Burnley Group Practice

Updated 3 May 2016

St Nicholas Group Practice is located close to the centre of Burnley and occupies a location on the third floor of purpose built health and leisure facility with adequate free parking for up to 40 minutes in the grounds of the property; parking in excess of 40 minutes was available at a fee. The building is well designed and spacious with good facilities for those with limited mobility. St Nicholas Group Practice offers a comprehensive range of services including minor surgery.

The practice delivers services under a general medical services (GMS) contract with NHS England to 9050 patients, and is part of the NHS East Lancashire Clinical Commissioning Group (CCG). The average life expectancy of the practice population is slightly below both CCG and national averages for males at 75 years compared to 77 years and 79 years respectively. Life expectancy for females is also slightly below the CCG and national averages at 80 years (CCG 81 years and national average 83 years). Age groups and population groups within the practice population are comparable with CCG and national averages.

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

The practice is staffed by four GP partners (one female and three male). The practice is a training practice and has previously supported trainees at different stages of their learning. The GPs are supported by two nurse practitioners, three practice nurses and two healthcare assistants. Clinical staff are supported by a practice manager and 13 administration and reception staff.

The practice is open between 8am to 6.30pm Monday to Friday. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments are also available for people that need them. When the practice is closed Out of Hours services are provided by East Lancashire Medical Services and can be contacted by telephoning NHS 111.

The practice provides online patient access that allows patients to book appointments and order prescriptions.

Updated 3 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Nicholas Group Practice on 23 March 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 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.
• There was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was involved in local pilot schemes to improve outcomes for patients that included hosting a Parkinson’s disease community nurse specialist and taking part in risk profiling activity with Age UK.
• The practice was a teaching practice and had received a Gold Quality Teaching Practice award in 2013-2014 from the University of Manchester. The practice had also received a Royal College of General Practitioners Practice Accreditation award in 2014.
• 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 several areas of outstanding practice including:

• The practice had developed patient specific care plans and health action plans to support the provision of care and enable patients to be involved in their own care.
• The practice worked in conjunction with other services and provided a dedicated telephone line to support patients and families during the provision of end of life care.

The areas where the provider should make improvement are:

• Action should be taken to ensure equipment registers are accurately maintained and equipment safety checks are completed within recommended timescales.
• Action should be taken to record consideration, planning and implementation of all potential opportunities for improvement identified during infection prevention and control audits.
• Continue to identify the underlying causes and take action to reduce Quality Outcomes Framework exception reporting levels.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 May 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 for diabetes related indicators was between 81% and 98% this was higher than the national average range of 78% to 94%.

• 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 maintained a comprehensive recall system that was monitored by a nominated care coordinator to ensure patient reviews were completed as required.

Updated 3 May 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.

• Contraceptive advice was provided to young people and families and a practice GP held a contraceptive implant clinic for practice patients and patients in the wider locality.

• The percentage of patients diagnosed with asthma who had an asthma review in the last 12 months was level with the national average at 75%.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Cervical screening uptake data from 2014/15 for women aged 25-64 years was 82%, which was the same as the national average.

• 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 and health visitors.

Updated 3 May 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.

• Patients aged over 75 years were offered annual health checks and signposted to external agencies as applicable.

• Where patients had been identified as at risk they were opportunistically screened for dementia.We were told that as a result of screening activity the diagnosis rate within the practice had improved from 55% in April 2014 to 74% in March 2015.

• The practice worked with locality specialist nurse practitioners to provide support for patients in residential homes.

• A ‘flu-day’ was held on a Saturday and advertised in the local media to encourage uptake.

Updated 3 May 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 reflected the needs for this age group.

• Appointments were available outside of the normal working day and telephone consultations were also available with GPs and Nurse Practitioners to reduce the need for patients to visit the practice in person.

Updated 3 May 2016

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

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.

• 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan, which was higher than the national average of 88%.

• A record of alcohol consumption was recorded for 96% of patients with mental health related conditions compared to 90% nationally.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had developed comprehensive care plans for patients diagnosed 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 May 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 homeless people and those with a learning disability.

• The practice offered longer appointments 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.