The Surgery Kirkby-in-Furness

Updated 16 August 2017

The Surgery, Kirkby-in-Furness (also known as Duddon Valley Medical Practice), is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 3,400 patients from two locations:

• Kirkby Surgery, Askew Gate, Kirkby-in-Furness, Cumbria, LA17 7TE.
• Broughton Surgery, Foxfield Road, Broughton-in-Furness, Cumbria, LA20 6EZ.

We visited these locations on this inspection.

Both practice sites are located in purpose built health centres, one of which is owned by the practice, the other is rented. All patient facilities are situated on the ground floor in both buildings. There are disabled toilet facilities, wheelchair and step-free access to all consulting and treatment rooms. There is a car park available at both sites.

The practice has 19 members of staff, including the lead GP/practice manager (male) and one salaried GP (female), five practice nurses (female), an assistant practice manager, an administrative manager, a practice support and training consultant, a lead dispenser, a lead receptionist and seven reception, administration, and/or dispensing staff.

The practice was inspected in 2015 while it was a GP partnership and registered with CQC as Duddon Valley Medical Practice. Overall the practice was rated as Good. The practice was registered with a new provider on 9 March 2016. The other member of the former GP partnership, and other staff, continue to work at the practice carrying out the same roles and responsibilities.

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 third (Kirkby in Furness) and fourth (Broughton in Furness) least deprived deciles. In general, people living in more deprived areas tend to have greater need for health services. The practice population profile shows that the number of patients between the ages of 50 and 79 is higher than average, while there are fewer patients than the national average in all age groups under 45.

The surgery is open from 8am to 6.30pm, Monday to Friday. Extended hours access is provided on a flexible basis to patients who are unable to attend during core hours. 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 Ltd (CHoC).

The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

Updated 16 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery, Kirkby-in-Furness (also known as Duddon Valley Medical Practice) on 16th June 2017. 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. Patients we spoke to said the practice felt like “family”.
• 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 the management team.
• 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 some examples of outstanding practice:

• The practice set up a service called Duddon Valley Volunteers to offer extra support to patients who needed it. The practice identified patients who might be in need of extra input due to fraility or social isolation, for example. These patients would then receive a phone call and/or a visit at home from one of the practice staff to offer them a “friendly face” to talk to. Patients who spoke to us told us how important this service was to them, and that the holistic approach taken by staff at the practice made them feel valued.
• The leadership drove continuous improvement and staff were accountable for delivering change. The management of the practice was shared across the whole team, to meet the demands of a small, rural practice and the challenge of transitioning to be a single-handed GP practice. This had resulted in a marked improvement in the Quality and Outcomes Framework performance, as well as allowing the practice to implement a new appointment system to manage demand. There was a high level of staff satisfaction, and staff were proud of the organisation and spoke highly of the culture.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 August 2017

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 asthma-related indicators rose from 83.4% of the total points available (national average 97.4%) in 2015/16 to 100% in 2016/17.

• 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 16 August 2017

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 higher than national average 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’s uptake for the cervical screening programme was 82%, which was in line with the local and national averages of 81%.
• 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 16 August 2017

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Performance for some conditions associated with older patients, such as heart failure, was better than the national average. The practice achieved 99.1% of the total points available for this condition, compared to the national average of 95.9%.
• The practice had set up a service called Duddon Valley Volunteers to offer extra support to patients who needed it. The practice identified patients who might be in need of extra input due to, for example, fraility or social isolation. These patients would then receive a telephone call and/or a visit at home from one of the practice staff to offer them a “friendly face” to talk to.

Updated 16 August 2017

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 reflected the needs for this age group.

Updated 16 August 2017

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

• Performance for mental health related indicators had improved to 100% of the total points available in 2016/17, compared to 52.5% of the total points available in 2015/16 (national average 92.8%).
• 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.
• In 2015/16, 75% of patients diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was lower than the national average of 84%.
• The practice achieved 100% of the total points available for depression, having achieved no points in this domain in 2015/16.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• There was 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 16 August 2017

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 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.
• There were four carers’ leads who offered support, and the practice had identified 53 patients as carers (2% of the practice list).
• Staff at the practice contacted any patients who might require additional support as part of their Duddon Valley Volunteers system.