.

Updated 3 March 2016

The practice is rated as outstanding 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 offered longer appointments for patients with a learning disability. Care plans were recorded for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.