Market Street Medical Practice

Updated 19 August 2016

Market Street Medical Practice 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 92 Market Street, Dalton in Furness, Cumbria, LA15 8AB.

The practice is based in a purpose-built surgery building which is approximately 20 years old and has been extended to its current size. It has level-entry access and all patient services are on the ground floor. There is a designated parking area for patients.

The practice has 30 members of staff, including six GP partners (three male, three female), three practice nurses (female), three healthcare assistants (female), a practice manager and 17 admin/reception staff including an assistant practice manager. The surgery is a training practice and regularly provides training to medical students and junior doctors, as well as offering work experience to sixth form students from local schools.

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 seventh most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice population has fewer patients than average between the ages of 20 and 44 and fewer children under the age of nine than the national average. There are more patients in every age category over 45 than the national average.

The surgery is open at the following times:

Monday: 8am – 6.30pm

Tuesday: 8am – 7.30pm

Wednesday: 8am – 6.30pm

Thursday: 8am – 7.30pm

Friday: 8am – 6.30pm

Weekends: Closed

The practice offers same-day, 24-hour and routine appointments, as well as telephone appointments and home visits. The 24-hour appointment slots are released daily for patients to be seen the next day. Telephones at the practice are answered from 8am until 6.30pm on Monday, Wednesday and Friday afternoons, and from 2pm to 7pm on Tuesday and Thursday. 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 General Medical Services (PMS) contract agreement for general practice.

Updated 19 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Market Street Medical Practice on 16 June 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 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.
• All staff were actively encouraged to engage in activities to monitor and improve quality and outcomes.
• There was a culture of audit within the practice, and clinical audits had been carried out as a result of the analysis of significant events or following attendance at training courses.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 August 2016

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 similar to the national average. For example, 90% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months (April 2014 to March 2015), compared to the national average of 88%.
• 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 19 August 2016

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 82%, which was the same as the national average.
• 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.
• Pupils from a local school were invited to attend the surgery, during which the practice was able gather feedback from the pupils about how they could improve to meet the needs of children.
• The practice operated a young-persons’ contraceptive and sexual health clinic which was open to patients of other practices and operated after school hours.

Updated 19 August 2016

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.
• There were lead clinicians for patients resident in care homes.
• The practice carried out palliative care audits to ensure more patients were able to receive the care they wanted at the end of life.

Updated 19 August 2016

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.

Updated 19 August 2016

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. For example, 98% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months (April 2014 to March 2015), compared to the national average of 88%.
• 73% 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.
• 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. Staff had recently undertaken “dementia friendly” training to increase their awareness.

Updated 19 August 2016

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 patients 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.