Archived: Kirkoswald Surgery

Updated 25 February 2016

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

The practice provides services to around 2,300 patients from one location at The Surgery, Kirkoswald, Penrith, Cumbria, CA10 1DQ. The practice is based in converted premises in the centre of Kirkoswald. The building is on one level. There is on-site parking, disabled parking, a disabled WC and access is step-free. There is sufficient room for wheelchairs to move around the surgery.

The practice has two GP partners (one male, one female). The practice employs a practice manager, two practice nurses, a lead dispenser and three staff who carry out receptionist, administration and dispensing duties. The practice provides services based on a General Medical Services (GMS) contact for patients living in the Kirkoswald, Lazonby, Eden Hall and Armathwaite areas of Cumbria.

The practice is open from 8am to 6:30pm on Tuesday, Thursday and Friday. On Monday the practice is open from 8am to 7:30pm and on Wednesday the practice is open from 8am to 1:30pm. When the practice is closed patients are directed to the NHS 111 service. This information is available on the practice noticeboard, telephone message and the practice website.

Information from Public Health England placed the area in which the practice is located in the 9th least deprived decile. The practice’s age population is noticeable weighted towards people of over the age of 45.

The practice is situated in rural Cumbria with limited public transport. The service for patients requiring urgent medical care out of hours is provided by the NHS 111 service and Cumbria Health on Call Limited (CHOC).

Updated 25 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kirkoswald Surgery on 19 November 2015. 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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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. The building had some limitations which the practice was working to address.
• 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 practices ethos and practice reflected the requirements of the Duty of Candour.
• The practice was open and honest in the management of significant events and complaints.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG).

• Staff are highly motivated and inspired to offer care that is kind and promotes peoples dignity. Patient's individual preferences and needs are always reflected in how care is delivered. There was a strong emphasis on providing good palliative care for patients who needed it and supporting their families at this time.

The areas where the provider should make improvements are:

• Complete a risk assessment of the window blinds used at the practice to reduce potential hazards for children and vulnerable adults.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 February 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.  The practice held an unplanned admissions register.

• Nationally reported data showed that outcomes for patients with long term conditions were good. For example, the practice had achieved 93% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was comparable to the local CCG average of 93.6% and above the national average of 89.2%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice met with the district nurses on a regular basis.

Updated 25 February 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 comparable to other local practice for all standard childhood immunisations. The practice nurse worked to encourage uptake for the immunisation programme.

• 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.

• The practice’s uptake for cervical screening was 85.1% which was in line with the local CCG average of 82.5% and the national average of 81.8%

• Appointments were available outside of school hours and the premises were suitable for children and babies. However, the window blinds in some rooms at the practice were a risk to children and vulnerable adults as no cleat was used to secure the looped cord.

• We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 25 February 2016

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

• The practice offered effective care to meet the needs of the older people in their population.

• They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This was acknowledged positively in feedback from patients and the patient participation group.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were good. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was similar to the local clinical commissioning group (CCG) average of 99.6% and above the national average of 97.9%.

• The percentage of people aged 65 or over who received a seasonal flu vaccination was 76.4%, which was above the local CCG average of 73.2%. For at risk groups the practice rate was 63.9% (CCG average 52.3%).

Updated 25 February 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 range of health promotion and screening that reflects the needs for this age group.

• Extended opening hours for appointments were available each Monday until 7:30pm; appointments were available with a GP or nurse.

• Patients could book appointments and order repeat prescriptions online.

• Additional services such as health checks for over 40s were provided.

• Telephone consultations were offered and the practice recognised the needs of the local farming community by working flexibly to provide care.

Updated 25 February 2016

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

• 100% of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (CCG average 83.7%, national average 86%).

• Nationally reported data showed that outcomes for patients with mental health conditions were mixed. For example, the practice had achieved 84.6% of the QOF points available for providing the recommended care and treatment for patients with a mental health condition. This was below the local CCG average of 95.4% and comparable to the national average of 84.2%.

• Nationally reported data showed that outcomes for patients with dementia were good. For example, the practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was above the local CCG average of 95.7% and the national average of 94.5%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• They carried out advance care planning for patients with dementia.

• The practice advised patients experiencing poor mental health about how to access various support groups and voluntary organisations. They also referred to a local mindfulness programme and a local ‘listening ear’ service for patients who were lonely.

• They 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 people with mental health needs and dementia. Most of the staff had undertaken dementia friends training.

Updated 25 February 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 number of patients with a learning disability was very low; all had received an annual health check with a doctor and nurse in the last year.

• They offered longer appointments for patients with a learning disability.

• The practice regularly worked 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 normal working hours and out of hours.

• They had told vulnerable patients about how to access various support groups and voluntary organisations.