Archived: Waterloo House

Updated 24 January 2017

Waterloo Surgery is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 8,500 patients from one location at Millom Hospital, Millom, Cumbria, LA18 4BY. We visited this location on this inspection.

The practice is based in part of a small community hospital managed by Cumbria Partnership NHS Foundation Trust. It has level access and patient services for the surgery are available on the ground floor. There is a designated parking area for patients, with disabled parking spaces available.

The practice has 29 members of staff, including three GP partners and two salaried GPs (three female, two male), one (female) nurse practitioner, four (female) practice nurses, two (female) healthcare assistants, a care coordinator, a practice manager, one medicines manager, 11 reception and administration staff, and three cleaners. There are other staff who have “honorary contracts” with the practice through the Millom Alliance, including a mental health nurse practitioner and an advanced community paramedic.

As well as the three GP partners, the local acute and community trusts are also partners in the practice as part of the Millom Alliance. This is a partnership between the practice, other health providers in the area, and patients (represented by the Millom Action Group) which aims to provide more care services within Millom and to reduce the need for hospital admissions or for patients to have to travel elsewhere to receive care.

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 most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The life expectancy for both men and women was 78 and 82 years respectively, which reflected the local (79 years for men, 82 years for women) and national averages (78 years for men, 83 years for women). The practice had 54.3% of patients who reported living with a long-term condition (local average 56.3%, national average 54%). The practice population profile is relatively similar to the national average, with slightly more patients than average over the age of 50 and slightly fewer under the age of 45.

The surgery is open from 8am to 6.30pm, Monday to Friday and closed at weekends. For two days each week, the practice opens at 7am. Walk-in appointments are available from Monday to Friday between 9.30am and 11.30am. Telephones at the practice are answered from 8am until 6.30pm, Monday to Friday. Outside of these times a message on the telephone answering system redirects patients to out of hours or emergency services as appropriate. The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Cumbria Health On Call (CHOC).

The practice provides services to patients of all ages based on a Personal Medical Services (PMS) contract agreement for general practice.

Updated 24 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Waterloo Surgery on 29th September 2016. Overall the practice is rated as outstanding.

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 easy to make an appointment with a named GP and 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.
• 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:

• In response to the threat of closure due to staff loses and insecure premises, the practice helped to establish the Millom Alliance. This was a partnership between the practice, other health providers in the area, and patients (represented by the Millom Action Group) which aimed to provide more care services within Millom and to reduce the need for hospital admissions or for patients to have to travel elsewhere to receive care. The practice played a key role in the foundation and operation of the alliance, and worked closely with other services in the area to achieve improvements. Data from the local acute hospital showed that following the formation of the alliance there had been a 16% reduction in ambulance attendances from Millom, non-elective admissions to the hospital from the population were down 8% and outpatient referrals had dropped by 11%.
• In collaboration with the alliance, the practice helped to produce a “GPs for Millom” promotional video which led to the recruitment of three new GPs, and allowed the continuation of the practice. This video won the Local Community Initiative Award at the UK Public Sector Communication Awards.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 January 2017

The practice is rated as outstanding for the care of people with long-term conditions, as the practice was rated as 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 asthma related indicators was 100% of the points available (CCG average, 98.8%, national average 97.4%).
• 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 24 January 2017

The practice is rated as outstanding for the care of families, children and young people, as the practice was rated as 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. 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 77%, which was comparable to the CCG average and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• A “School Week” was organised by the alliance, during which GPs from the practice went into schools in Millom to give health advice on managing minor ailments.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 24 January 2017

The practice is rated as outstanding for the care of older people, as the practice was rated as 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.
• A full-time care co-ordinator was employed by the practice. They worked with other members of the practice team and the Millom Alliance (such as the mental health nurse practitioner and advanced community paramedic) to put care plans in place for patients on the “frail elderly” pathway. They also acted as a point of contact for these patients at the practice, and were able to signpost them to other services.

Updated 24 January 2017

The practice is rated as outstanding for the care of working-age people (including those recently retired and students), as the practice was rated as 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 reflects the needs for this age group.
• There was extended opening twice a week from 7am for patients who could not make appointments during working hours.
• Flu vaccination clinics were held on Saturday mornings during the vaccination programme.

Updated 24 January 2017

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

• The practice were able to offer mental health clinics with a nurse practitioner who was a specialist in the field. They could undertake physical and mental health assessments. Patients also had access to video consultations with a consultant psychiatrist, which had reduced referrals to the community mental health team by 80%. The mental health nurse practitioner had an “honorary contract” with the practice to offer this service through the Millom Alliance.
• 84% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was the same as the national average.
• Performance for mental health related indicators was better than average at 97.6% of the points available (CCG average, 95.1%, national average 92.8%).
• 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. The practice staff had completed “dementia friendly” in order to make the practice more accessible to patients with dementia. A member of staff from the practice was delivering training to the local population in a bid to make Millom a “dementia friendly” town. The practice had also purchased software which aided communication between patients with dementia and their relatives and carers.

Updated 24 January 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• 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.
• 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.