Archived: Warwick Square Group Practice

Updated 18 August 2017

Drs. Wigmore and Kari provides care and treatment to 7,600 patients of all ages, based on a General Medical Services (GMS) contract. The practice is part of the NHS North Cumbria clinical commissioning group (CCG) and provides care and treatment to patients living in the Carlisle area. The practice serves an area where deprivation is higher than the England average. In general, people living in more deprived areas tend to have greater need for health services. The practice population includes fewer patients who are under 18 years of age, and more patients aged over 65 years of age, than the England average.

The practice provides services from the following locations:

The Grosvenor House Surgery, Warwick Square, Carlisle, Cumbria, CA1 1LB.

The Morton Surgery, Langrigg Road, Carlisle, Cumbria, CA2 6DT.

We visited the Grosvenor House Surgery during this inspection.

The main practice and its branch surgery are located in purpose built buildings which provide patients with fully accessible treatment and consultation rooms. The practice has three GP partners (two male and one female), one salaried GP (male), three practice nurses (all female), a healthcare assistant (female), a practice manager and an assistant practice manager, a clinical interface manager, a medicines manager, and a team of administrative and reception staff. When the practice is closed patients can access out-of-hours care via the Cumbria Health on Call service, and the NHS 111 service.

The Grosvenor House Surgery: The practice is open Monday to Friday between 8am and 6:30pm. Appointments are available between 8:10am and 5:30pm.

The Morton Surgery: The practice is open Monday and Wednesday between 8:30am and 5:30pm, and Tuesday, Thursday and Friday between 8:30am and 12:30pm. Appointment times are available on Monday and Wednesday between 8:40pm and 5pm, and on Tuesday, Thursday and Friday between 8:40am and 12:10pm.

Updated 18 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs. Wigmore and Kari on 10 May 2016. The overall rating for the practice was good, although the practice was rated as requires improvement for safety. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Drs. Wigmore and Kari on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 31 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 10 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good for safe services, and overall the practice is rated as good.

Our key findings were as follows:

• The practice had taken action to address the concerns raised at the CQC inspection in May 2016. They had put measures in place to ensure they were compliant with regulations.
• Appropriate arrangements were now in place for undertaking suitable pre-employment checks.
• The practice had a pre-employment checklist to ensure references were obtained for permanent and locum GPs and relevant qualifications were checked.
• Recommendations made at the previous inspection, such as infection control audits to be carried out more regularly, had been actioned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2016

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

Nationally reported QOF data, for 2014/15, showed that the practice’s performance was comparable with other practices, in relation to those conditions experienced by people with long-term conditions. For example, the percentage of patients with asthma, who had had an asthma review in the preceding 12 months, that included an assessment of asthma control using the three Royal College of Physicians good practice questions, was higher than the England average (88.1% compared to 75.3%). Patients with long-term conditions were offered a structured annual review, to check their health needs were being met. A good 'call and recall' system was in place which helped ensure that all patients requiring an annual review received one. Clinical staff were good at working with other professionals to deliver a multi-disciplinary package of care to patients with complex needs.

Updated 4 August 2016

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

Systems were in place to protect children who were at risk and living in disadvantaged circumstances. For example, childhood immunisation clinics were held bi-weekly, alternating between the main practice and the branch surgery. Patients were able to access ante-natal clinics run locally by the community midwifery service. Appointments were available outside of school hours and the main practice site and branch surgery were suitable for children and babies. The practice website provided a range of information designed to encourage patients to look after their sexual health. A good range of health promotion leaflets was available in the patient waiting area, including information about the practice being breastfeeding friendly. Regular multi-disciplinary safeguarding meetings were held, where the needs of vulnerable children and families were discussed. All staff had completed safeguarding training that was relevant to their roles and responsibilities.

Updated 4 August 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed that the practice’s performance was comparable with other practices, in relation to those conditions experienced by older people. For example, the percentage of patients with Chronic Obstructive Pulmonary Disease who had had a review undertaken, including an assessment of breathlessness using the Medical Research Council dyspnoea (difficult breathing) scale, in the preceding 12 months, was higher than the England average, (95.7% compared to 89.9%.) The practice offered proactive, personalised care which met the needs of older patients. For example, all patients over 75 years of age had a named GP, and on turning 75, patients were invited for a health check. Good palliative care arrangements were in place which included a register identifying patients requiring this type of care and the holding of regular multi-disciplinary meetings to review their needs.

Updated 4 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students.)

Nationally reported QOF data, for 2014/15, showed that the practice’s performance was comparable with other practices in relation to those conditions experienced by this patient group. For example, the percentage of patients with diabetes, for whom the last blood pressure reading, measured in the preceding 12 months, was 140/80 mmHg or less, was in line with the England average, (77.4% compared to 78%). The practice had assessed the needs of this group of patients and developed their services to help ensure they received a service which was accessible, flexible and provided continuity of care. The practice was proactive in offering online services, as well as a full range of health promotion and screening that reflected the needs of this group of patients. Extended hours GP and nurse appointments were not offered.

Updated 4 August 2016

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

Nationally reported QOF data, for 2014/15, showed that the provider’s performance in carrying out these reviews was comparable to other practices. For example, the data showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had had a comprehensive care plan documented in their records, in the preceding 12 months, was comparable to other practices. (90.7% compared to the national average of 88.4%.) Patients experiencing poor mental health were provided with advice about how to access various support groups and voluntary organisations. The practice’s website provided patients with links to helping organisations. Nationally reported QOF data also showed the practice’s performance regarding the carrying out face-to-face reviews of patients diagnosed with dementia was lower, at 72.9, that the national average of 84%. There were good arrangements for meeting the needs of patients who had dementia. Staff kept a register of these patients, and the practice’s clinical IT system clearly identified them to help make sure clinical staff were aware of their specific needs. Some staff had attended dementia awareness training to help them understand the needs of these patients and improve the care they received at the practice.

Updated 4 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

There were good arrangements for meeting the needs of vulnerable patients. Systems had been put in place to help reduce unplanned emergency admissions into hospital. For example, the practice maintained a register of vulnerable patients who were at risk of an unplanned admission into hospital, approximately 4.38% of the total practice population. Audits were carried out to make sure that each person on the register had an emergency care plan in place. Patients discharged from hospital received a review within three days of returning home. T he practice maintained a register of patients with learning disabilities which they used to ensure they received an annual healthcare review. Extended appointments were offered to enable this to happen. Systems were in place to protect vulnerable children from harm. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns. Arrangements had been made to meet the needs of patients who were also carers.