Background to this inspection
Updated
1 July 2019
Workington Primary Care Centre provides Primary Medical Services to the town of Workington and surrounding villages on the West Cumbrian coast. The service provides operates from one location at Workington Community Hospital, Park Lane, Workington, Cumbria, CA14 2EW. We visited this address as part of the inspection.
All consultation rooms are on the ground floor. There is wheelchair access and a low rise reception counter. There are disabled toilet facilities and marked disabled bays in the large dedicated car park for patients at the hospital.
The service is staffed on a rotational basis by both male and female GPs from the five GP practices in Workington whose patients access the Primary Care Centre for their urgent appointments. There was also a permanent staff group who worked for the service. This consisted of a clinical director and a service manager; nine nurse practitioners or advanced nurse practitioners; two urgent care practitioners; two staff nurses; two wound care/vascular nurses; two senior nurses, one staff nurse and one assistant practitioner with the Frail Elderly Assessment Team; an assistant practitioner; three care coordinators; four hub coordinators and a senior hub coordinator; a senior administrator and four reception/administration staff; plus some bank staff.
The service was initially set up as a pilot in 2014 after winning funding from the Prime Minister’s Challenge Fund. The aim was to improve access to GP appointments in Workington and reduce non-elective admissions to hospital and high A&E and out of hours use. The service carries out the same-day appointments for a population of approximately 35,000 patients across the five GP practices in the town, as well as offering a walk-in minor injury service which sees between 350 and 400 patients a month on average,
The service is part of NHS North Cumbria Clinical Commissioning Group (CCG). Information from Public Health England placed the area in which the service is located in the fourth most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. Average life expectancy in Workington is lower than average for both males and females (77 years compared to the national average of 79 years for men, 80 years compared to the national average of 83 years for women).
The service is open from Monday to Friday from 8am to 8pm and on Saturday and Sunday between 10am and 4pm. It is also open on bank holidays.
The service for patients requiring urgent medical attention out of hours is through the NHS 111 service and Cumbria Health On Call (CHOC).
Updated
1 July 2019
We carried out an announced comprehensive inspection at Workington Primary Care Centre on 26 April 2019 as part of our inspection programme.
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 have rated this practice as good overall and for four of the population groups population groups, and as outstanding for the responsive domain and for the older people and long-term conditions population groups.
We rated the population group of older people outstanding for receiving effective and responsive care, and people with long-term conditions as outstanding for receiving responsive care because:
- The nurse practitioner home visiting service had carried out home visits for 541 patients, saving GP time at the five practices in Workington.
- Teams employed by the service had responded to the needs of local people when other services had been reduced. In 2018/19, a team of wound and vascular nurses had carried out 197 new patient appointments and 3,847 follow up appointments for patients who were no longer eligible to be seen by the community nursing team, and the Frail Elderly Assesment Team had given flu vaccinations to 445 elderly patients with no means of accessing GP practice or local pharmacy.
- The ECG and blood pressure monitoring service reduced waiting times for patients from Workington who needed these tests from seven weeks to two.
We found that:
- The service provided care in a way that kept patients safe and protected them from avoidable harm.
- Patients received effective care and treatment that met their needs.
- Staff treated patients with kindness and respect and involved them in decisions about their care.
- Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
- The involvement of other organisations and the local community was integral to how services were planned and ensured they met people’s needs.
- The way the service was led and managed promoted the delivery of high-quality, person-centred care.
We some areas of outstanding practice:
- Over the past three years there had been a 1.9% reduction in patient attendances at A&E by patients from Workington. This compared to a 6% and 9.1% increase in neighbouring boroughs. The Primary Care Centre was initially set up not only to take the pressure off the five Workington GP practices but also to reduce A&E and out of hour attendances.
- The service had grown in response to local need and now offered services such as the Frail Elderly Assessment Team (FEAT), wound and vascular nurses and a nurse practitioner home visiting service, all of which had had a demonstrable positive impact on patients in the area. For example, in 2018/19: the FEAT had given flu vaccinations to 445 elderly patients in care homes and sheltered accomodation who would not otherwise have been able to receive one; the wound and vascular service carried out 197 new patient appointments and 3847 follow up appointments for patients who were no longer eligible to be seen by the community nursing team; and the nurse practitioner visiting service had saved the local GP practices 541 appointments since October 2018.
There was an area where the provider should make an improvement:
- Put a system in place and assure themselves that it is working effectively to ensure that all necessary checks on indemnity, registration and training have been carried out by GP pratices who hire locum GPs before these locums take up shifts for the service.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP