Archived: Haverthwaite Surgery

Updated 4 August 2016

Haverthwaite Surgery is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 2700 patients from two locations:

• Haverthwaite Surgery, Backbarrow, Ulverston, Cumbria LA12 8QF.
• Greenodd Village Hall, Main Street, Greenodd, UIverston, Cumbria, LA13 7QZ.

These are the locations we visited on the day of our inspection.

The main surgery is based in a purpose-built, two-storey building which is rented by the GP. There is level access to the building and a car park available for patients. All services for use by patients are on the ground floor. The practice hires a room at Greenodd Village Hall to provide a surgery to patients in the village every day except Wednesdays and weekends.

There is a dispensary at the practice offering pharmaceutical services to patients on the practice list who live more than one mile from their nearest pharmacy premises. The practice is signed up to the Dispensing Services Quality Scheme, which rewards practices for providing high quality services to patients from their dispensary.

The practice is a single-handed GP practice (male GP) with two long-term locum GPs (one male, one female) and 11 permanent members of staff, comprising two practice nurses (both female), one healthcare assistant (female), two dispensing staff, a practice manager, and five administrative and reception staff.

The practice is part of Cumbria clinical commissioning group (CCG). Information taken from Public Health England placed the area in which the practice was located in the seventh most deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The main surgery is open from 8am until 6.30pm every weekday except Wednesday, when the practice closes at 12pm. Patients are seen by the out-of-hours service or a neighbouring practice on Wednesday afternoons. Extended hours are no longer offered due to lack of patient demand. Instead, the practice offers Friday afternoon appointments at the branch surgery, as requested by patients. The practice is closed at weekends. The telephone lines operate at all times during opening hours. Outside of these times, a message on the surgery phone line directs patients to out of hours care, NHS 111 or 999 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 (CHoC).

The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice. The practice population has a higher-than-average percentage of patients in all age brackets from 40-44 upwards, and particularly the 65-69 age bracket. The percentage of patients in all age brackets under 40 are below average, with the percentage of patients aged 20-24 particularly low.

Updated 4 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Haverthwaite Surgery on 26 May 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients were highly satisfied with their care. For example, 97% said the last GP they spoke to was good at treating them with care and concern (CCG average 89%, national average 85%). 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. 100% of patients who responded to the National GP Patient Survey said the last appointment they got was convenient, compared to the national average of 92%.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Results for the National GP Patient Survey were well above local and national averages. For example, 95% of patients described the overall experience of their GP surgery as fairly good or very good (local average 88%, national average 85%).
• There was a clear leadership structure and staff felt supported by management. 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.

We saw an area of outstanding practice:

• The practice was highly responsive to the needs of their patient group and the rural community in which they were based. People’s individual needs and preferences were central to the planning and delivery of tailored services. For example, given the lack of access to public transport the practice offered services to reduce the need for patients to travel to hospital. Staff had also set up initiatives to improve the physical and mental health and wellbeing of their patients, such as a weekly Health Fitness Club and a book swap scheme operated by patients.

The areas where the provider should make improvement are:

• Consider a review of written procedures within the main dispensary to ensure these describe the activities required to provide the remote dispensing service at the branch surgery and that there is a clear process for determining and reviewing which medicines should be prepared and taken to the branch surgery.
• Provide all staff with regular appraisals.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2016

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.
• The practice had achieved 82.4 of the 86 quality and outcomes framework (QOF) points available for diabetes in 2015/16, compared to 62.9 points the previous year.
• Longer appointments and home visits were available when needed.
• The practice had below average rates of unplanned emergency admissions.
• 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 4 August 2016

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 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.

Updated 4 August 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 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 cared for all the patients in a local nursing home, including those not on their patient list.
• The practice hired a room at Greenodd Community Centre in order to provide appointments to patients in the village after the GP there retired and the practice building was deemed unsuitable for use. Public transport between Greenodd and the main surgery at Backbarrow was not good enough for patients who lived in Greenodd to be able to access appointments there.

Updated 4 August 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, flexible and offered continuity of care.
• The practice’s uptake for the cervical screening programme was 79.3%, which was above the local average of 77.8% and the national average of 74.3%.
• 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 4 August 2016

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

• The practice had achieved all the points available for patients with dementia and for mental health indicators on the Quality and Outcomes Framework in 2015/16.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice worked with a partnership of local businesses and organisations, including dementia charities to develop a leaflet and questionnaire to help patients with dementia and their family and carers to access support.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had 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 4 August 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.
• The practice offered longer appointments for patients who needed them.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.