Archived: Queens Street Medical Practice

Updated 27 September 2017

Dr Graham John Ironside is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 4,200 patients from one location:

• Queens Street Medical Practice, 149 Queen Street, Whitehaven, Cumbria, CA28 7BA.

We visited this location on this inspection.

The practice was registerred with CQC previously but had not been inspected. They changed their registration on 2 February 2016 to reflect the change from a partnership to a single-handed GP practice. The other member of the former GP partnership, and other staff, continue to work at the practice carrying out the same roles and responsibilities.

The practice is located in a converted building in the centre of Whitehaven, which is rented by the practice. Patient facilities are situated on the ground floor and first floor. There is a lift for patients to use as well as disabled toilet facilities, wheelchair and step-free access to all consulting and treatment rooms.

The practice has 15 members of staff, including the lead GP (male) and one salaried GP (female), a nurse practitioner (female), two practice nurses (female), a practice manager, an administrator/care-coordinator, a medicines manager/clinicial interface manager, a practice secretary, a head receptionist, and five reception and administration staff, including an apprentice. At the time of inspection, the practice had an interim practice manager in place, as well as a long-term locum GP in addition to the two permanent doctors. The practice was also actively seeking a healthcare assistant.

The practice is part of North Cumbria clinical commissioning group (CCG). Information taken from Public Health England places the area in which the practice is located in the fourth more deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice population profile roughly reflects the national average. The number of patients between the ages of 45 and 54 and 65 and 69 is slightly higher than average, while there are slightly fewer patients than the national average between 25 and 39.

The surgery is open from 8am to 6.30pm, Monday to Friday, with the exception of Wednesday when the practice closes at 4pm but a doctor remains on call until 6.30pm. Extended hours are offered on Monday and Friday until 7.30pm. Telephones at the practice are answered from 8am until 6.30pm, Monday to Friday. Outside of these times a message on the telephone answering system redirects patients to out of hours or emergency services as appropriate. The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Cumbria Health on Call Ltd (CHoC).

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

Updated 27 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queens Street Medical Group on 3rd August 2017. 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 an effective system in place for reporting and recording significant events.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Risks to patients were assessed and generally well managed. The system to identify when risk assessments required reviewing was being improved at the time of inspection.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by the management team.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

There were areas of practice where the provider should make improvements:

• Request and keep copies of references for new members of staff.
• Continue to put in place systems to identify risk assessments and policies which need to be updated, and update those which have passed their renewal date.
• Keep to the established programme of meetings for the nursing, admin and reception teams.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 September 2017

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 hospital admission were identified as a priority.

• Performance for diabetes related indicators was higher than the national average. The practice achieved 100% of the total points available, compared to the national average of 89.8%.

• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 27 September 2017

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 higher than national average 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.
• The practice’s uptake for the cervical screening programme was 90%, which was in line with the local and national average of 81%.
• 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. 

Updated 27 September 2017

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 their population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice employed a care coordinator who could visit older patients in their own homes to offer support and to direct them to other services as required.
• Performance for conditions associated with older patients, such as Chronic Obstructive Pulmonary Disease, was better than the national average. The practice achieved 100% of the total points available for this condition, compared to the national average of 95.9%.

Updated 27 September 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 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 reflected the needs for this age group.

Updated 27 September 2017

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

• Performance for mental health related indicators was 100% of the total points available in 2015/16 (national average 92.8%).
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• In 2015/16, 87% of patients diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was above the national average of 84%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• There was a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 September 2017

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.
• The practice offered longer appointments for patients who needed them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed 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.
• There was a carers’ lead who offered support, and the practice had identified 81 patients as carers (2% of the practice list).