14 June 2017
Bentham Medical Practice is registered with the Care Quality Commission to provide primary care services. It is located in the Lancaster area of North Yorkshire. The practice provides services to around 7,250 patients from two locations:
- Grasmere Drive, High Bentham, Lancaster, North Yorkshire, LA2 7JP
- Ingleton Surgery, High Street, Ingleton, Carnforth, Lancashire, LA6 3AB.
We visited both addresses as part of the inspection.
The practice has four GP partners (three female and one male), three salaried GPs (two female and one male), four practice nurses (all female), a practice manager, and 17 staff who carry out reception, administrative and dispensing duties. The practice is a training practice and two of the GPs are accredited GP trainers.
The practice is part of Morecambe Bay clinical commissioning group (CCG). The practice population is made up of a higher than average proportion of patients over the age 65 (27.6% compared to the national average of 17.1%). Information taken from Public Health England placed the area in which the practice is located in the eighth less deprived decile. In general, people living in less deprived areas tend to have less need for health services.
The main surgery is located in purpose built, two storey premises. All patient facilities are on the ground floor. The branch surgery is located in a converted single storey building. There is on-site parking, disabled parking, disabled WCs and step-free access at both sites. Opening hours are between 8.00am and 6.30pm Monday to Friday, with at least one early morning and one evening
session per week in addition to this. Patients can book appointments in person, on-line or by telephone. Appointments were available at the following times:
- Monday - 8.30am to 11.55am; then from 1pm to 7.15pm
- Tuesday – 7am to 11.55am; then from 1.45pm to 8.40pm
- Wednesday – 8.30am to 11.55am; then from 1.45pm to 5.30pm
- Thursday – 8.30am to 11.55am; then from 1.45pm to 5.30pm
- Friday – 8.30am to 11.55am; then from 1.45pm to 5.30pm.
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).
14 June 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Bentham Medical Practice on 7 June 2016. The overall rating for the practice was good, although the practice was rated as requires improvement for safety. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Bentham Medical Practice on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 16 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 7 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
The practice is now rated as good for safe services, and overall the practice is rated as good.
Our key findings were as follows:
- The practice had taken action to address the concerns raised at the CQC inspection in June 2016. They had put measures in place to ensure they were compliant with regulations.
- Appropriate arrangements were now in place for the secure storage of medicines.
- Effective arrangements to assess the risk of, prevent, detect and control the spread of healthcare related infections were in place. These included ensuring that appropriate measures were in place to dispose of clinical waste from the branch surgery at Ingleton and ensuring toys were cleaned regularly.
- Disclosure and Barring Service (DBS) checks were carried out for clinical staff and those carrying out chaperoning duties.
- Furthermore, the recommendations following the June 2016 inspection to review standard operating procedures to ensure they reflect current arrangements within the dispensary, improve accessibility to the branch surgery premises, and consider the need to develop a clear and realistic long term strategy for the practice had been acted on.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
4 July 2016
The practice is rated as good for the care of patients with long-term conditions.
- Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
- 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.
- Patients had regular reviews to check with health and medicines needs were being met.
- For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
4 July 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 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 relatively high 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 positive examples of joint working with midwives, health visitors and school nurses.
- The practice’s uptake for the cervical screening programme was 84.1%, which was above the CCG average of 82.5% and the national average of 81.8%.
- Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
4 July 2016
The practice is rated as good for the care of older people.
- 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. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
- The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
- A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.
- Doctors carried out a weekly ward round and had regular telephone contact with staff at a local nursing home.
4 July 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 extended opening hours at least one early morning and one evening per week for working patients who could not attend during normal opening hours. Appointments were available with doctors and nurses.
- The practice offered 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.
- Additional services were provided such as health checks for the over 40s and travel vaccinations.
4 July 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.
- The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.
4 July 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 and were offered longer appointments, if required. One of the GPs visited a local care home for patients with learning disabilities every year to carry out health checks.
- 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.
- Arrangements were in place to support patients who were carers. The practice was improving the arrangements for identifying carers. Carers were offered a health check and referred for a carer’s assessment.