Drs Irving, Smith, Hacking & Rylance Also known as Park View Surgery

Updated 2 December 2016

Drs Irving, Smith, Hacking and Rylance (also known as Park View Surgery) provides Primary Medical Services in the towns of Milnthorpe and Carnforth.

The practice provides services from two locations at:

• Haverflatts Lane, Milnthorpe, Cumbria, LA7 7PS.
• 21 New Street, Carnforth, Lancashire, LA5 9BX

We visited both sites as part of the inspection.

The main surgery is located in a purpose built surgery building which is owned by the partners and has been extended and developed over time. There is level entry access and disabled facilities are available. There is also a small car park adjoining the building. The practice have put forward a bid with the backing of the local clinical commissioning group (CCG) for a new health centre to accommodate themselves and another GP practice in Milnthorpe. The branch surgery in Carnforth is located in a converted terraced house. Disabled facilities have been added where possible, and the treatment room has been recently refurbished.

The practice has four GP partners (two male, two female) and one salaried GP (female). The practice hosted medical students during placements. There are also two practice nurses (both female), two healthcare assistants (both female), a practice manager and nine admin/reception staff, including a care navigator. The latter provides support to patients at a number of different practices but is employed by Park View Surgery, and is one of only two care navigators employed by practices in the area.

The practice provides services to approximately 6000 patients of all ages. The practice is commissioned to provide services within a General Medical Services (GMS) contract with NHS England.

The surgery is open at the following times:

Milnthorpe:

Monday to Friday, 8am to 6.30pm. Weekends closed.

Carnforth:

Monday – 8am to 5pm (closed 12.30-1pm)

Tuesday – 8am to 5pm (closed 12.30-2pm)

Wednesday – 8am to 5pm (closed 1-2pm)

Thursday – 8am to 5pm (closed 1-1.30pm)

Friday - 8am to 5pm (closed 1-1.30pm)

Weekends closed

Telephones are operated at all times during the opening hours. The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Cumbria Health On Call (CHOC).

Information taken from Public Health England placed the area in which the practice was located in the second least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The average male life expectancy is 82 years and the female is 84. Both of these are higher than the CCG average and national averages. The average male life expectancy in the CCG area is 79 and nationally 79. The average female life expectancy in the CCG area is 82 and nationally 83. The practice has a higher percentage of patients over the age of 45, when compared to national averages. There are fewer patients than average in all age groups under 44. The percentage of patients reporting with a long-standing health condition is higher than the national average (practice population is 63% compared to a national average of 54%). 

Updated 2 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Irving, Smith, Hacking and Rylance on 26 August 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, and the system for doing so was regularly reviewed by all staff. 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.
• Feedback from patients about their care was consistently and strongly positive.
• 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.
• The practice implemented suggestions for improvements and made changes to the way they delivered services as a consequence of feedback from patients and from the patient participation group (PPG).
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• 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 some areas of outstanding practice:

• There was a strong focus on continuous learning and improvement at all levels, leading to innovations such as remote blood pressure monitoring via text message and improved management of clinician time through the use of 20-minute cycles. Learning was shared with other practices in the locality, and we saw evidence of the improvements this was helping to drive in other services.

• The care delivered by the practice was highly regarded by their patients and other providers. They showed they provided effective support for the approximately 4% of their patient list who had been identified as being carers, and had won awards from a local carers’ organisation. An employee at the practice was a care navigator, who also cared for patients at other practices in the area. We saw numerous examples of how this had benefitted patients and their carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 December 2016

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

• 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 better than the national average. The practice achieved 100% of the points available in this area, compared to 89.2% 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.
• The practice had recently started remote blood pressure monitoring. Patients received reminders to check their blood pressure and returned the results to the GPs by text message. The practice had purchased the equipment for the patients to so this.
• A stoma nurse could be accessed at the practice, meaning patients did not need to travel for hospital for reviews.

Updated 2 December 2016

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

• 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.
• 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.
• 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 2 December 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in their population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Performance for indicators for diseases often experienced by older people was better than the national average. For example, the practice achieved 100% of the points available for chronic obstructive pulmonary disease (COPD), compared to 96% nationally.
• When the care navigator role was due to be lost the practice offered to host it, along with another practice in the area. One of their staff took on the role to provide support to patients at a number of different practices. They worked with older patients and could direct them to services which would help them meet their health and social care needs.

Updated 2 December 2016

The practice is rated as outstanding for the care of working-age people (including those recently retired and students) as the practice is rated outstanding overall.

• 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.
• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG average and the national average of 82%.
• Flu clinics were offered on Saturdays during flu vaccination season, so that people who worked could attend.

Updated 2 December 2016

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

• Performance for mental health related indicators was better than the national average. The practice achieved 100% of the points available in this area, compared to 92.8% nationally. 82% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• 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 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 2 December 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable, as the practice is rated outstanding overall.

• The practice showed they provided effective support for patients who were also carers and had identified approximately 4% of their patients as being carers They had won an award from a local carers’ charity during the past two years for the support that they offered to carers.
• The practice was able to offer longer appointments for those who required them.
• A learning disability nurse had appraised the premises to identify ways to make the practice more accessible to patients with a learning difficulty.
• The practice held a register of patients living in vulnerable circumstances including those 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.
• 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.