Archived: Whitehaven Medical Centre

Updated 2 February 2017

Whitehaven Medical Centre provides care and treatment to 4396 patients of all ages, based on a General Medical Services (GMS) contract. The practice is part of the NHS Cumbria clinical commissioning group (CCG). We visited the following location as part of inspection: Catherine Street, Whitehaven, Cumbria, CA28 7PA. The practice had merged with a local GP surgery in August 2016, with staff and patients transferring across to the Whitehaven Medical Group.

The practice is a dispensing surgery which means they can, if they meet certain criteria, supply eligible patients with medicines directly.

The practice serves an area where deprivation is higher than the England average. In general, people living in more deprived areas tend to have a greater need for health services. The percentage of people with a long-standing health condition is higher than the national average, 61.3% compared to 54%. Life expectancy for men is lower than the national average, 77 years compared to 79 years. The life expectancy for women is also lower than the national average, 81 years to 83 years.

The practice relocated to its current site in November 2014 and now occupies a building that has been adapted to meet patients’ needs. All treatment and consultation rooms are located on the ground floor. The practice has a lead GP (male) who is one of the providers. The other provider is the practice/medicines manager (female). The practice also employs a regular, experienced long-term GP (male). There is a nurse practitioner (NP) and three practice nurses (female), as well as a healthcare assistant (female), and a team of administrative and reception staff. There were no arrangements for patients to be able to see a female GP if they wanted to. However, the NP held their own daily clinical sessions, and we were told the other practice nurses would be available if patients were not comfortable with seeing a male GP.

It states we have no arrangements for female patient to see a female GP. They can access the Nurse Practitioner clinics as she sees all patients.

The practice is open:

Monday to Friday: 8am to 6:30pm.

Extended hours are provided between 6:30pm and 7pm Monday to Friday.

Staff are available to answer the telephone from 8am and 6:30pm.

GP appointment times are:

Monday to Friday: 8:10am to 12 noon, and then 2pm to 6pm.

The practice is closed at the weekend.

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

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Whitehaven Medical Centre on 17 November 2016. Overall, the practice is rated as good.

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

• There was an open and transparent approach to safety and the practice had a system for reporting and recording significant events, and learning from them.

• Risks to patients and staff were assessed and well managed. This included the development of systems and processes to support non-clinical staff to undertake delegated clinical tasks, and audits were being undertaken to ensure these were being carried out safely.

• Effective governance arrangements were in place.

• All staff were actively engaged in monitoring and improving quality and patient outcomes.

• Staff assessed patients’ needs and delivered care and treatment in line with current evidence based guidance. They had the skills, knowledge and experience to deliver effective care and treatment.

• The practice worked with other organisations when planning how services were provided, to ensure patients’ needs were met.

• Patients said they were treated with dignity and respect and that they were involved in decisions about their treatment.

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

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Staff were very committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

• A culture had been created which encouraged and sustained learning and improvement at all levels. Staff felt supported and respected, but it was evident that the new team was still undergoing a period of adjustment, following the recent merger.

• The provider had a clear vision and strategy for the development of the practice and were committed to providing their patients with good quality, safe care.

We saw some areas of outstanding practice:

• The lead GP provider had introduced a system for audio-recording and transcribing patient consultations. This system enabled him to focus on what the patient was saying, rather than on recording what was being said, and he was also able to see more patients during each clinical session. A further benefit of the system was that the clinical records were of a very high quality.

• Data from the NHS National GP Patient Survey of the practice, published in July 2016, showed patient satisfaction with access to appointments, was very good. For example: 100% of patients said the last appointment they got was convenient, compared to the local Clinical Commissioning Group (CCG) average of 94% and the national average of 92%; 96% of patients said they were able to get an appointment to see or speak to someone the last time they tried, compared with the local CCG average of 87% and the national average of 85%; 99% of patients found it easy to get through to the surgery by telephone, compared with the local CCG average of 80% and the national average of 73%.

However, there were also areas where the provider should make improvements. The provider should:

• Carry out more two-cycle clinical audits, to help demonstrate improvements in patient outcomes.

• Prepare a practice development plan which clearly sets out how the provider intends to enact their vision and strategy.

• Review the systems and protocols for preparing referral letters and dealing with incoming patient letters and blood results, to make sure that potential risks are assessed and minimised.

• Review the standard letter issued in response to complaints received to include details of the Parliamentary and Health Service Ombudsman.

• Consider providing a loop system for the use of patients who have a hearing impairment and, making the reception desk more accessible to patients who require the use of a wheelchair.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 February 2017

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

• The QOF data, 2015/16, showed the practice had performed above, or broadly in line with, most of the local CCG and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

• Patients with long-term conditions were offered regular reviews to check their health needs were being met and that they were receiving the right medication. Longer appointments and home visits were available when needed.

• A member of the nursing team carried out reviews in patients’ own homes for those who were housebound.

Updated 2 February 2017

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

• There were systems in place to protect children who were at risk and living in disadvantaged circumstances. For example, regular multi-disciplinary safeguarding meetings were held where the needs of vulnerable children and families were discussed. All clinical staff had completed appropriate safeguarding training. Appointments were available outside of school hours and the practice’s premises were suitable for children and babies.

• The practice offered contraceptive and sexual health advice, and information was available, about how patients could access specialist sexual health services.

• The practice had a comprehensive screening programme. Publicly available information showed the practice had performed well in relation to the national breast screening average, and broadly in line with the cervical screening national average. The uptake of cervical screening for females aged between 25 and 64, attending during the target period, was, at 76%, slightly below the national average of 81.8%. However, publicly available data showed that less patients had accessed the national bowel cancer screening programme.

• The practice offered a full range of immunisations for children. Publicly available information showed they had performed better than the local CCG averages in relation to delivering immunisations to five year olds. For five year olds, the rates ranged from 92.3% to 100% (the local CCG averages ranged from 81.4% to 95.1%). The immunisation rates for children aged 12 months old were 85.7%. (These were broadly in line with the local CCG averages which ranged from 73.3% to 93.1%).

Updated 2 February 2017

• Nationally reported Quality and Outcomes Framework (QOF) data, for 2015/16, showed the practice had performed above, or broadly in line with, most of the local clinical commissioning group (CCG) and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

• Staff were committed to providing proactive, personalised care to meet the needs of older patients. For example, they were participating in a CCG-led pilot to set up a ‘Care Co-ordinator.’ (This is a new role where the post holder provides support to patients at risk of an unplanned hospital admission and losing their independence.) Staff told us that this had helped to monitor the health and wellbeing of older patients who had little or no contact with the practice. All patients over 75 years of age had a named GP who was responsible for their care.

• Staff worked in partnership with other health care professionals to ensure that older patients received the care and treatment they needed.

• The practice had recently introduced nurse-led home visits to monitor the health of housebound patients with the long-term conditions (LTCs). Older patients had access to influenza, shingles and pneumococcal vaccinations, either at the practice or in their own homes.

Updated 2 February 2017

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

• The needs of the working population had been identified, and the practice adjusted the services it provided to ensure there 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 reflected the needs of this group of patients.

• The QOF data showed the practice had performed either above, or broadly in line with, most of the local CCG and England averages, in providing recommended care and treatment to this group of patients.

• Working age patients had very good access to appointments. Extended hours appointments were routinely provided between 6:30pm and 7pm each weekday.

• Information on the practice’s website, and on display in their patient waiting areas, informed them how to access the out-of-hours service.

Updated 2 February 2017

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

• The QOF data, for 2015/16, showed the practice had performed above the local CCG and national averages, in relation to providing care and treatment to this group of patients.

• The practice’s clinical IT system clearly identified patients with dementia and mental health needs, to ensure staff were aware of their specific needs. The QOF data, for 2015/16, indicated that the percentage of patients with specified mental health conditions, who had a care plan documented in their medical record during the previous 12 months, was much better than the national average, (96.7% compared to 88.5%.)

• Patients experiencing poor mental health had access to information about how to contact various support groups and voluntary organisations.

• Clinical staff actively carried out opportunistic dementia screening, to help ensure their patients were receiving the care and support they needed to stay healthy and safe.

• Staff had completed Dementia training, which helps to raise awareness of dementia related issues.

Updated 2 February 2017

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

• The practice held registers of patients living in vulnerable circumstances. For example, staff maintained a register of patients with learning disabilities which they used to ensure they received an annual healthcare review.

• Information about the practice’s most vulnerable patients was shared with the local out-of-hours service, to help promote continuity of care for these people.

• Systems were in place to protect vulnerable children from harm. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns, and they regularly worked with multi-disciplinary teams to help protect vulnerable patients. Staff were aware of how to contact relevant agencies in normal working hours and out-of-hours.

• Appropriate arrangements had been made to meet the needs of patients who were also carers.