• Doctor
  • GP practice

Archived: Solway Health Services

Overall: Good read more about inspection ratings

Workington Community Hospital, Park Lane, Workington, Cumbria, CA14 2RW (01900) 705150

Provided and run by:
Dr Maxine Virginia English

Latest inspection summary

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Background to this inspection

Updated 9 September 2016

Solway Health Services provides care and treatment to approximately 5271 patients from the Workington area of Cumbria. It is part of the NHS Cumbria Clinical Commissioning Group (CCG) and operates on a Personal Medical Services (PMS) contract.

The practice provides services from the following address, which we visited during this inspection:

Solway Health Services

Workington Community Hospital

Park Lane

Workington

Cumbria, CA14 2RW

The surgery is located in purpose built accommodation within the local community hospital. All reception and consultation rooms are on the ground floor and fully accessible for patients with mobility issues. An on-site car park is available which includes dedicated disabled car parking spaces.

The surgery is open from 8am to 6.30pm on a Monday, Tuesday, Thursday and Friday and from 8am to 8pm on a Wednesday. Patients registered with the practice are also able to access urgent appointments with a GP or nurse practitioner at Workington Hospital Primary Care Centre from 8am to 8pm, seven days per week.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Cumbria Health on Call (CHoC).

Solway Health Services offers a range of services and clinic appointments including asthma, chronic obstructive pulmonary disease and diabetes clinics and minor surgery. The practice is a dispensing practice and dispenses to patients in more rural locations.

The practice consists of:

  • One GP partner (female)
  • Two nurse practitioners (both female)
  • One practice nurses (female)
  • One health care assistants (female)
  • 9 non-clinical members of staff including a practice manager, practice administrators, receptionists, dispensers and a secretary

The area in which the practice is located is in the fourth (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The average life expectancy for the male practice population is 77 (CCG average 79 and national average 79) and for the female population 80 (CCG average 82 and national average 83).

59.5% of the practice population were reported as having a long standing health condition (CCG average 56.3% and national average 54%). Generally a higher percentage can lead to an increased demand for GP services. 62.8% of the practice population were recorded as being in paid work or full time education (CCG average 59.1% and national average 61.5%). Deprivation levels affecting children and older people were higher than the local CCG averages and national averages.

Overall inspection

Good

Updated 9 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Solway Health Services on 21 July 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • Risks to patients were assessed and well managed.
  • The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this. However, the practice did not have a planned, structured approach to identifying topics for clinical audit.
  • Feedback from patients about their care was consistently positive. Patients reported that they were treated with compassion, dignity and respect. However, patient feedback in relation to access was lower than the local clinical commissioning group and national averages.
  • Urgent appointments were available on the day they were requested at the local primary care centre. Pre- bookable appointments were available within acceptable timescales.
  • The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
  • The practice had proactively sought feedback from patients and had an active patient participation group. The practice implemented suggestions for improvement and made changes to the way they delivered services in response to feedback.
  • The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved an overall result which was higher than local and national averages.
  • Information about services and how to complain was available and easy to understand.
  • The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed with staff and stakeholders.

We saw an area of outstanding practice:

  • The practice nurse had attended a Dose Adjusted for Normal Eating (DAFNE) course. Although aimed at diabetic patients the nurse had attended this course so she was able to understand what diabetic patients were being taught and therefore be able to give them appropriate dietary advice.

However, there were some areas where the provider should make improvements:

  • Maintain appropriate records of stock checks, including for controlled drugs and emergency equipment
  • Review arrangements for the security of blank prescriptions
  • Develop a significant event policy so staff unaware of the process have access to relevant guidance
  • Ensure that the practice manager is given the opportunity of regular appraisal
  • Review their process for selecting topics for clinical audit activity
  • Continue to monitor demand for appointments and patient satisfaction and improve access
  • Offer patients with a learning disability an annual health check


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

People with long term conditions

Good

Updated 9 September 2016

The practice is rated as good for the care of people with long term conditions.

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. Patients with multiple long term conditions were offered an annual comorbidity review.

Practice clinicians attended regular training to ensure they delivered up-to-date evidence based care to patients with long term conditions. The practice nurse had attended a Dose Adjusted for Normal Eating (DAFNE) course. Although aimed at diabetic patients the nurse had attended this course so she was able to understand what diabetic patients were being taught and therefore be able to give them appropriate dietary advice. The practice opportunistically screened patients for pre-diabetic conditions during health checks. Patients identified as pre-diabetic were then referred to the Walking Away from Diabetes programme where they obtained structured education in the prevention of diabetes.

Patients with chronic obstructive pulmonary disease were sent a detailed information sheet prior to their annual review which gave details of the benefits of having a rescue pack at home, how to effectively use an inhaler and other useful information.

The QOF data (2014/15) showed the practice had achieved very good outcomes in relation to the conditions commonly associated with this population group. For example:

  • The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 1.5% above the local CCG average and 2.6% above the national average.
  • The practice had obtained 100% of the point available to them in respect of chronic obstructive pulmonary disease. This was 2.4% above the local CCG average and 4% above the national average
  • The practice had obtained 100% of the points available to them in respect of hypertension (1.1% above the local CCG average and 2.2% above the national average).
  • The practice had obtained 99% of the points available to them in respect of diabetes (5.4% above the local CCG average and 9.8% above the national average).

Families, children and young people

Good

Updated 9 September 2016

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

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Patients were also able to access the Workington Primary Care Centre which had been set up to deal with same day/emergency appointment requests which was open from 8am to 8pm seven days per week. Arrangements had been made for new babies to receive the immunisations they needed. A town wide childhood immunisation service was in operation which served all of the GP practices in Workington and was staffed by two experienced children’s nurses. Data available for 2014/15 showed that the practice childhood immunisation rates for the vaccinations given to two year olds ranged from 94.1% to 98.5% (compared with the CCG range of 83.3% to 96%). For five year olds this ranged from 73.7% to 100% (compared to CCG range of 72.5% to 97.9%)

At 80%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was comparable with the CCG average of 82.5% and national average of 82%.

Pregnant women were able to access antenatal clinics at the Workington Community Hospital provided by healthcare staff attached to the practice. The practice GPs carried out post-natal mother and baby checks.

Older people

Good

Updated 9 September 2016

The practice is rated as good for the care of older people.

Nationally reported Quality and Outcomes Framework (QOF) data for 2014/15 showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 99.6% and the England average of 97.9%.

Patients aged over 75 had a named GP and the practice offered shingles and influenza immunisations to older people. The practice had a risk rated palliative care register and held regular multi-disciplinary meetings to discuss and plan end of life care.

The practice had worked with other GP practices in the area to develop the Workington Primary Care Centre to deal with same day/emergency appointment requests. This had enabled them to increase their standard appointment time to 15 minutes and dedicate more time to caring for patients with multiple, chronic and complex conditions.

The practice had also been involved in developing Workington’s Frail Elderly Assessment Team who deliver targeted, proactive and reactive care to elderly patients to enable them to stay in their own homes and avoid unplanned admission to hospital. This had helped to ensure that all frail and elderly patients had been involved in the development of a comprehensive care plan, a copy of which was kept at their home addresses as an aid for any visiting clinician.

Working age people (including those recently retired and students)

Good

Updated 9 September 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 met. The surgery was open from 8am to 6.30pm on a Monday, Tuesday, Thursday and Friday and from 8am to 8pm on a Wednesday. Patients were also able to access the Workington Primary Care Centre to deal with same day/emergency appointment requests which was open from 8am to 8pm seven days per week.

The practice offered minor surgery, travel health services, NHS health checks (for patients aged 40-74) and a dispensary service for patients living in more rural locations.

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. A text messaging service was available which was used to remind patients of their appointments as well as advertising the availability of the influenza and meningitis vaccinations to relevant patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 September 2016

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

Nationally reported QOF data for 2014/15 showed the practice had achieved the maximum point available to them for caring for patients with dementia, depression and mental health conditions. However, at 71.7% the percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face meeting in the last 12 months was 12% below the local CCG and 12.3% below the national average.

Patients on the practice mental health register were offered annual reviews and longer appointments. Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as local wellbeing and psychological support services.

Patients with dementia were also offered an annual review and referral to a memory clinic as early as possible.

Practice staff had undertaken training to ensure they had an understanding of the Mental Capacity Act and their responsibilities in relation to this.

People whose circumstances may make them vulnerable

Good

Updated 9 September 2016

The practice is rated as good for the care of people whose circumstances make them vulnerable.

The practice held a register of patients living in vulnerable circumstances, including 21 patients who had a learning disability. Longer appointments were available for patients with a learning disability, who were also offered an annual flu immunisation. However patients with a learning disability were no longer offered an annual health review due to staffing levels within the practice.

The practice had established effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.

The practice pro-actively identified carers and ensured they were offered appropriate advice and support. At the time of our inspection they had identified 180 of their patients as being a carer (approximately 3% of the practice patient population).