Dr Roberts, Mr Eddy, Dr Stonehouse, Dr O'Sullivan, Dr Melhuish & Dr Hughes Also known as St Marys Surgery

Updated 10 March 2016

The location Dr Winter-Barker, Roberts, Stonehouse, O’Sullivan and Mr Eddy is registered with the Care Quality Commission to provide primary care services. The practice provides services to approximately 6,050 patients at two locations, both of which were visited as part of this inspection:

• St Mary’s Surgery, Applethwaite, Windermere, Cumbria, LA23 1BA.

• Staveley Surgery, Crook Road, Staveley, Kendal, LA8 9NG.

Dr Winter-Barker, Roberts, Stonehouse, O’Sullivan and Mr Eddy provides care and treatment to patients of all ages, based on a General Medical Services (GMS) contract. The main practice is situated in the town of Windermere and is part of the NHS Cumbria clinical commissioning group (CCG.) Dispensing services are provided at both the main practice and the branch surgery. This service was provided for patients who lived more than a mile away from a pharmacy, The health of people who live in Cumbria is varied when compared to the England average. Deprivation is lower than average, however, about 12,000 (14.7%) of children live in poverty. The practice has less patients (15.6%) aged under 18 years of age than the England average, but more patients (26.8%) aged 65 years or over. A significant number of the patient population (61.9%) have a long-standing health condition. The practice had a very low proportion of patients who were from ethnic minorities.

The main practice is located in an adapted building, the old vicarage. There are some treatment and consultation rooms on the ground floor, and there are additional rooms on the first floor which can be accessed by patients who are independently mobile. The Staveley branch surgery is a purpose built building and provides patients with fully accessible services. The main practice and the branch surgery provide a range of services and clinics including, for example, services for patients with asthma, heart disease and diabetes. There are four GP partners (two male and two female) and two GP associates (salaried and female), a nurse practitioner, a practice nurse, two healthcare assistants and a team of reception and administrative staff.

The main practice is open Monday to Friday between 8am and 6:30pm. The Staveley branch surgery is open Monday, Tuesday, Thursday and Friday between 9am and 5:30pm, and on Wednesday between 9am and 1pm. A GP also provides a three-hour extended surgery at the main practice every Monday from 6:30pm to 9:30pm.

Appointment times were:

The main practice at Windermere:

Monday to Friday: morning surgeries take place between 9am and 12 noon and afternoon surgery start times range from 2.30pm to 3.30pm and finish at approximately 6pm, apart from a Monday evening when an extended surgery was provided.

The Staveley branch surgery:

Monday to Friday: morning surgeries take place between 9am and 12 noon and afternoon surgery start times range from 2.30pm to 3pm and finish at 5.30pm. The branch surgery is closed on a Wednesday afternoon.

When the practice is closed patients can access out-of-hours care via the Cumbria Health On-Call service, and the NHS 111 service.

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Winter-Barker, Roberts, Stonehouse, O’Sullivan and Mr Eddy on 16 November 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.

• All staff were actively engaged in activities to monitor and improve quality and outcomes for patients.

• Risks to patients and staff were assessed and well managed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and responsibilities.

• The practice had satisfactory facilities and was equipped to treat patients and meet their needs at both sites. Plans had been made to improve access arrangements at the main practice site.

• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available to them.

• There was a clear leadership structure and staff felt supported by the management team. Good governance arrangements were in place.

• Staff had a clear vision for the development of the practice and were committed to providing their patients with good quality care.

• Feedback from patients was positive about the way staff treated them. Patients said they were treated with compassion, dignity and respect. Arrangements had been made which promoted and supported patients to become active partners in their care. However, the arrangements for preventing unauthorised access to patient related information could be improved.

• Information about how to complain was available and easy to understand.

  W e also saw areas of outstanding practice:

• The NHS GP Patient Survey results showed the practice had performed very well in all areas , especially in relation to patient satisfaction with the quality of GP and nurse consultations, staff’s commitment to providing patients with good continuity of care and access to appointments.

• Following feedback from the local NHS Trust, the practice improved how it delivered services to patients with dermatological conditions. In 2014, a GP partner completed a diploma in Dermatology. They saw the practice’s own patients who had dermatological needs as well as patients from other practices. There was evidence that this had had a very positive impact on the way in which the needs of these patients were managed. For example, the referral rate to secondary specialist services had reduced from 198 patients, in 2014, to 80 for the same period in 2015, which meant more patients benefitted from receiving care and treatment closer to home.

• A named GP provided a fortnightly ‘ward round’ at a local care home for patients with complex healthcare needs. This helped to pre-empt any potential health problems. These patients were also able to access same-day urgent care, from the same GP.

• The practice participated in the ‘Unplanned Admissions’ enhanced service and had identified 2% of patients who were at greater risk of hospitalisation. Arrangements had been made to carry out reviews of the needs of these patients and provide feedback to the clinical team each month. Staff also reviewed the needs of patients who had been admitted into hospital to identify whether this could have been prevented. Recent local Clinical Commissioning Group data showed that unplanned admissions into hospital had reduced by 12.7% and that the practice had the second lowest level of unplanned admissions for the most recent month.

In addition, the provider should:

• Consider using a second thermometer to check the accuracy of the temperature readings displayed on the thermometer installed in the dispensary refrigerator. The provider should also arrange for annual calibration checks to be carried out of the thermometer installed in the dispensary refrigerator.

• Provide the member of staff designated as the practice’s infection control lead with advanced infection control training.

• Make sure that patient related information is kept secure at all times and can only be accessed by authorised persons.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed very well in relation to providing care and treatment for the clinical conditions commonly associated with this population group. For example, QOF data showed the practice had achieved 100% of the total points available to them for providing the recommended care and treatment to patients with chronic obstructive pulmonary disease (COPD.) (This was 2.4% above the local CCG average and 4% above the England average.)

Staff offered proactive, personalised care to meet the needs of patients with long-term conditions. In addition to the practice’s work supporting the development of the new ‘Care Navigator’ and ‘Case Manager’ roles referred to above, nursing staff provided a range of clinics and services aimed at educating patients about their long-term conditions, and helping them to better manage their health and wellbeing.

Updated 10 March 2016

The practice is rated as good for the care of families, children and young people.

The GPs offered maternity care in collaboration with the midwife attached to the practice. Child development clinics were also provided, and patients were able to access health visitor staff at both the main practice and the branch surgery. All the GPs helped to provide a family planning service which included access to a five day emergency coil service and contraceptive implants. Arrangements had been made to support and encourage women to access cervical screening services. The QOF data, for 2014/15, showed the practice had obtained 100% of the overall points available to them for providing cervical screening services. (This was 0.6% above the local CCG average and 2.4% above the England average.) Nationally reported data showed that the majority of childhood immunisation rates were above average, when compared to the overall percentages for children receiving the same immunisations within the local CCG area. Most of the immunisation rates were above 90%. Younger patients were able to access contraceptive and sexual health services, and appointments were available outside of school hours. Regular multi-disciplinary meetings were held to help ensure important information about vulnerable patients was shared. There were systems in place to identify and follow up children who were at risk.

Updated 10 March 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had, overall, performed well in relation to providing care and treatment for the clinical conditions commonly associated with this population group. For example, QOF data showed the practice had achieved 100% of the total points available to them for providing the recommended care and treatment to patients with cancer. (This was 0.2% above the local CCG average and 2.1% above the England average.)

Staff were committed to providing proactive, personalised care to meet the needs of these patients. For example, staff were working in collaboration with other health and social care professionals to develop the new ‘Care Navigator’ and ‘Case Manager’ roles. (These new roles will be used to support patients at risk of an unplanned hospital admission and losing their independence, and those who require help to access extra help and assistance.) The GP team carried out fortnightly visits to patients living in a local care home, so they could receive proactive, planned care. The practice offered home visits and longer appointment times where this was needed by their older patients. Staff had completed care plans for the 2% of vulnerable patients who had been assessed as being most at-risk. These covered, where appropriate, patients’ end of life needs.

Updated 10 March 2016

The practice is rated as good for the care of working age people (including those recently retired and students.)

The practice was proactive in offering on-line services. For example, patients were able to book appointments and order repeat prescriptions on-line. Extended hours appointments were offered to make it easier for families and working-age patients to obtain convenient appointments. Staff provided a full range of health promotion and screening that reflected the needs of this age group.

Updated 10 March 2016

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

The practice regularly worked with multi-disciplinary teams, involved in the case management of people experiencing poor mental health, including those with dementia. Staff had carried out advance care planning for patients with dementia to help them document their preferences and wishes about how they wanted to be cared for should they be unable to make decisions for themselves. Staff gave patients experiencing poor mental health information and assistance about how to access relevant support groups and voluntary organisations. The practice 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. Staff had received training on how to care for patients with mental health needs and dementia.

Updated 10 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice maintained a register of patients living in vulnerable circumstances, including homeless people and those with a learning disability. Clinical staff had carried out annual health checks for patients with a learning disability and they offered longer appointments to these patients. The practice regularly worked with multi-disciplinary teams, involved in the case management of vulnerable people. Staff gave vulnerable patients information and advice about how to access relevant support groups and voluntary organisations. They knew how to recognise signs of abuse in vulnerable adults and children. Staff understood their responsibilities regarding information sharing and documenting safeguarding concerns, and knew how to contact relevant agencies in normal working hours and out-of-hours.