The Mount View Practice

Updated 13 April 2017

The Mount View Practice is based in Fleetwood, Lancashire. The practice is part of Fylde and Wyre Clinical Commissioning Group (CCG) and delivers services under a Personal Medical Services contract with NHS England

The practice is located in a large purpose built medical centre in the town. There is easy access to the building and disabled facilities are provided. Consultation rooms are across three floors. There is a large car park serving all of the medical facilities on the site. There are three male GPs and two female GPs working at the practice. The Mount View Practice is a training practice and as such currently has a trainee GP. The practice also hosts placements for medical students and student nurses. There are six female practice nurses and one male nurse practitioner, and five health care assistants (all female). They have recently employed an advanced paramedic practitioner and practice pharmacist (both male). There is a team of six mental health nurses. There is a practice manager, one assistant practice manager and a team of administrative/reception staff.

In the last four years the practice team have suffered a number of staff losses, mainly due to unforeseen circumstances which had affected some areas of service provision. The practice had raised this matter with the CCG.

Within the building there is a same day health service and other community services.

The practice opening times are 8.00am until 6.30pm Monday to Friday. Extended hours are available on Monday, Tuesday and Wednesday evenings until 9pm. The Mount View Practice works in collaboration with two other Fleetwood practices as a Federation. Between the three practices they offer weekend appointments. We saw evidence of close joint working across the Fleetwood practices including the provision of weekend opening hours and agreed clinical protocols for long term conditions. We asked the practice to consider the effect of this federation arrangement on their CQC registration and directed them to CQC guidance on this matter.

Patients requiring a GP outside of normal working hours are advised to call NHS 111 service to access the out of hours service provided locally by Fylde Coast Medical Services.

There are 11700 patients on the practice list. The majority of patients are white British. A high number of patients have a long-standing health condition (65% as opposed to the national average of 54%). Life expectancy is less than national averages by four years for both genders.

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.

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Mount View Practice on 10 November 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 generally 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 easy to make an appointment, 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 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:

• The practice worked closely with other agencies in the local area. One GP Partner led an initiative called ‘Healthier Fleetwood’ a partnership of local stakeholders (including council members, police, sports clubs and residents) which focussed on improving engagement and supporting active involvement. Through this the practice were extending their range of social prescribing to include more activity based interventions such as gardening and walking football for people over 50. The practice was also involved with the local police force Early Intervention Scheme. A Police Community Support Officer was based at the practice who sought to identify adults at risk and worked closely with the care co-coordinator to develop support plans.

The areas where the provider should make improvement are:

• Risk assess decisions relating to the provision of equipment/medicines needed for treatment in emergencies

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2017

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. The practice had amalgamated all vascular type conditions (conditions affecting the veins and arteries) into a single clinic appointment to reduce the number of appointments one patient would need to attend

• Performance for diabetes related indicators was generally better than the national average. For example 85% of patients had their blood sugar levels well controlled compared to 84% locally and 78% nationally. The percentage of patients with blood pressure readings within recommended levels was 81% compared to 82% locally and 78% nationally. The percentage of patients whose last measured total cholesterol was 5 mmol/l or less was 90% compared to 82% locally and 80% nationally. The percentage of patients with a record of a foot examination within the preceding six months was 92% compared to 91% locally and 89% nationally.

• 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.

Updated 13 April 2017

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.

• The practice’s uptake for the cervical screening programme was 97%, which was higher than the CCG average of 85% and the national average of 81%.

• 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 13 April 2017

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. Patients aged over 75 had a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Older patients at risk of hospital admission, in residential care and aged over 75 and living alone had a care plan in place
• The practice maintained a palliative care register and held monthly meetings attended by a multidisciplinary team to enable sharing of information relating to patients to improve palliative and end of life care

Updated 13 April 2017

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.

• Extended hours surgeries were offered until 9pm every Monday, Tuesday and Wednesday for working patients who could not attend during normal opening hours. Telephone consultations were also available.

• The practice worked closely with other local practices and between them offered additional appointments at weekends.

Updated 13 April 2017

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

• Performance for mental health related indicators was generally better than local and national averages. For example 95% of people experiencing poor mental health had a comprehensive, agree care plan documented in the record compared to 88% locally and 89% nationally. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 96% compared to 90% locally and 89% nationally. 72% of patients diagnosed with dementia had their care reviewed in a face to face review compared with CCG average of 83% and national average of 84%. The practice recognised this figure was lower and had recently employed a paramedic practitioner who worked closely with care homes and visited people in their own homes to create and update care plans.

• 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 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.

• Patients experiencing poor mental health were told about how to access various support groups and voluntary organisations.

• The practice recognised that they served a population with a high proportion of patients with Mental Health needs and sought to tailor the services they provided. The practice employed a team of Mental Health Nurses to help patients with mild mental health difficulties such as depression and anxiety. Both individual and group care such as anxiety management, mindfulness and stress management were offered. Recovery rates were routinely monitored.  Rooms used for consultations were carpeted so were less clinical and had a painting on the wall to promote calm and prompt discussion. A remembrance day display in the waiting area helped to proactively identify veterans in need of support.
• Where staff recognised signs of elderly patients becoming forgetful they contacted the mental health team who invited the patient for a memory assessment and worked closely with the Memory Service.
• The mental health team had a target to offer CBT (cognitive behavioural therapies) to those patients with a diagnosis of COPD and/or diabetes.

Updated 13 April 2017

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.

• The practice offered longer appointments for patients with a learning disability and other complex needs.

• 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.

• 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.

• Carers were proactively identified and referred to the practice Carers Champion to signpost them to appropriate support services.

• Prior to being built patients had been consulted as to the design and layout of the building and what rooms would be needed and where. A group of pupils from a local school had then visited the building to assess its accessibility for children and young people, especially those with additional needs. This had led to some minor changes such as larger signage but overall the feedback was good. The pupils also provided a training session to practice staff to raise awareness of the needs of people with additional needs.

• Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice, including patients in care homes. The paramedic practitioner conducted a large number of these visits using telephone and video calls for support from the on call GP. The paramedic practitioner also produced and reviewed care plans for patients at risk of acute hospitalisation.