Archived: Dr Jonathan Smith Also known as Glenridding Health Centre

Updated 27 August 2015

The Glenridding Health Centre is based in a very rural area and is situated on the edge of Lake Ullswater. It has a small practice population of just over 700 patients. This number fluctuates during the year, due to the local tourist trade. Many new patients register at the start of the tourist season

when they come to work in local services, including hotels, catering and recreational services and then leave at the end of the season. These patients are often from a diverse range of nationalities that come to Glenridding and surrounding areas for work.

Dr Smith is the lead GP and registered provider of the service. There is also a female associate GP, a practice nurse, a practice manager, three dispenser / receptionists and a cleaner working at the practice. The practice is a training practice and therefore normally has a GP registrar. However, there was none allocated at the time of our inspection.

The practice is commissioned to provide services within a Personal Medical Services (PMS) agreement with NHS England. The practice provides primary medical care services to patients in the area around Glenridding, Ullswater, Troutbeck, Greystoke, Dacre, Stainton, Eamon Bridge and Penrith. Glenridding Health Centre is a dispensing practice. This means under certain criteria they can supply eligible patients with medicines directly.

All patient services are delivered from the ground floor. There are two consultation rooms, a treatment room and reception and waiting area. There are good access facilities for patients with physical disabilities and there is a disabled parking bay outside the building. There is a large National Trust car park to the rear of the building, which patients can use if they inform reception staff of their car registration on arrival.

The service for patients requiring urgent medical attention out of hours is provided by Cumbria Health on Call Ltd (CHOC).

Updated 27 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced inspection of this practice on 20 November 2014 during which a breach of a legal requirement set out in the Health and Social Care Act (HCSA) 2008 was found:

• Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting staff (which corresponds to Regulation 18 of the HCSA 2008 (regulated Activities) Regulations 2014

On the 13 April 2015 we commenced a focussed inspection where we asked the practice to send us information to evidence that they now met legal requirements. This report only covers our findings in relation to this requirement. You can read the report from out last comprehensive inspection by selecting the ‘all reports’ link for Dr Jonathan Smith on our website at www.cqc.org.uk.

Our key findings were as follows:

• The practice had addressed the issue identified during the previous inspection and was now ensuring that staff appraisals for all employees were carried out on an annual basis

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 February 2015

The practice is rated as good for the care of people with long-term conditions. There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 19 February 2015

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 in line with national and local averages for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors. Emergency processes were in place and referrals were made for children and pregnant women whose health deteriorated suddenly.

Updated 19 February 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

There was care planning in place for the most elderly and infirm. There were good communication mechanisms with other providers of care and treatment for frail older patients, including communication with district nurses. There were arrangements in place to support people when they reached the end of their life.

Updated 19 February 2015

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 of this age group. Patients told us they liked the way the open surgery operated and the access this gave them to a GP.

Updated 19 February 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The percentage of patients with physical and/or mental health conditions whose notes contained an offer of support and treatment within the preceding 15 months was 93.8%. 100% of patients diagnosed with dementia had their care reviewed in the previous 15 months.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. They carried out advance care planning for patients with dementia. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

CQC comment cards we received were positive about the emotional support provided by the practice and rated it well in this area. Some in particular, mentioned support given to patients suffering anxiety and the skill with which clinicians recognised the link between physical and mental health.

Updated 19 February 2015

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 patients who had a learning disability. Because of the small number of patients registered with the practice, they were able to identify and monitor those most at risk of experiencing poor or deteriorating health. The open access surgery was flexible to patient needs, allowing more time to be spent with the most vulnerable patients or those who may have difficulty communicating their needs.

The practice regularly worked 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 normal working hours and out of hours.