Court Thorn Surgery

Updated 24 November 2016

Court Thorn Surgery is registered with the Care Quality Commission to provide primary care services. It is located in the Carlisle area of Cumbria.

The practice provides services to around 3,000 patients from one location: Low Hesket, Carlisle, Cumbria, CA4 0HP. We visited this address as part of the inspection. The practice has three GP partners (two female and one male), two practice nurses (both female), a business manager, a dispensary manager, a medicines manager and six staff who carry out reception, administrative and dispensing duties.

The practice is a teaching and training practice and one of the GPs is an accredited GP trainer. At the time of the inspection there was one trainee GP working at the practice.

The practice is part of Cumbria clinical commissioning group (CCG). The practice population is made up of a higher than average proportion of patients over the age 65 (21.8% compared to the national average of 17.1%). Information taken from Public Health England placed the area in which the practice is located in the third less deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The practice is located in a purpose built two storey building. All patient facilities are on the ground floor. There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access.

Opening hours are between 8.15am and 6pm Monday to Friday. Patients can book appointments in person, on-line or by telephone. Appointments are available from 8.20am to 11.30am every morning and from 2.30pm to 5.50pm every afternoon. A duty doctor is available each morning between 8am and 8.15am and every afternoon until 6.30pm.

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

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

Updated 24 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Court Thorn Surgery on 4 October 2016. Overall the practice is rated as outstanding.

Our key findings were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All staff were involved in discussions about complaints and significant events. Managers were keen to ensure that staff had the opportunity to give their input and take an active role in agreeing any corrective action or learning points.
• Feedback from patients and their families about the way staff treated people was continually and overwhelmingly positive. Every one of the 15 patient CQC comment cards and the 33 ‘share your experience’ forms we received was very positive about the service experienced.
• Information about services and how to complain was available and easy to understand.
• Patients could access appointments and services in a way that suited them. Results from the National GP Patient Survey, published in January 2016, showed that patients’ satisfaction with how they could access care and treatment was much higher than local and national averages
• The practice was integrated in the local community; managers were aware of the problems faced by some people and provided appropriate support.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Leaders had an inspiring shared purpose, strove to deliver person centred care and motivated staff to succeed. There was a clear leadership structure in place and staff felt supported by management.
• The practice proactively sought feedback from staff and patients, which they acted on.
• Staff throughout the practice worked well together as a team.

We saw several areas of outstanding practice including:

• There were innovative approaches to providing care and support for patients. The practice had commissioned a self-care programme for patients with long term conditions. A specialist facilitated the sessions at the practice, and around 14 patients attended each of the modules. The programme was then made available electronically via email for all patients to access.
• The practice had established an effective patient participation group (PPG). Managers supported the PPG to organise a number of health seminars for patients; 11 had been held so far. Patients made suggestions as to which topics they would like to be covered, then the practice and PPG sourced speakers to attend. The seminars were advertised across the area and the previous event had been attended by 52 patients.
• All accident and emergency attendances for care home residents were reviewed monthly to help identify specific health needs or any safeguarding concerns. The number of attendances at accident and emergency for care home patients had reduced from 21 (January to August 2015) to 7 for the same period in 2016.
• There was a weekly prescription delivery service, run by the practice’s PPG. Many patients lived in isolated areas, without access to public transport. Each week throughout the year, a number of volunteers delivered medicines to patients at their homes. There were well established governance and management arrangements in place to ensure the effective running of the service.
• The practice had very good arrangements in place to ensure carers’ needs were met. Each month one of the nurses carried out a check of all carers on the practice register to ascertain if any further support or interventions were necessary. The practice worked closely with a local carers support group; the group held a drop in clinic once a month to provide support and encourage carers to register themselves. Feedback from the carers support group about the practice was very positive.

The area where the provider should make improvements is:

• Take steps to ensure medicines management processes are up to date and closely monitored.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 November 2016

The practice is rated as outstanding for the care of patients with long-term conditions. The positive aspects of the practice which led to these ratings apply to everyone using the practice, including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
• There were comprehensive arrangements in place to encourage patients with long term conditions to attend for their review appointments. Administrative staff and the nursing team worked closely together. Each month a list of all patients due for review was prepared, a nurse reviewed and noted the type and length of appointment needed. Administrative staff then made the arrangements to book patients in for personalised appointments.
• Longer appointments and home visits were available when needed.
• Patients had regular reviews to check health and medicines needs were being met.
• For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had commissioned a self-care programme for patients with long term conditions. This provided advice on relaxation techniques, exercise, healthy eating, emotional well-being and pain management.
• The practice supported the PPG to organise a number of health seminars for patients; 11 had been held so far. Patients made suggestions as to which topics they would like to be covered, then the practice and PPG sourced speakers to attend. Topics previously covered included diabetes, heart diseases, arthritis and dementia. The seminars were advertised across the area and the previous event had been attended by 52 patients.

Updated 24 November 2016

The practice is rated as outstanding for the care of families, children and young people. The positive aspects of the practice which led to these ratings apply to everyone using the practice, including this population group.

• The practice had identified the needs of families, children and young people, and put plans in place to meet them.
• 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.
• 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.
• The practice’s uptake for the cervical screening programme was 86.4%, which was above the clinical commissioning group (CCG) average of 82.5% and the national average of 81.8%. There were comprehensive arrangements in place to encourage patients to attend for their cervical screening test.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff.
• Health visitors provided a regular monthly clinic at the practice to support families with children under the age of five.

Updated 24 November 2016

The practice is rated as outstanding for the care of older people. The practice was rated as outstanding for providing caring, responsive and well led services. The positive aspects of the practice which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.
• Several patients lived in local residential or nursing homes; one of the GPs, who had a diploma in geriatric medicine, carried out a weekly ward round to review patients, and had regular phone contact with staff. All accident and emergency attendances for care home residents were reviewed monthly to help identify specific health needs or any safeguarding concerns. The practice also offered regular training and development sessions for care home staff to help meet patients’ needs.

Updated 24 November 2016

The practice is rated as outstanding for the care of working age people (including those recently retired and students). The positive aspects of the practice which led to these ratings apply to everyone using the practice, including this population group.

• 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 and flexible.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
• Additional services were provided such as health checks for the over 40s and travel vaccinations.

Updated 24 November 2016

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). The positive aspects of the practice which led to these ratings apply to everyone using the practice, including this population group.

• The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
• Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
• The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.
• One of the GPs had a special interest in dementia; they had provided training to local first responders on dementia awareness.
• A number of staff had also completed ‘dementia friends’ training. This encouraged staff to look for ways to make the practice more accessible to patients with dementia.

Updated 24 November 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. The positive aspects of the practice which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances, including those with a learning disability.
• Patients with learning disabilities were invited to attend the practice for annual health checks and were offered longer appointments, if required.
• The practice had 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 had implemented lessons learned from safeguarding serious case reviews; including the introduction of a new patient registration form for children and ensuring that all children had a new patient check with a GP.
• There were effective arrangements in place to ensure carers’ needs were met. Each month one of the nurses carried out a check of all carers on the practice register to ascertain if any further support or interventions were necessary, for example, if the person they were caring for had been in hospital then they were contacted to ask if they needed anything.
• The practice worked closely with a local carers support group; the group held a drop in clinic once a month to provide support and encourage carers to register themselves.