Background to this inspection
Updated
6 June 2018
The Lakes Medical Practice is registered with the Care Quality Commission to provide primary care services. The practice provides services to around 10,000 patients from the following location: Penrith Health Centre, Bridge Lane, Penrith, CA11 8HW. We visited this address as part of the inspection. The practice website is www.thelakesmedicalpractice.co.uk. The practice is part of NHS North Cumbria Clinical Commissioning Group (CCG).
Deprivation indicators place this practice in an area with a score of eight out of ten. A lower number means an area is more deprived. People living in more deprived areas tend to have greater need for health services. This practice had lower levels of deprivation when compared to the local CCG and England averages. The practice has greater numbers of patients aged 65 and over compared to CCG and England averages.
The practice occupies a purpose built building which it shares with another practice. Consultation rooms and patient areas are on the ground floor and fully accessible, for patients with mobility needs. There is car parking directly outside, with disabled bays.
The practice has five GP partners, one salaried GP, a physician’s associate, an Emotional Wellbeing Practitioner (a psychotherapist), five practice nurses, four healthcare assistants and a phlebotomist. These are supported by a team of administrative and management staff. The practice is a training practice, although no GP registrars were there at the time of our inspection. A GP Registrar is a qualified doctor who is training to become a GP through a period of working and training in a practice. They work under supervision of a senior GP or trainer.
The practice reception is open at the following times:
•Monday 8.30am to 6.30pm
•Tuesday 8.30am to 7.30pm
•Wednesday 8.30am to 7pm
•Thursday 8.30am to 7pm
•Friday 8.30am to 6.30pm
The surgery also provides a Saturday morning surgery from 8.30am until 11.30am, for pre-booked appointments. When the practice is closed patients are directed to the NHS 111 service, with out of hours services being provided by Cumbria Health on Call (CHoC). This information is also available on the practices’ website and in the practice leaflet.
Updated
6 June 2018
This practice is rated as Outstanding overall.
We last inspected the service in November 2014, when it was rated as good overall.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Outstanding
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Outstanding
We carried out an announced comprehensive inspection at The Lakes Medical Practice on 5 April 2018, as part of our inspection programme.
At this inspection we found:
•The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them, involved all staff, shared the information internally and externally, and improved their processes.
•The practice proactively reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. We were able to see the positive impacts on patient care and outcomes. Innovation was valued and actively encouraged, and we saw where, for instance, changes to clinics had resulted in improved access for patients. Treating patients holistically was seen as a cornerstone to good results.
•Staff involved and treated patients with compassion, kindness, dignity and respect. Patient feedback was positive.
•Patients found the appointment system easy to use and reported that they were able to access care when they needed it. Telephone triage allowed GP advice within two hours, or one hour for children, and direction to the most appropriate member of staff.
•There was a strong focus on continuous learning, improvement and innovation at all levels of the organisation. Staff were heavily invested in their roles and were empowered to develop their skills.
We saw areas of outstanding practice:
•The Infection Prevention Control (IPC) lead had initiated a series of weekly ‘Soapbox’ emails, which she used to communicate any infection control updates and best practice to all staff, or to communicate good news stories.
•The practice had proactively reduced opiate and benzodiazepine prescribing as part of a programme with input from the Patient Participation Group (PPG). The practice were the lowest prescribers for hypnotics in the area, reducing the numbers of patients prescribed these drugs from 180 to 20. We saw further evidence of the success of this programme through decreasing opiate usage, for instance a 30% reduction in codeine use, and a 42% reduction in Tramadol usage. The practice had shared their learning from this with others at Clinical Commissioning Group (CCG) learning events.
•Staff innovation and suggestions were valued and encouraged and we saw patient outcomes had improved as a result, for instance improving rates for asthma review clinics after a telephone consultation option was offered.
•The practice had developed an in-house service to offer extra support, psychotherapy, advice and signposting to patients who had undergone a termination of pregnancy. The practice proactively contacted these patients.
•Patients could receive additional holistic support from an in-house Emotional Wellbeing Practitioner who provided psychotherapy. The practice could demonstrate this had significantly improved patients well-being scores and also reduced the frequency of GP contacts from people suffering poor mental health.
•The practice were committed to supporting their staff. Staff were invited to complete a Professional Quality of Life Questionnaire to help them reflect on their roles and stress. Staff could access extra support including a two hour Personal Development session where they could discuss issues such as stress and burn out.
•Staff were given high levels of support and access to training, and were encouraged and empowered to develop specialisms and skill sets. Practice staff had developed specialist interest areas, including for women’s health and sexual health services. As a result of this the practice offered a same day appointment or call back service for sexual health, contraception or menopause advice, ensuring fast access for patients. The service generally dealt with over 100 call backs each month. The specialist staff member was given protected time and additional support to facilitate this service.
•Staff meeting minutes were mapped to CQC domains of safe, effective, caring, responsive and well led to provide structure and clear direction, to ensure not only legislative compliance but also to encourage continuous improvement.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice