Archived: ELMS Pendle Valley Mill Medical Practice

Updated 5 August 2016

ELMS Pendle Valley Mill is a GP practice within East Lancashire Clinical Commissioning Group (CCG) with a personal medical services (PMS) contract with NHS England. The service is provided by ELMS Federated Practices.

ELMS Pendle Valley Mill Practice provides primary care services for 20,306 patients at four branch sites. The four sites are all located within property managed by NHS Property Services. ELMS Federated Practices took over the contract and responsibility for ELMS Pendle Valley Mill in April 2013.

The four branch sites are:

• ELMS Pendle Valley Mill, in the town of Nelson in East Lancashire.
• The Horsfield Practice, based in Colne Health Centre, Colne
• Eagle Medical Practice, based at the Acorn Health Centre in Accrington
• Brierfield, based in Brierfield Health Centre in Brierfield.

The main practice site, ELMS Pendle Valley Mill is located in Yarnspinners Primary Health Care Centre which is owned by Community Health Partnerships (CHP). The site also hosts four other practices and a variety of community services including podiatry, dietician and podiatry clinics. This property is maintained and serviced by NHS Property Services Ltd.

Staffing is shared throughout the four practices, with some staff being based primarily at ELMS Pendle Valley Mill. There is one registered manager for all the ELMS locations.

Out of hours provision is provided by East Lancashire Medical Services (ELMS).

Within ELMS Pendle Valley Mill the clinical team includes eight GPs who are employed by the Federation (one of whom is the newly appointed lead clinician), six nurse practitioners, (one of whom leads the nursing team), seven practice nurses, one triage nurse and eight health care assistants (HCAs).

There is a nursing team for patients aged over 75 years of age which comprises a community matron and one of the HCAs, this team is shared between all four branch sites. There is also a clinical pharmacist. The practice has two GPs trainers and one branch site is accredited to deliver training to trainee GPs.

The practice is supported by a business manager and practice manager, four site supervisors and 29 administrative staff including receptionists and secretaries. The ELMS Federated practice senior management team provides management support for human resources, information technology, health and safety, facilities and other mandatory employer responsibilities.

The practice is open Monday to Friday 8am until 6.30pm.

Patients can attend any site, although they have a nominated branch. There are around 12,000 patients at the ELMS Pendle Valley Mill site with almost 1,900 at the Eagle Medical Practice site, 2,200 at the Horsfield site and 3,500 at the Brierfield site. Around 25% of the practice population are Pakistani or British Pakistani, although around 50% of the Brierfield site population are British Pakistani. Eagle Medical and Horsfield have a higher percentage of white British patients. The practice had also seen an increase in the diversity of the population recently.

Age ranges are broadly in line with national averages though the practice has more patients aged 0-9 years old than average. Male and female life expectancy is around three years below East Lancashire Clinical Commissioning Group (CCG) and national averages.

Information published by Public Health England rates the level of deprivation within the practice population as two on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest).

East Lancashire has a range of health inequalities and generally has a higher prevalence of Chronic Obstructive Pulmonary Disease (COPD, a disease of the lungs), cardio vascular disease (associated with the heart and circulatory system) smoking and smoking related ill-health, cancer, mental health and dementia than national averages.

Updated 5 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at ELMS Pendle Valley Mill on 23 June 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 difficult to get through to the practice by phone and described difficulties in obtaining appointments, though they were positive about the way in which all staff cared for them.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice:

A member of staff had identified that British Pakistani women and young children felt excluded from a variety of community health promotion and exercise opportunities. She was supporting a small group of patients with weight management and had encouraged the local pool to commence women only swimming sessions, which was then extended to an additional local pool.

The areas where the provider should make improvement are:

• Complete the programme to ensure all staff have appraisals
• Review the process for sharing learning from significant events and to ensure that opportunities for learning from these are maximised.
• Provide chaperone training for all staff who undertake chaperoning duties.
• Introduce effective screening and immunisation programmes for all clinicians working with patients.
• Involve all clinicians in the planned audit programme to ensure that continual improvements to patients outcomes are monitored and shared.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 August 2016

The practice is rated as good 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.
• Performance in long-term condition management was similar to national average. For example, 97% of patients with diabetes had an influenza immunisation the previous ‘flu season, above the national and CCG average of 95%.
• 86% of patients with diabetes had a recent cholesterol test which was within a normal range, which was above the CCG average of 84% and national average of 81%.
• 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 trained nurses and health care assistants in management of long-term conditions and they had produced helpful lifestyle advice leaflets for their patients.

Updated 5 August 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.
• 72% of eligible women had a cervical screening test carried out in the previous five years, which was below the CCG and national average of 82%. The practice nurses recognised the cultural and linguistic barriers to improving take-up. The practice was looking to raise awareness amongst the British Pakistani patients with coloured leaflets and using Urdu and Punjabi speaking staff to contact patients who did not attend.
• 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 5 August 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.
• The practice employed a community matron and health care assistant (HCA) who provided care for patients aged over 75 years old through a Clinical Commissioning Group (CCG) funded scheme.
• The practice had 1,180 patients on the register of patients aged over 75 years old and all these patients had received an assessment of their needs since the scheme commenced in 2015.
• All patients who reached 75 years of age were sent a health check invite.
• Since 2015, 50 advanced notices had been completed which would ensure patients were given the care they preferred at this later stage of their lives (advanced notices are written statements which cover an individual patient’s preferences over what care and treatment they wish to receive in the later stages of life including hospital admission and cardio pulmonary resuscitation).

Updated 5 August 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 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.
• A range of family planning services were available.
• Travel vaccination clinics were offered by nurses.

Updated 5 August 2016

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

• 77% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%
• 82% of patients with severe mental health conditions had received a face to face review in the previous 12 months which was below the CCG and national average of 89%.
• 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 informed 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 5 August 2016

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• Patients with drug and alcohol linked conditions were supported by the local community substance misuse service, which worked closely with a GP. Shared clinics were offered where appropriate.
• 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.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice had recently been visited by the CCG to review arrangements for safeguarding looked after children and had received initial feedback which recognised the good work which ELMS Pendle Valley Mill was doing.
• 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.
• The practice provided primary care services through the zero tolerance scheme (this was a CCG funded scheme caring for patients who had turned away from other practices due to aggressive behaviour) and built up good communication and relationships with patients identified within this scheme.