Archived: Fusehill Medical Practice

Updated 26 November 2015

Fusehill Medical Practice is within walking distance of the centre of Carlisle, near the University of Cumbria. The practice provides services to just over 8099 patients of all ages.

The area covered by the practice is within the city boundaries of Carlisle. The catchment area for the practice covers the city east of the River Caldew and north of the River Eden and as far as Rockcliffe to the north, Warwick Bridge to the east and Wreay to the south.

The practice is located at Fusehill Medical Centre, Fusehill Street, Carlisle, Cumbria, CA1 2HE, which we visited during this inspection:

The branch surgery associated with the practice at Scotland Road, Carlisle, has been closed for approximately two years and no services are delivered through this location. The practice intends to remove this from their CQC registration and is in discussions with NHS England to remove this from their contractual obligations.

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

Fusehill Medical Centre is accessible for people with disabilities. Limited onsite parking is available and as such the practice encourages patients to reserve this for patients with disabilities.

The practice is a training practice with five GP partners (two of which are male and three female). There is also one salaried GP (who is female), three practice nurses, five healthcare assistants and a team of administrative support staff. The practice is open Monday to Friday between 8am and 6:30pm. On alternating weeks the practice is open one night a week, either a Tuesday or Thursday until 8:15pm.

They serve an area with lower levels of deprivation affecting children and people aged 65 and over, when compared to the England average. The practice area is within the fifth most deprived decile in England. There were lower numbers of people in paid work or full time employment at 55% (compared to an England average of 60.2%). The unemployment rate in the area is the same as the national average at 6.2%. There were a higher proportion of disability allowance claimants (at 58.7 per 1000 population, compared to an England average of 50.3 per 1000 population).

There are a higher proportion of patients over the age of 65, 75 and 85 when compared to England averages. The average male life expectancy is 79 years, which is the same as the England. The average female life expectancy is 82 years, which is one year lower than the England average at 83.

The percentage of patients reporting with a long-standing health condition is slightly lower than the national average (practice population is 53.7% compared to a national average of 54.0%). The percentage of patients with health-related problems in daily life is higher than the national average (65.8% compared to 48.8% nationally). There are a higher percentage of patients with caring responsibilities at 23.5% compared to 18.2% nationally.

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

Updated 26 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fusehill Medical Practice on 3 September 2015. Overall the practice is rated as good.

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

• There were systems in place to mitigate safety risks including analysing significant events and safeguarding. The premises were clean and tidy. Arrangements in the practice for managing medicines, including emergency drugs and vaccines, kept patient safe. There were appropriate recruitment checks in place.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients and observations throughout our inspection showed the staff were kind, caring and helpful.
• The practice had systems in place to respond to and act on patient complaints and feedback. Services were planned and delivered to take into account the needs of different patient groups and to help provide flexibility, choice and continuity of care.
• The practice had a clear vision to deliver high quality care and promote good outcomes for patients. The staff worked well together as a team.
• Results from the National GP Patient Survey showed that some aspects of patients’ satisfaction with how they could access care and treatment was lower than local and national averages. The practice had reinstated the patient participation group (PPG) to help them to improve.

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

Importantly the provider should :

• Develop and implement an action plan to improve the levels of patient satisfaction, including improving the experience for patients of contacting the practice, making an appointment, feeling involved with decisions about their health and treatment and consulting with doctors and nurses at the practice.
• Increase the percentage of patients with a range of mental health conditions that have a comprehensive care plan documented within the preceding 12 month.
• Ensure blank prescriptions are recorded in accordance with national guidance to reduce the risk of theft or misuse.
• Consider the use of a paginated, bound book for recording controlled drugs to reduce the risk of theft or misuse.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 November 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of an emergency hospital admission were identified as a priority. 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 26 November 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 similar to local and National averages for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. 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, health visitors and school nurses.

Updated 26 November 2015

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

The practice is rated as good for the care of older people. Staff offered proactive, personalised care which met the needs of these patients. Patients living in local care homes received routine GP visits. 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 and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits, longer appointment times and rapid access appointments for those with enhanced needs.

Updated 26 November 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 reflects the needs for this age group.

Updated 26 November 2015

The practice is rated as good for the care of people with poor mental health (including patients with dementia). The practice held a register of patients experiencing poor mental health and there was evidence they carried out annual health checks for these patients. The practice regularly worked with the multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice performed lower than comparators on the percentage of patients with a range of mental health conditions who had a comprehensive care plan documented within the preceding 12 months.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. 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.

Updated 26 November 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 homeless people, travellers and those with a learning disability. It had carried out annual health checks and offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. 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.