Longtown Medical Centre

Updated 7 January 2016

Longtown Medical Centre is registered with the Care Quality Commission to provide primary care services. It is located in Longtown, north of Carlisle, Cumbria.

The practice provides services to around 3,500 patients from one location: Moor Road, Longtown, Cumbria, CA6 5XA. We visited this address as part of the inspection. The practice has three GP partners (two female and one male), a nurse practitioner and two practice nurses (all female), a healthcare assistant, a practice manager, a medicines manager and six staff who carry out reception and administrative duties.

The practice is part of Cumbria clinical commissioning group (CCG). The practice population is made up of a higher than average proportion of patients over the age 65 (21.8% compared to the national average of 16.7%). Information taken from Public Health England placed the area in which the practice was located in the fifth more deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The practice is located in a purpose built two storey building. There is on-site parking, disabled parking, a disabled WC, a lift and wheelchair and step-free access.

Opening hours are between 8.00am and 6.30pm Monday to Friday. Patients can book appointments in person, on-line, by telephone or using an ‘App’ on their mobile phone. Appointments were available at the following times during the week of the inspection:

• Monday – 9.00am to 12.30pm; then from 2.00pm to 5.30pm
• Tuesday – 8.30am to 12.30pm; then from 2.00pm to 5.30pm
• Wednesday – 9.00am to 12.00pm; then from 1.30pm to 5.10pm
• Thursday – 8.10am to 12.30pm; then from 2.00pm to 5.30pm
• Friday – 9.00am to 12.30pm; then from 2.00pm to 5.30pm

A duty doctor is available each afternoon until 6.30pm.

The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

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

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Longtown Medical Centre on 3 November 2015. Overall the practice is rated as good.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• 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.
• Patients said they were able to get an appointment with a GP when they needed one, 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 in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.

• Staff throughout the practice worked well together as a team

• Staff had received training appropriate to their roles.

• Feedback from patients was overwhelmingly positive and the practice achieved high scores in the National GP Patient Survey.
• Appointments could also be booked via a mobile device ‘App’.

We saw several areas of outstanding practice including:

• Despite scoring well in the National GP Patient Survey in relation to getting through to the practice on the telephone, a monitoring system had been introduced, which showed, for example, the number of calls waiting and any abandoned calls. Staff told us they wanted to further improve patient access.

• Managers were aware of the pressures on general practice and had implemented a ‘change framework’ to aid the practice’s future development. Staff had received training in various areas, including the ‘lean methodology’ (the lean methodology had been adapted by NHS England’s Sustainable Improvement Team and is an approach to improve flow and eliminate waste). This had resulted in a number of areas of waste being identified and actions taken to ultimately improve patient care.For example, staff had reported that patients were not always signposted to the correct service at the correct time; wasting appointment and clinical time. Staff said this could be improved by reception staff asking the right questions when patients contacted the practice. The team worked together and produced a telephone standards guide for staff to follow. The benefits were then analysed, these included, providing the patient with a better experience and better use of time as they would be booked in to see the most appropriate clinician.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Implement arrangements to ensure medicines are stored securely.
• Continue to take steps to set up a patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 7 January 2016

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

The practice had a patient-centred approach to care planning for long term conditions. There was an emphasis on the empowerment and involvement of patients in the planning of their care. Health tests were carried out in advance of a review appointment. The patients were then sent a letter detailing all the test results and what they meant. They then had an appointment with the practice nurse to discuss the test results and develop person-centred care plans, agreeing goals collaboratively with the patient

Longer appointments and home visits were available when needed. The practice’s electronic 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.

Nationally reported QOF data (2014/15) showed the practice had achieved 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 percentage points above the local CCG average and 2.6 points above the national average.

Updated 7 January 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. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were in line with the national averages.

Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 7 January 2016

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

Nationally reported data 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 slightly above local clinical commissioning group (CCG) average (99.6%) and 2.1 points above the England average.

The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, all patients over the age of 75 had a named GP and patients at high risk of hospital admission and those in vulnerable circumstances had care plans. A register of housebound patients was maintained; clinical staff carried out home visits as necessary and arrangements were in place to deliver prescriptions to this group of patients.

The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Updated 7 January 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 identified and the practice had adjusted the services it offered to ensure these were accessible and flexible. The practice offered online services as well as a full range of health promotion and screening which reflected the needs for this age group.

Patients could order repeat prescriptions and book appointments on-line. Appointments could also be booked via a mobile device ‘App’. The practice had previously offered extended hours surgeries but a review determined that the uptake was low. Clinicians told us they offered to see patients before morning or after the end of surgery if they were unable to attend during normal appointment hours.

Additional services were provided such as health checks for the over 45s and travel vaccinations.

Updated 7 January 2016

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

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia. Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.

Nationally reported QOF data (2014/15) showed the practice had achieved good outcomes in relation to patients experiencing poor mental health. For example, the practice had obtained 100% of the QOF points available to them for providing recommended care and treatment for patients with poor mental health. This was 4.6 percentage points above the local CCG average and 7.2 points above the England average. The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.

Updated 7 January 2016

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 those with a learning disability. Patients with learning disabilities were invited to attend the practice for annual health checks. The practice offered longer appointments for people with a learning disability, if required.

The practice had 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.

Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check and referred for a carers assessment.