Lunesdale Surgery Also known as Dr Hall and Partners

Updated 28 November 2016

Lunesdale Surgery provides primary medical services in the towns of Kirkby Lonsdale and Hornby.

The practice provides services from two locations at:

• The Lunesdale Surgery, Kirkby Lonsdale Cumbria, LA6 2HQ.
• The Hornby Surgery, West View, Hornby, LA2 8JS

We visited both sites as part of the inspection.

The main surgery is located in a purpose-built surgery which was constructed in 2004 and is rented by the partners. There is level entry access and disabled facilities are available. There is also a large car park adjoining the building. The branch surgery in Hornby is located in a converted semi-detached house. Disabled facilities have been added where this has been practiceable. . The practice has a dispensary at both sites.

The practice has five GP partners (three male, two female) as well as two associate partners (the practice manager and one of the nurse practitioners). There are two salaried GPs (one female, one male). There are two nurse practitioners (both female), two practice nurses (both female), two healthcare assistants (both female), a practice manager and seven admin/reception staff, including a care navigator. The latter provides support to patients at a number of different practices but is employed by Lunesdale Surgery, and is one of only two care navigators employed by practices in the area. There is also a dispensary manager and five dispensers.

The practice provides services to approximately 6000 patients of all ages in a predominately rural area. The practice is commissioned to provide services within a General Medical Services (GMS) contract with NHS England.

The surgery is open at the following times:

Lunesdale Surgery:

Monday to Friday, 8am to 6.30pm, with extended hours on Monday until 7.30pm. Weekends closed.

West View:

Monday – 9am to 12pm then 2pm to 6pm.

Tuesday – 9am to 12pm.

Wednesday – 9am to 12pm then 4.30pm to 6pm.

Thursday – 9am to 12pm.

Friday - 9am to 12pm then 4.30pm to 6pm.

Weekends closed

Telephones are operated at all times during the opening hours. The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Cumbria Health On Call (CHOC).

Information taken from Public Health England placed the area in which the practice was located in the second least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The average male life expectancy is 82 years, whilst for females it is 85. Both of these are higher than the clinical commissioning group (CCG) and national averages. The practice has a much higher percentage of patients over the age of 45, when compared to national averages. There are fewer patients than average in all age groups under 44 with the exception of 10 to 19-year-olds. The percentage of patients reporting with a long-standing health condition is higher than the national average (practice population is 64% compared to a national average of 54%).

Updated 28 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lunesdale Surgery on 6 September 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.
• 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.
• Overall, risks to patients were assessed and well managed, however, the systems for medicines management required improvement to keep patients safe.

We saw an area of outstanding practice:

• The practice employed a care navigator, one of only two employed by practices in the area, who also provided support to patients at a number of different practices. They worked with older patients and could direct them to services which would help them meet their health and social care needs.

The areas where the provider should make improvement are:

• Review the procedure for monitoring prescriptions to ensure that patients who do not collect them are being followed up.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 November 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 better than the national average. The practice achieved 95% of the points available in this area, compared to 89.2% nationally.
• Longer appointments and home visits were available when needed. All standard appointments were 15-minutes in length.
• 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 28 November 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 Accident &Emergency 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.

Updated 28 November 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.
• Performance indicators for diseases often experienced by older people was better than the national average. For example, the practice achieved 97.9% of the points available for chronic obstructive pulmonary disease (COPD), compared to 96% nationally.
• The practice was one of only two in the area to employ a care co-ordinator, who provided care to older patients.

Updated 28 November 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.
• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG average and the national average of 82%.

Updated 28 November 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. The practice achieved 94.1% of the points available in this area, compared to 92.8% nationally.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• 78% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 84%.
• 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.

Updated 28 November 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 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.