Glenridding Health Centre

Updated 8 December 2017

Cumbria Health on Call is registered with the Care Quality Commission to provide primary care services from:

• Glenridding Health Centre, Glenridding, Penrith, Cumbria, CA11 0PD.

We visited this location on this inspection. The practice provides services to approximately 765 patients.

The practice was registered with CQC previously and was rated as good. They changed their registration in February 2016 when the GP who was operating the practice retired and the service changed provider. The practice is now operated by Cumbria Health on Call (CHoC), who also provide the out of hours GP service for Cumbria. This is the only GP practice currently operated by CHoC.

The practice is located in a purpose-built surgery in the centre of Glenridding, which is owned and managed by NHS Property services. It is a single storey building with all patient facilities on the ground floor. The interior of the building was fully refurbished after the new provider took over in 2016. There are disabled toilet facilities, and wheelchair and step-free access to the three consulting and treatment rooms in the building. The practice was able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from a pharmacy.

The practice has eight members of staff, consisting of three GPs (two male, one female) one practice nurse (female), a practice manager, and three receptionists (one of whom is also the dispenser). One of the GPs is the medical director for CHoC.

The practice is part of North Cumbria clinical commissioning group (CCG). Information taken from Public Health England places the area in which the practice is located in the fifth least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice covers a large, rural and mountainous area in the north-eastern Lake District. Glenridding is a small village next to Lake Ullswater, popular with tourists and hill walkers, and as such the practice population fluctuates as tourists and people who come to work in the area during the summer months join as temporary patients. The nature of the landscape also means that journeys to visit patients in their own homes can take a long time. Patients aged over 40 account for 61% of the practice patient population. Patients between the ages of 50 and 59, and 60 and 69 are the most represented age groups.

The surgery is open from 9am to 11am, Monday to Friday, then again from 3pm to 5.30pm on Monday and Friday. Urgent appointments with a GP can be booked on Tuesday, Wednesday and Thursday afternoons. Telephones at the practice are answered from 8.30am until 11.30am and 3pm to 6pm, 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 CHoC.

The practice provides services to patients of all ages based on an Alternative Provider Medical Services (APMS) contract agreement for general practice.

Updated 8 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Glenridding Health Centre on 20th October 2017. Overall the practice is rated as outstanding.

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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Risks to patients were assessed and well managed.
• 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 the management team.
• The practice proactively sought feedback from staff and patients, which it acted on. Rigorous and constructive challenge from people who use services, the public and stakeholders was welcomed and seen as a vital way of holding the service to account
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The leadership drove continuous improvement and staff were accountable for delivering change. Safe innovation was celebrated. There was a clear and proactive approach to seeking out and embedding new ways of providing care and treatment.

We saw some examples of outstanding practice:

• Since the new provider had taken over the practice a number of new initiatives had been put in place, such as a video consultation pilot for some of their housebound and elderly patients living in more rural locations. This not only allowed patients to access timely consultations with a practice GP but also enabled more socially isolated patients to connect with other users of the system and access video games and puzzles.

• The practice played an integral role in the local community and we saw numerous examples of joint working with other organisations to improve health outcomes, tackle care inequalities and obtain best value for money. The benefits of this reached beyond their own patient group, as they were able to help a nearby practice to improve their access to GP appointments.

There was one area where the provider should make improvements:

• Continue to investigate ways for increasing uptake of health reviews and screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 December 2017

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

• One of the GPs had a lead role and specialist training in chronic disease management, and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was slightly below the national average. The practice achieved 84% of the total points available, compared to the national average of 91%.

• 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 8 December 2017

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

• 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 72%, which was below the national average of 77%.

• Appointments were available outside of school hours, and some were embargoed specifically for patients who attended school during the day. The premises were suitable for children and babies.

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

• The practice maintained close links with the local school, and pupils were invited to attend the surgery to learn about healthy living and healthcare. Pupils with an interest in a career in nursing had attended for work experience.

Updated 8 December 2017

The practice is rated as outstanding for the care of older people, as the practice is rated outstanding overall.

• 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.

• A toe nail cutting service had been made available from the practice every six weeks, and the practice manager had undertaken training to repair hearing aids, to save patients having to travel to receive this service.

• The practice manager helped to raise funds each year for and organise a Christmas lunch at a local hotel for the over 60’s in the village, many of whom were practice patients.

• Performance for conditions associated with older patients in line with national averages. For example, the practice achieved 97% of the total points available for chronic obstructive pulmonary disorder (national average, 96%) and 98% of the total points available for stroke and transient ischaemic attack (national average, 97%).

Updated 8 December 2017

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

• 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.

• Appointments were embargoed in the late afternoon/evening for patients who worked during the day.

• 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 8 December 2017

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

• In 2016/17, 100% of patients diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was above the national average of 84% and an increase from 80% the previous year.

• 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.

• Performance for mental health related indicators was significantly lower than the national average. The practice achieved 55% of the total points available, compared to the national average of 94%. However, they had low numbers of patients who were eligible for these interventions, and had not reported any exceptions for these indicators which allow for patients who cannot attend for review to be discounted from the numbers. The national average for exception reporting in mental health was 13%.

• 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 8 December 2017

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

• 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.

• Due to the rural area where the practice was situated there were a number of isolated patients. As such, the practice was trialling a system of offering patients teleconferencing equipment to be installed in their own homes so that they could have video consultations with the practice when required. The system could also be used by patients to hold video calls with family.

• 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 at the practice collected food to donate to the local food bank.

• 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 was a carers’ lead at the practice and on the Patient Participation Group who offered support, and the practice had identified nine patients as carers (1.2% of the practice list).