Hoad Medical Practice

Updated 11 May 2017

Dr Johnston and Partners is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 4,300 patients from one location at Ulverston Health Centre, Stanley Street, Ulverston, Cumbria, LA12 7BT. We visited this location on this inspection.

The practice is located in a purpose built health centre. All patient facilities are situated on first floor which is accessible by stairs or a lift. There are disabled toilet facilities, wheelchair and step-free access to all consulting and treatment rooms. There is a car park available adjacent to the health centre.

The practice has 15 members of staff, including three GP partners (two female, one male), three practice nurses (female), a practice manager, an assistant practice manager, and eight reception and administration staff, including a Medicines Manager. The practice had recently recruited a health care assistant, who was due to start their role shortly after the date of inspection.

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 least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice population profile broadly reflects the national average, with no one age group particularly over- and under-represented.

The surgery is open from 8am to 6.30pm, Monday to Friday, with extended access one evening a week from 6.30pm to 7.30pm on either Monday and/or Tuesday evenings. 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 Ltd (CHoC).

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

Updated 11 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Johnston and Partners on 17th March 2017. 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 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 the management team.
• 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.

There were areas of practice where the provider should make improvements:

• Put a system in place to ensure Patient Group Directions (PGD) are kept up to date.
• Continue to monitor the new methods put in place for identifying carers, to ensure that these are working and that patients who are carers are being offered appropriate support.
• Ensure staff are clear about what should be reported as a significant event.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 May 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.
• Performance for diabetes related indicators was better than the national average. The practice achieved 96% of the total points available, compared to the national average of 89.8%.
• 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 11 May 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 79%, which was in line with the local and 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 11 May 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 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 conditions associated with older patients, such as chronic obstructive pulmonary disorder (COPD), was better than the national average. The practice achieved 99% of the total points available for this condition, compared to the national average of 95.9%.

Updated 11 May 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 reflected the needs for this age group.

Updated 11 May 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 better than the national average. The practice achieved 100% of the total points available, compared to the national average of 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.
• 89% of patients diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was better than the national average of 84%.
• 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 11 May 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 who needed them.
• 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.
• There was a carers’ lead who offered support, however the practice had identified 22 patients as carers (0.5% of the practice list).New measures have been put in place to identify carers since the inspection.