Sedbergh Medical Practice

Updated 31 October 2016

Sedbergh Medical Practice provides care and treatment to approximately 4148 patients from Sedbergh, Cumbria and the surrounding areas within a 10 mile radius of the practice. It is part of the NHS Cumbria Clinical Commissioning Group (CCG) and operates on a General Medical Services (GMS) contract.

The practice provides services from the following address, which we visited during this inspection:

Sedbergh Medical Practice

Station Road

Sedbergh

Cumbria

LA10 5DL

The surgery is located in purpose-built accommodation which opened in 2013. All reception and consultation rooms are on the ground floor and fully accessible for patients with mobility issues. A lift is available if patients need to access the first floor pf the building. An on-site car park is available which includes dedicated disabled car parking spaces.

The surgery telephone lines opened at 8am. The surgery was open from 8.15am to 8pm on a Monday (appointments from 8.15am to 7.45pm), 8.15am to 7pm on a Tuesday and Thursday (appointments from 8.15am to 6.45pm) and 8.15am to 6.30pm on a Wednesday and Friday (appointments from 8.15am to 5.30pm).

The practice also operated a small satellite clinic for an hour per week on a Monday morning from the Methodist Church Hall in the nearby village of Dent. This was for pre bookable non-urgent appointments only for patients from the rural area of Dentdale who were elderly or had mobility and transport issues.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Cumbria Health on Call (CHoC).

Sedbergh Medical Practice offers a range of services and clinic appointments including minor surgery, contraception advice, travel clinic, anti-coagulation clinic, childhood immunisation service, sexual health advice, long term condition reviews, 24 hour blood pressure monitoring and dressings service. The practice is a dispensing practice and dispenses to patients in more rural locations. The practice also employs a research nurse which means that the practice are actively involved in clinical research and their patients are able to participate in clinical trials should they wish to do so.

The practice consists of:

• Two GP partners (one male and one female)
• Three salaried GPs (one male and two female)
• One advanced nurse practitioner (female)
• Three practice nurses (all female)
• One research nurse (female)
• One health care assistant (female)
• One phlebotomist (female)
• Eight non-clinical members of staff including a practice manager, medicines manager, receptionists and dispensers.

The area in which the practice is located is in the eighth (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The average life expectancy for the male practice population is 81 (CCG average 79 and national average 79) and for the female population 85 (CCG average 82 and national average 83).

56.4% of the practice population were reported as having a long standing health condition (CCG average 56.3% and national average 54%). Generally a higher percentage can lead to an increased demand for GP services. 56.2% of the practice population were recorded as being in paid work or full time education (CCG average 59.1% and national average 61.5%). Deprivation levels affecting children and older people were much lower than the local CCG and national averages.

Updated 31 October 2016

We carried out an announced comprehensive inspection of Sedbergh Medical Practice on 10 August 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate good improvements to patient care as a result of this.
• Feedback from patients about their care was consistently positive. Patients reported that they were treated with compassion, dignity and respect. Patient feedback in relation to access was higher than local clinical commissioning group and national averages.
• Patients were able to access same day appointments during daily open surgeries. Pre-bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice had proactively sought feedback from patients and had a doverse, actove and engaged patient participation group. The practice implemented suggestions for improvement and made changes to the way they delivered services in response to feedback.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved the maximum results available to them for 2014/15.
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed with staff and stakeholders.
• All GP appointments were scheduled for 15 minutes. All nurse appointments were scheduled for 30 minutes.

We saw areas of outstanding practice:

• The practice was participating in a video consultation pilot for some of their housebound and elderly patients living in more rural locations. This not only allowed patients to access timely consultations with a practice GP but also enabled more socially isolated patients to connect with other users of the system and access video games and puzzles.
• When the practice had to use a locum GP they were given a half day induction session to familiarise themselves with practice policies, procedures, systems and staff. Feedback we received from previous locum GPs was consistently positive and praised the practice for its access to appointments, patient safety systems, motivated and knowledgeable staff and robust policies and protocols.
• The practice was proactive in the development and application of care plans. Patients with a care plan were offered a 30 minute annual care plan review with a GP. The practice reported that of their patients who had died during 2015/16, 48% had an advanced care plan in place.

However, there were areas where the provider should make improvements. The provider should:

• Consider implementing an annual review of significant events and incidents and record and monitor who is responsible for carrying out action points from significant events.
• Review and improve the arrangements in place to log and monitor the movement and use of blank prescription pads
• Review out-of-date practice guidance used by the healthcare assistant when administering vaccinations under patient specific directions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 October 2016

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

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. Patients with multiple long term conditions were offered an annual comorbidity review. All appointments with a practice nurse were scheduled for 30 minutes.

The QOF data (2014/15) showed the practice had achieved very good outcomes in relation to most of the conditions commonly associated with this population group. For example:

• The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 1.5% above the local CCG average and 2.6% above the national average.
• The practice had obtained 100% of the point available to them in respect of chronic obstructive pulmonary disease. This was 2.4% above the local CCG average and 4% above the national average
• The practice had obtained 100% of the points available to them in respect of hypertension (1.1% above the local CCG average and 2.2% above the national average).
• The practice had obtained 100% of the points available to them in respect of diabetes (6.4% above the local CCG average and 10.8% above the national average).

The practice ran a twice weekly INR monitoring clinic (for patients on anticoagulation medicines) and daily blood testing clinic. They also provided a near patient testing service for patients with chronic rheumatology or gastroenterology conditions.

Updated 31 October 2016

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

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. The practice operated an open surgery from 8.30am to 10am on a Monday to Friday which meant that patients were able to access same day appointments. Practice policy dictated that acutely unwell children were seen within an hour and any unwell child was seen the same day.

Two of the practice nurses ran a weekly baby immunisation clinic. Data available for 2014/15 showed that the practice childhood immunisation rates for the vaccinations given to two year olds ranged from 80.6% to 100% (compared with the CCG range of 83.3% to 96%). For five year olds this ranged from 74.1% to 100% (compared to CCG range of 72.5% to 97.9%)

At 87%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was higher than the CCG average of 82.5% and national average of 82%.

Pregnant women were able to access a full range of antenatal and post-natal services at the practice. The practice GPs carried out post-natal mother and baby checks.

Updated 31 October 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data for 2014/15 showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 99.6% and the England average of 97.9%.

The practice had taken steps to ensure that comprehensive regularly reviewed care plans were in place for patients most at risk of avoidable admission to hospital. All patients discharged from hospital received a phone call from a GP within 48 hours of discharge.

The practice dispensed medicines to patients in more rural locations and ensured weekly dosette boxes were available for older patients and those with multiple medicines or memory issues. Patients living in more rural locations were also able to collect prescriptions from a shop in a local village and access pre bookable appointments for some conditions once per week in the village church hall.

One of the practice nurses offered weekly home visits to frail and elderly patients to carry out long term condition reviews and administer flu vaccinations.

The practice was participating in a video consultation pilot for some of their housebound patients and elderly patients living in more rural locations. This not only allowed patients to access timely consultations with a practice GP but also enabled more socially isolated patients to connect with other users of the system and access video games and puzzles.

Visiting podiatry, physiotherapy and optometry services were available at the practice on a weekly basis which meant that patients did not have to travel to hospital for these services. The practice also provided hearing aid batteries.

Updated 31 October 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 met. The surgery was open from 8.15am to 8pm on a Monday (appointments from 8.15am to 7.45pm), 8.15am to 7pm on a Tuesday and Thursday (appointments from 8.15am to 6.45pm) and 8.15am to 6.30pm on a Wednesday and Friday (appointments from 8.15am to 5.30pm).

The practice offered minor surgery, contraception services, travel advice, an anti-coagulation clinic, childhood immunisation service, sexual health advice, long term condition reviews, 24 hour blood pressure monitoring clinic and dressing’s service. They also offered new patient, over 74 and NHS health checks (for patients aged 40-74) and a dispensary service for patients living in more rural locations. Patients cold also access a minor injuries unit at the surgery which was often used by parents and their children to avoid having to travel to the local A&E department.

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. A text messaging service was available which was used to remind patients of their appointments as well as for advising patients of test results. The practice used social media as a way of keeping patients informed of news and developments.

Updated 31 October 2016

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

Nationally reported QOF data for 2014/15 showed the practice had achieved the maximum point available to them for caring for patients with dementia, depression and mental health conditions. However, at 77.5% the percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face meeting in the last 12 months was 6.2% below the local CCG and 6.5% below the national average.

Patients on the practice mental health register were offered annual reviews and longer appointments. Patients experiencing poor mental health were signposted to various support groups and third sector organisations, such as local wellbeing and psychological support services.

Patients were opportunistically screened for dementia using a recognised screening tool. Staff from the practice had joined the local dementia friends group and the practice was in the process of developing a dementia friendly practice. One of the GPs had undertaken dementia awareness training and other practice staff had attended workshops around dementia and mental health.

Practice staff had undertaken training to ensure they had an understanding of the Mental Capacity Act and their responsibilities in relation to this.

Updated 31 October 2016

The practice is rated as good for the care of people whose circumstances make them vulnerable.

The practice held a register of patients living in vulnerable circumstances, including 14 patients who had a learning disability. Longer appointments were available for patients with a learning disability, who were also offered an annual health check and flu immunisation.

The practice had established effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.

The practice identified carers and ensured they were offered appropriate advice and support and an annual flu vaccination.

Patients known to have experienced bereavement were contacted by phone by one of the GPs and offered a home visit when appropriate. They were also given relevant information detailing how to access bereavement support services.