Archived: Derwent Surgery

Updated 7 July 2016

Derwent Surgery is registered with the Care Quality Commission to provide primary care services. The area covered included the whole of Cockermouth and the surrounding large rural area.

The practice provides services to around 6,600 patients from one location:

• Isel Road, Cockermouth, Cumbria, CA13 9HT.

We visited this this address as part of the inspection.

Derwent Surgery is based in purpose built premises in Cockermouth. The premises is shared with another GP practice (Castlegate Surgery) and external services. All reception and consultation rooms are fully accessible. There is on-site parking and disabled parking. Disabled WCs are available and wheelchairs provided for the use visitors to the building when needed.

The practice merged with Castlegate Surgery in December 2015, this merger was the result of a shortage of GPs at Derwent Surgery. At the time of the inspection, the administration of the practice and nursing services had fully merged and provided services to patients registered at both Derwent and Castlegate Surgeries. Services provided by GP’s were not yet merged and patients were still required to book and appointment with a Derwent GP. The merged practice is now known as Castlegate and Derwent Surgery.

Since the merger the practice is now:

• An approved training practice where qualified doctors gain experience in general practice. At the time of the inspection, no doctors were training with the practice.
• Active in clinical research and patients are encouraged to participate in appropriate clinical trials.

The practice has two partners and one salaried GP (one male, two female). Prior to the merger with Castlegate Surgery the practice employed a practice manager, an IT/finance lead, a practice nurse and three healthcare assistants. There was also a dispensary manager and two dispensing assistants. In addition, they employed nine staff who carried out reception or administration duties. Following the merger with Castlegate Surgery the staffing levels increased with a further 40 staff members including 7 GP partners, 1 salaried GP, a business manager, and office manager, also additional nurses and staff who carried out reception of administration duties . Two CCG funded admission prevention nurses are also employed by the practice; they provide care for Derwent and Castlegate Surgery patients. The practice provides services based on a General Medical Services (GMS) contract agreement for general practice.

The practice is a dispensing practice; this service is only available to patients who live more than one mile away from a pharmacy This equates to 49% of the practice’s patients.

Derwent Surgery is open at the following times:

• Monday to Friday 7:30am to 6:30pm.

The telephones are answered by the practice from 8am to until 6:30pm. When the practice is closed patients are directed to the NHS 111 service. This information is available on the practice’s telephone message, website and in the practice leaflet.

Appointments are available at Derwent Surgery at the following times:

• Monday to Friday 7:30am to 6:30pm.
• Extended hours appointments are available from 7:30am until 8am Monday to Friday.

The practice is part of NHS Cumbria clinical commission group (CCG). Information from Public Health England placed the area in which the practice is located in the eighth least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. Average male life expectancy at the practice is 79 years compared to the national average of 79 years. Average female life expectancy at the practice is 85 years compared to the national average of 83 years.

The proportion of patients with a long-standing health condition is above average (58% compared to the national average of 54%). The proportion of patients who are in paid work or full-time employment or education is in line with the average (61% compared to the national average of 62%). The proportion of patients who are unemployed is below average (1% compared to the national average of 5%).

The service for patients requiring urgent medical care out of hours is provided by the NHS 111 service and Cumbria Health on Call.

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Derwent Surgery on 11 May 2016. Overall, the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned when incidents and near misses occurred.
• Risks to patients were assessed and well managed.
• 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.
• Most 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.
• Urgent appointments were available on the day they were requested. However, most patients told us that they had to wait two or three weeks for routine appointments and appointments with a named GP.
• Extended hours appointments were available Monday to Friday between 7:30am and 8am.
• 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 practice had engaged with the staff during the recent merger with another local practice, staff members had been part of the steering group for this merger.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had adapted their clinical system to support effective care of patients at increased risk of acute kidney injury due the medicines the patient was prescribed. When a clinician recorded relevant symptoms, the system checked the medicines prescribed and displayed a visual alert during the consultation. This reduced the risk of patients suffering acute kidney injury.

The areas where the provider should make improvement are:

• The practice should continue to implement a system of staff appraisals as soon as possible to provide staff with a formal opportunity to discuss training, learning and development requirements.
• Review the arrangements for clinical audit in order to be able to demonstrate a clear link between audits and quality improvement.
• Continue to review patient access for routine appointments with a GP.
• Review their staff induction and recruitment process for the checking of clinical and non-clinical staff immunity status.
• Complete the process for appointing a registered manager for the merged practice in line with CQC guidance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 7 July 2016

The practice is rated as good for the care of people with long-term conditions.

• The practice had adapted their clinical system to support effective care of patients at increased risk of acute kidney injury due the medicines the patient was prescribed. When a clinician recorded relevant symptoms, the system checked the medicines prescribed and displayed a visual alert during the consultation. This reduced the risk of patients suffering acute kidney injury.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Patients at risk of hospital admission were identified as a priority for care and support by the practice, comprehensive care plans were in place and regularly reviewed.
• Nationally reported data showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example, the practice had achieved 98.5% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 4.9% above the local CCG average and 9.3% above the national average.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition had a named GP and were offered 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.
• The practice held regular clinics for some long terms conditions, for example, for patients with diabetes. A recently appointed nurse had been employed to focus on patients with diabetes.

Updated 7 July 2016

The practice is rated as good for the care of families, children and young people.

• There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Urgent appointments for children were available on the same day.
• There were arrangements for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 80% to 100% (CCG average 83% to 97%) and for five year olds ranged from 80% to 100% (CCG average 73% to 98%).
• Pregnant women were able to access an antenatal clinic provided within the building, staff worked closely with the staff who provided this service.
• Nationally reported data showed that outcomes for patients with asthma were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 1.5% above the local CCG average and 2.6% above the national average.
• The practice provided contraceptive and sexual health services.

Updated 7 July 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.
• All patients over the age of 75 had a named GP and patients over the age of 75 were offered an annual health check.
• The practice worked to reduce the unplanned hospital admissions for patients over the age of 75. Admission prevention nurses were based at the practice; as part of a project aimed at reducing hospital admissions for the frail and elderly (over 75’s). The nurses were employed to work outside of practice hours to support care homes and housebound patients with the management of their health to assist in the prevention of them being admitted to hospital.
• The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs. The practice worked closely with the local care homes.
• Nationally reported data showed that outcomes for patients with 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 0.4% above the local clinical commissioning group (CCG) average and 2.1% above the national average.
• The practice maintained a palliative care register and offered immunisations for shingles and pneumonia to older people.
• Two GPs had recently undertaken a Royal Collage of General Practice (RCGP) diploma in geriatric medicine in response to the elderly demographic of the patients at the practice.

Updated 7 July 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.
• Patients could order repeat prescriptions and book GP and some nursing and routine healthcare appointments online. Telephone appointments were available and a text message reminder service was available.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group. The practice’s uptake for cervical screening was 86%, compared to the CCG and national average of 82%.
• Additional services such as new patient health checks, travel vaccinations and minor surgery were provided.
• The practice website provided a good range of health promotion advice and information.
• The practice was active on social media and used this as one method of sharing practice and health related information. ​

Updated 7 July 2016

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

• The practice held a register for patients experiencing poor mental health. There were 38 patients on this register, and 96% of those eligible for a care plan had one completed (2015/2016 data, which is yet to be verified or published).
• Nationally reported data showed that outcomes for patients with mental health conditions were below average. The practice had achieved 68.1% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 27.3% below the local CCG average and 24.7% below the national average.
• Nationally reported data showed that outcomes for patients with dementia were above average. The practice had achieved 97.3% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 2% above the local CCG average and 3.2% above the national average. 80% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, compared to the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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. Some staff had completed dementia awareness training.

Updated 7 July 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.
• The practice held a register of patients with a learning disability; patients with learning disabilities had been invited to the practice for an annual health check. 34 patients were on this register and 59% had a health check in the last 12 months.
• Nationally reported data showed that outcomes for patients with a learning disability were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with a learning disability. This was the same as the local CCG average and 0.2% above the national average.
• The practice offered longer appointments for patients with a learning disability if required.
• The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people.
• 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.
• Good arrangements were in place to support patients who were carers.