Appleby Medical Practice

Updated 30 October 2019

Appleby Medical Practice is registered with the Care Quality Commission to provide primary care services. The practice provides services to just over 4,800 patients from the following location: The Riverside Building, Chapel Street, Appleby in Westmorland, CA16 6QR. We visited this address as part of the inspection. The practice is part of NHS North Cumbria Clinical Commissioning Group (CCG).

Deprivation indicators place this practice in an area with a score of eight out of ten. A lower number means the more deprived an area is. People living in more deprived areas tend to have greater need for health services. This practice had lower levels of deprivation than the CCG and England averages.

The practice is located in a purpose built two storey building, all patient facilities are situated on the ground floor. It also has on-site parking, disabled parking, a disabled WC and wheelchair access.

The practice has one GP partner, a Practice Manager partner, four salaried GPs, one practice nurse, a healthcare assistant and an assistant practitioner, a phlebotomist, and a practice pharmacist. These are supported by a team of administrative and management staff.

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

Updated 30 October 2019

We carried out an announced focused inspection at Appleby Medical Practice on 27 September 2019. This was to check the practice had made the improvements we said they should, when we last inspected the practice in May 2018.

At the last inspection, we rated the practice as requires improvement for providing safe services. We said the provider should:

• Improve recording of actions and learning points arising from significant events;
• Continue to develop systems to ensure all patients have their medication reviewed in a timely fashion;
• Develop a process of systematic review, dissemination and discussion of new clinical guidelines;
• Continue to develop systems so that safeguarding documents and communications are fully recorded, stored and attributable to the individual patient, such that they are easily available and accessible by clinicians who may need to take over the patient’s care.

At this inspection, we found that the provider had acted to address these areas.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected;
• information from our ongoing monitoring of data about services, and;
• information from the provider, patients, the public and other organisations.

We rated this practice as good overall. (Previous rating May 2018 – Good).

We rated the practice as good for providing safe services because the practice had:

• Made changes to the safeguarding procedures to ensure that concerns were always recorded and dates for any actions needed were set;
• Set up multidisciplinary team meetings where safeguarding concerns were discussed with other professionals;
• Put systems in place so that all safeguarding documentation was now scanned into the patient’s medical record;
• Started holding a daily “huddle” meeting with staff, and we were told that safeguarding concerns would be raised at these meetings if appropriate;
• Put a system in place so that NICE guidance was received via email by a member of the practice team who then disseminated this to other clinicians. This was then discussed at practice meetings;
• Set up alerts on the practice’s computer system to flag up when patients who were not on high-risk medicines were due a medication review, and 90% of patients on repeat medication had had a review;
• Started a daily staff “huddle” meeting were safeguarding, audits, clinical guidelines and significant events could be discussed;
• Changed the documentation for significant events so each one had the actions clearly documented and had a review date set. We saw minutes of the review meetings which had been set up to discuss learning.

As well as taking action to improve safety, the practice had also followed recommendations in the last report to:

• Develop a planned and structured approach to carrying out clinical audits. They had held meetings as a clinical team to discuss audits and to decide which clinicians would like to study certain topics. We saw minutes of a meeting where these were discussed;
• Attempt to encourage patients to attend a patient participation group, however as yet there had not been sufficient numbers to be able to begin the group.

We recommend that the practice should:

• Continue to look for ways to build a patient participation group.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Updated 15 August 2018

Updated 15 August 2018

Updated 15 August 2018

Updated 15 August 2018

Updated 15 August 2018

Updated 15 August 2018