Archived: Fellview Healthcare Ltd

Updated 24 December 2015

Fellview Healthcare Limited is registered with the Care Quality Commission to provide primary care services. The service is located in and around the Whitehaven area of Cumbria. Fellview Healthcare Limited is a limited company, formed by 10 of the GPs from the practice.

The practice provides services to around 22,310 patients from four locations:

• Flatt Walks Health Centre, 3 Castle Meadows, Whitehaven, Cumbria, CA28 7QE;
• Beech House, St Bridget’s Lane, Egremont, Cumbria, CA22 2BD;
• Cleator Moor Health Centre, Birks Road, Cleator Moor, Cumbria, CA25 5HP;
• Griffin Close, Frizington, Cumbria, CA26 3SH.

We visited all of these addresses as part of the inspection.

The practice has 11 GPs (eight male and three female), three nurse practitioners, two community nurse practitioners, 11 practice nurses (all female), three healthcare assistants, two practice managers, and 64 staff who carry out reception, administrative and cleaning duties.

The practice is part of Cumbria clinical commissioning group (CCG). Information taken from Public Health England placed the area in which the practice was located in the fourth more deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice population is made up of a slightly higher than average proportion of patients over the age 65 (19.3% compared to the national average of 16.7%). The proportion of patients with a long-standing health condition is well above average (71.5% compared to the national average of 54%).

The four surgeries are located in purpose built buildings. All patient facilities at each site are on the ground floor. There is on-site parking, disabled parking, a disabled WC (except at the Griffin Close site), wheelchair and step-free access.

Opening hours at Flatt Walks, Beech House and Griffin Close are between 8.00am and 6.30pm Monday to Friday. The surgery at Cleator Moor is open between 8.00am and 8.00pm Monday to Friday and from 8.00am until 1.00pm on Saturdays. Patients can book appointments in person, on-line, by telephone or by using an ‘App’ on their mobile device. Appointments were available at the following times during the week of the inspection:

• Monday – 9am to 12pm; then from 3pm to 6pm
• Tuesday – 9am to 12pm; then from 3pm to 6pm
• Wednesday – 9am to 12pm; then from 3pm to 6pm
• Thursday – 8.30am to 12pm; then from 2pm to 4.30pm
• Friday – 9am to 11.50pm; then from 3pm to 6pm
• Saturday (Cleator Moor) – 9am to 12pm

A duty doctor is available at the Cleator Moor site each evening until 8.00pm, although if patients telephone after 6.30pm they are directed to the out of hours service.

The practice provides services to patients of all ages based on an Alternative Provider Medical Services (APMS) contract agreement for general practice.

The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Cumbria Health on Call (CHOC).

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fellview Healthcare Limited on 12 November 2015. Overall the practice is rated as good.

Our key findings were as follows:

• 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.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• 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.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.

• Staff throughout the practice worked well together as a team.

• Staff had received training appropriate to their roles.

We saw several areas of outstanding practice including:

• A chronic disease ‘template’ (guidance for staff) had been developed within the practice to support nurses to carry out more effective and efficient checks for patients. The template had proved successful and other practices in the Whitehaven area had adopted the system. The practice IT manager also provided technical support to the other practices in the area.

• A new service for patients had been introduced in May 2015. The practice had employed two community nurse practitioners (CNPs) to carry out home visits to patients in 12 local care homes. The CNPs visited patients in the care homes, which reduced the workload for GPs but provided continuity of care for the patients. A survey of those who used the service had been carried out. A total of 15 responses were received. The results were overwhelmingly positive, for example, 100% of respondents felt the service was of benefit to them and 80% felt communication between clinicians and patients had improved.

• The practice was an early implementer of the patient access service (the facility was available well before the required implementation date of April 2016). The service enabled patients to access parts of their own medical records, including medication and allergy information.

• An influential and active patient participation group (PPG) had been established. The PPG had influenced the practice’s social media campaign and the chair of the group had recently been invited to deliver a presentation to managers on the key internal and external issues the practice faced.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure daily checks of the fridge temperatures are carried out across all four sites.
• Complete appraisals for all members of the nursing team.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 24 December 2015

The practice is rated as good for the care of patients with long-term conditions.

Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. A chronic disease ‘template’ (guidance for staff to follow during a consultation) had been developed within the practice to support nurses to carry out more effective and efficient checks for patients. The template contained all documents in one place so the nurses could easily access relevant information for each patient.

Nationally reported QOF data (2014/15) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example, the practice had obtained 97.7% of the points available to them for providing recommended care and treatment for patients with diabetes. This was 4.1 percentage points above the local CCG average and 8.5 points above the national average.

Updated 24 December 2015

The practice is rated as good for the care of families, children and young people.

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were in line with the national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 90.1% to 100% and for five year olds from 77.7% to 100%. The practice’s uptake for the cervical screening programme was 81.6%, which was comparable with the national average of 81.8%, but slightly below the clinical commissioning group (CCG) average of 82.5%.

Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 24 December 2015

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

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was slightly above local clinical commissioning group (CCG) average (99.6%) and 2.1 points above the England average.

The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, all patients over the age of 75 had a named GP and patients at high risk of hospital admission and those in vulnerable circumstances had care plans.

A new service for patients had been introduced in May 2015. The practice had employed two community nurse practitioners (CNPs) to carry out home visits to patients in 12 local care homes. The CNPs visited patients in the care homes, which reduced the workload for GPs but provided continuity of care for the patients. A survey of those who used the service had been carried out. A total of 15 responses were received. The results were overwhelmingly positive, for example, 100% of respondents felt the service was of benefit to them and 80% felt communication between clinicians and patients had improved.

The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Updated 24 December 2015

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 and flexible. The Cleator Moor site was open until 8pm Monday to Friday and on Saturday mornings for working patients who could not attend during normal opening hours.

The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line. Appointments could also be booked via a mobile device ‘App’.

Additional services were provided such as health checks for the over 45s and travel vaccinations.

Updated 24 December 2015

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

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia. Patients experiencing poor mental health were sign posted to various support groups and third sector organisations. The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.

Nationally reported QOF data (2014/15) showed the practice had not achieved good outcomes in relation to patients experiencing poor mental health. For example, the practice had obtained 84.6% of the QOF points available to them for providing recommended care and treatment for patients with poor mental health. This was 10.8 percentage points below the local CCG average and 8.2 points below the England average. Performance for dementia related indicators was below the national average (88.5% compared to 94.5% nationally). A review of the data had been carried out to determine the cause; it was found that this related to some patients who had not attended annual reviews. A study was carried out to determine the most appropriate way to encourage the patients to attend and a protocol was set up for staff to follow. This had recently been implemented and the lead GP said the impact of the work would be reviewed over the following months.

Updated 24 December 2015

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 those with a learning disability. Patients with learning disabilities were invited to attend the practice for annual health checks. The practice offered longer appointments for people with a learning disability, if required.

The practice had effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.

Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check and referred for a carer’s assessment.