The Care Quality Commission
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Appleby Medical Practice

Overall: Good read more about inspection ratings

The Riverside Building, Chapel Street, Appleby in Westmorland, Cumbria, CA16 6QR (017683) 51584

Provided and run by:
Appleby Medical Practice

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Appleby Medical Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Appleby Medical Practice, you can give feedback on this service.

27 Sep 2019

During an inspection looking at part of the service

We carried out an announced focused inspection at Appleby Medical Practice on 27 September 2019. This was to check the practice had made the improvements we said they should, when we last inspected the practice in May 2018.

At the last inspection, we rated the practice as requires improvement for providing safe services. We said the provider should:

  • Improve recording of actions and learning points arising from significant events;
  • Continue to develop systems to ensure all patients have their medication reviewed in a timely fashion;
  • Develop a process of systematic review, dissemination and discussion of new clinical guidelines;
  • Continue to develop systems so that safeguarding documents and communications are fully recorded, stored and attributable to the individual patient, such that they are easily available and accessible by clinicians who may need to take over the patient’s care.

At this inspection, we found that the provider had acted to address these areas.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected;
  • information from our ongoing monitoring of data about services, and;
  • information from the provider, patients, the public and other organisations.

We rated this practice as good overall. (Previous rating May 2018 – Good).

We rated the practice as good for providing safe services because the practice had:

  • Made changes to the safeguarding procedures to ensure that concerns were always recorded and dates for any actions needed were set;
  • Set up multidisciplinary team meetings where safeguarding concerns were discussed with other professionals;
  • Put systems in place so that all safeguarding documentation was now scanned into the patient’s medical record;
  • Started holding a daily “huddle” meeting with staff, and we were told that safeguarding concerns would be raised at these meetings if appropriate;
  • Put a system in place so that NICE guidance was received via email by a member of the practice team who then disseminated this to other clinicians. This was then discussed at practice meetings;
  • Set up alerts on the practice’s computer system to flag up when patients who were not on high-risk medicines were due a medication review, and 90% of patients on repeat medication had had a review;
  • Started a daily staff “huddle” meeting were safeguarding, audits, clinical guidelines and significant events could be discussed;
  • Changed the documentation for significant events so each one had the actions clearly documented and had a review date set. We saw minutes of the review meetings which had been set up to discuss learning.

As well as taking action to improve safety, the practice had also followed recommendations in the last report to:

  • Develop a planned and structured approach to carrying out clinical audits. They had held meetings as a clinical team to discuss audits and to decide which clinicians would like to study certain topics. We saw minutes of a meeting where these were discussed;
  • Attempt to encourage patients to attend a patient participation group, however as yet there had not been sufficient numbers to be able to begin the group.

We recommend that the practice should:

  • Continue to look for ways to build a patient participation group.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

17/05/2018

During a routine inspection

This practice is rated as Good overall. (Previous inspection November 2014 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Appleby Medical Practice on 17 May 2018, as part of our inspection programme.

At this inspection we found:

  • The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice recorded them and staff knew how to record or report incidents. However it was not clear from records that learning points and actions had been identified and carried out.
  • We found that safeguarding procedures and communications were not clearly documented. Staff received safeguarding and safety training appropriate to their role. They knew how to identify and report concerns.
  • The practice carried out some review of the effectiveness and appropriateness of the care provided, although clinical audit was limited and did not always clearly demonstrate improvements in patient care and outcomes.
  • Staff involved and treated patients with compassion, kindness, dignity and respect. Patients spoke positively of the caring service they received. Staff had good local and personalised knowledge of patients, and saw themselves as an integral part of the community.
  • Patients found the appointment system easy to use and reported that they were generally able to access care when they needed it. National GP Patient Survey results showed results that were either comparable to or better than local and national averages for how easy patients found it to access the service
  • Practice staff told us of an open, supportive culture, where feedback was valued.

The areas where the provider should make improvements are:

  • Improve recording of actions and learning points arising from significant events.
  • Continue to develop systems to ensure all patients have their medication reviewed in a timely fashion.
  • Develop a process of systematic review, dissemination and discussion of new clinical guidelines.
  • Develop a planned and structured approach to carrying out clinical audits.
  • Continue to develop systems so that safeguarding documents and communications are fully recorded, stored and attributable to the individual patient, such that they are easily available and accessible by clinicians who may need to take over the patient’s care.
  • The practice should continue in its efforts to establish a patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP

13 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We inspected Appleby Medical Practice on 13 November 2014 and visited the surgery in Appleby. We inspected this service as part of our new comprehensive inspection programme.

Overall, we rated the practice as good. Our key findings were as follows:

  • The practice covered a large geographical and rural area; services had been designed to meet the needs of the local population.
  • Feedback from patients was positive; they told us staff treated them with respect and kindness.
  • Staff reported feeling supported and able to voice any concerns or make suggestions for improvement.
  • The practice was visibly clean and tidy.
  • The practice learned from incidents and took action to prevent a recurrence of the incident.

We saw the following areas of outstanding practice:

  • Staff within the practice knew their local population very well and delivered a service which reflected local needs. For example, the practice was flexible with regard to appointments for patients who worked away or for visitors to the area. We saw many examples where staff had ‘gone the extra mile’ for their patients.
  • The practice had effective arrangements to deliver end of life care.

However, there was also an area of practice where the practice should make improvements. 

The practice should:

  • Ensure robust arrangements are put into place for the GPs to check any changes made to patients’ prescriptions following receipt of hospital letters.
  • Ensure medicines reviews are carried out on a timely basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

7 May 2014

During a routine inspection

Appleby Medical Practice is near the centre of Appleby. It is operated by a sole partner and three salaried general practitioners (GP), a practice manager, two practice nurses, a nursing assistant and administration staff. It has strong relationships with the community nursing staff, health visitors and midwives whose offices were located in the same building.

Below is a summary of what we found during our inspection. The summary is based on our observations during the inspection, speaking to patients, relatives and staff and looking at some records.

We found in November 2013 the practice had a change of management and new quality assurance systems were developed to ensure the practice was safe, effective, responsive and well led. However, at our inspection many of the systems were in the process of being introduced or had not been embedded so staff were not always following them robustly. Areas where we found improvements were needed were medicines management, infection control, safety of equipment and quality assurance.

Patients we spoke with during our inspection told us they were satisfied with their care and treatment, the staff always listened to their views. They told us they had no complaints about the service.