Archived: Risedale Surgery

Updated 12 August 2016

Risedale Surgery is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 6,900 patients from one location at 2-6 Gloucester Street, Barrow in Furness, Cumbria, LA13 9RX.

The practice is based in adjoining houses which have been converted into a surgery. It has level-entry access and all patient services are on the ground floor. There is no designated parking area for patients, with parking available on the streets around the practice.

The practice has 25 members of staff, including three (two female, one male) GP partners, one (male) salaried GP, one (female) nurse practitioner, two (female) practice nurses, three (female) healthcare assistants, a phlebotomist, a practice manager, and 13 reception and administration staff, including an assistant practice manager.

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 second most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. Health outcomes for people in Barrow in Furness are generally lower than national averages and vary significantly. The life expectancy in the most deprived areas for men is 13 years lower and for women eight years lower than people in the least deprived areas. The area also has higher-than-average rates of obesity, self-harm and smoking related deaths. The practice population profile broadly matches the national average, with very few age groups over or under represented.

The surgery is open at the following times:

Monday – 7am to 7pm

Tuesday, Wednesday and Thursday – 8am to 8pm

Friday – 7am to 6.30pm

Weekends – closed.

Appoinments with a GP or nurse can be booked during these opening times. The practice operates a telephone triage system, whereby patients receive a telephone call from a GP on the same day as they call the practice. These patients are assessed by the doctor, who then makes them an appointment at the practice or redirects them to a more appropriate service. Telephones at the practice are answered from 8am until 6.30pm, Monday to Friday. 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 Personal Medical Services (PMS) contract agreement for general practice.

Updated 12 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Risedale Surgery on 7 June 2016. Overall the practice is rated as good.

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

• 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• 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 mostly assessed and well managed.
• While most staff had undertaken recent training, records could not be provided to show that some staff had recently received certain training.

We saw an area of outstanding practice:

• The practice worked to improve the care of people with learning difficulties. For example, one of the GPs visited a local home for patients with learning difficulties to help with care planning and to offer vaccinations to patients and staff who worked there. The practice nurse had attended workshops with patients with learning difficulties to give talks and let people handle medical equipment such as stethoscopes to help them to feel more at ease when undergoing care.

The areas where the provider should make improvements are:

• Support staff to understand their role in identifying and reporting significant events.
• Prescribers should continue to assess named patients for their suitability to receive medication under a Patient Specific Direction before these are signed.
• Consider other ways of sourcing emergency medication if difficulties with suppliers persist.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 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, 78% of patients with diabetes, on the register, had a result of 64 mmol/mol or less for their last IFCC HbA1c (a blood test which measures the levels of glucose in the blood) in the preceding 12 months (April 2014 to March 2015), which was the same as the national average.
• Longer appointments and home visits were available when needed.
• All patients with a long term condition 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 12 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.
• 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 80%, which was comparable to the CCG and national average of 82%.

Updated 12 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 its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had decided to manage their workload by dividing the town into zones, each of which was covered by a particular doctor. This led to a more equal distribution of workload among the clinical staff and allowed better management of home visits and visits to patients in care homes.

Updated 12 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 12 August 2016

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

• 83% 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.
• Performance for mental health related indicators was below the national average. For example, 83% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (April 2014 to March 2015) compared to the national average of 88%.
• 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.

Updated 12 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 those with a learning disability.
• The practice worked to improve the care of people with learning difficulties. For example, one of the GPs visited a local home for patients with learning difficulties to help with care planning and to offer vaccinations to patients and staff who worked there. The practice nurse had attended workshops with patients with learning difficulties to help them to feel more at ease when undergoing care by giving talks and by allowing patients to handle medical equipment such as stethoscopes.
• 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.