Archived: Carlisle House Also known as Dr Redpath & Partners

Updated 9 August 2016

Carlisle House, also known as Carlisle House surgery, is located in a Victorian aged building at 53 Lagland Street, Poole, Dorset, BH15 1QD. The GP partners lease the building from a private landlord. The practice is based in the town centre of Poole and has approximately 5800 registered patients.

The practice provides services under a NHS General Medical Services contract and is part of NHS Dorset Clinical Commissioning Group (CCG). The practice is based in an area of high deprivation compared to the national average for England. The practice patient population have greater health needs compared to national averages. Approximately 8% of patients registered at the practice are unemployed, which is higher than the Dorset CCG average of 4% and national average of 5%. A total of 63% of patients registered at the practice have a long-standing health condition compared to the national average of 54% and Dorset CCG average of 57%. The practice estimate that approximately 25% of patients do not have English as a first language.

The practice has five GPs, three female, and two male, who are all GP partners. The practice rarely uses locum doctors to provide additional GP support. Together the GPs provide care equivalent to approximately 3.5 whole time equivalent GPs over 31 sessions per week. The GPs are supported by two practice nurses and one health care assistant who provide a range of treatments and are equivalent to just over one and a half whole time equivalent nurses. The practice also employs a specialist nurse for patients aged over 75 years of age. The clinical team are supported by a management team with secretarial and administrative staff. The practice is a training practice for medical students training to be doctors.

Carlisle House is open between 8am and 6.30pm Monday to Friday. Appointments are available daily between 8.30am and 6pm. Extended hours surgeries are available every Monday evening until 8pm. Appointments with a GP are available from 8.30am until 11.30am and again from 2.30pm until 5.50pm daily. The GPs also offer home visits to patients who need them.

Care to patients is provided over two floors of the building. One GP room is based on the first floor; the other GP rooms are all located on the ground floor. The practice has a treatment room which is also used for minor operations, based on the ground floor. There is a waiting area for patients based on the ground floor of the practice, and another waiting area upstairs. The first floor of the building also has offices for practice support and management staff.

The practice operates a branch surgery located at Poole NHS Healthcare Centre, Boots, The Dolphin Shopping Centre, 190-196 High Street, Poole, Dorset BH15 1SX. Poole NHS Healthcare centre is operated and managed by Dorset Foundation University Hospital NHS Trust. A range of community health facilities are provided, such as phlebotomy, chiropody and heart scans. Reception staff at the Healthcare centre are employed by Dorset Foundation University Hospital NHS Trust and are not able to access the records of patients registered at Carlisle House. The GP is able to access records held at Carlisle House. Carlisle house rents a clinical room in the Healthcare centre in order to offer additional appointments to patients. Only pre-bookable GP consultations are offered at this location. Any subsequent investigations or appointments that might be required following an appointment with the GP are organised by the GP at the time. Appointments are offered to patients on weekday mornings from 9am until 11.30am. We visited the branch surgery as part of this inspection on 17 June 2016.

The practice has opted out of providing out-of-hours services to their own patients and refers them to the Dorset Urgent Care service via the NHS 111 service and local Minor Injuries Units. The practice offers online facilities for booking of appointments and for requesting prescriptions.

We visited Carlisle House and the branch surgery as part of this inspection. Both locations have not previously been inspected by the Care Quality Commission.

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Carlisle House on 14 June 2016 and 17 June 2016. 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.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. 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.

We saw areas of outstanding practice:

The practice prioritised safety in the practice. There was a lead GP for safety who promoted a culture of openness with regard to reporting safety incidents. As well as discussing significant events with staff, they were discussed with people outside the practice so that ideas for improvement could be shared.

The practice actively sought feedback from carers about the practice by encouraging them to join the patient participation group (PPG). Approximately 10% of the PPG were carers.

The areas where the provider should make improvement are:

• Consider the process for the review of pathology results so they are actioned in a timely way.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 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.
• The percentage of patients with diabetes whose last average blood glucose reading was acceptable was 96%, which is better than the Clinical Commissioning Group (CCG) average of 83% and national average of 78%. Exception reporting for diabetes indicators was 19%, compared to the CCG average of 15% and national average of 11%.
• Longer appointments and home visits were available when needed.
• All these patients 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 9 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.
• The practice performed in line with clinical commissioning group (CCG) and national averages for conditions commonly found in children. For example, 79% of patients with asthma had an asthma review in the preceding 12 months that includes an assessment of asthma control, compared to a CCG average of 78% and national average of 75%.
• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG average of 84% and the national average of 82%.
• 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.

Updated 9 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 employed a dedicated nurse to support the health needs of patients aged over 75 years of age.

The practice performed in line with the Clinical Commissioning Group (CCG) and national averages for conditions commonly found in older people. For example, the percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 84%, which is comparable to the CCG average of 85% and national average of 84%.

Updated 9 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 and text messaging services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered telephone appointments for patients who could not attend in person.
• The practice engaged with residents in local student accommodation to ensure that students are aware of the services available to them at the practice.

Updated 9 August 2016

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

• 85% 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 of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 100%. This was better than the national average of 90% and the clinical commissioning group average of 91%.
• 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 is a designated ‘dementia friendly’ practice.
• 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 9 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• All patients with a learning disability were offered an annual physical health check. 72% of these patients accepted the health check.
• 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.