Archived: James Street Group Practice

Updated 29 July 2016

James Street Group Practice is located in the centre of Workington, Cumbria and provides care and treatment to approximately 8,982 patients from the electoral districts of Clifton, Harrington, Moorclose, Mossbay, Seaton, St Johns, St Michaels and Stainburn in Workington. It is part of the NHS Cumbria Clinical Commissioning Group (CCG) and operates on a General Medical Services (GMS) contract.

The practice provides services from the following address, which we visited during this inspection:

James Street Group Practice, James Street, Workington, Cumbria, CA14 2DL.

The practice is located in a converted and extended ex-residential property. All reception and consultation rooms are fully accessible for patients with mobility issues. The practice does not have a car park and a disc parking scheme is in operation in the neighbouring area. However, a pay and display car park is available nearby.

The practice is open from 8am to 6.30pm on a Monday to Friday. Patients registered with the practice are also able to book an appointment with a practice GP at Workington Hospital Primary Care Access Centre on a Tuesday (from 6.30pm to 7.30pm), Wednesday and Thursday (from 6.30pm to 7pm) and a Saturday (from 9am to 10am and 2.30pm to 3.30pm).

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Cumbria Health On Call Ltd.

James Street Group Practice offers a range of services and clinic appointments including minor surgery, cervical screening, travel immunisations and various chronic disease management clinics. The practice is a training practice and provides training for GP trainees (fully qualified doctors with experience of hospital medicine who are training to become a GP).

The practice consists of:

• Six GP partners (two male and four female)
• Two salaried GPs (both female)
• Two practice nurses (both female)
• Two health care assistants (female)
• 18 non-clinical members of staff including a practice manager, deputy practice manager, medicines manager, administrators, receptionists and cleaners.

The area in which the practice is located is in the third (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The average life expectancy for the male practice population is 77 (CCG average 79 and national average 79) and for the female population 80 (CCG average 82 and national average 83).

55.5% of the practice population were reported as having a long standing health condition (CCG average 56.3% and national average 54%). Generally a higher percentage can lead to an increased demand for GP services. 60.7% of the practice population were recorded as being in paid work or full time education (CCG average 59.1% and national average 61.5%). Deprivation levels affecting both children and adults were higher than local CCG and national averages.

The practice is part of the Workington Health Ltd not for profit GP federation with four other practices from the Workington area. This enables them to co-commission services more cost effectively and deliver more joined up and shared services.

Updated 29 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at James Street Group Practice on 19 May 2016. 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 to report incidents and near misses.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• Feedback from patients about their care was positive. Patients reported that they were treated with compassion, dignity and respect.
• National GP Patient Survey results in relation to appointment availability and experience and ease of making an appointment were lower than local and national averages. The practice was aware of patient dissatisfaction in this area and were committed to improvement.
• Urgent appointments were usually available on the day they were requested. When this was not possible patients were able to access same day pre bookable appointments at the local primary care access centre.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice did not have a patient participation group (PPG) but a town wide patient participation group was in operation. PPG members had been involved in canvassing patient opinion, delivering leaflets and advertising the function of the access centre.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved 97.7% of the point’s available (local clinical commissioning group average 96.8% and national average 94.7%)
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and improvement was prioritised. The strategy to deliver this vision was regularly discussed and reviewed with staff and stakeholders.
• Practice staff were aware of, and complied with Duty of Candour requirements.

However there were also areas of practice where the provider needs to make improvements.

The provider should:

• Strengthen the arrangements currently in place for checking the expiry dates of emergency medicines and equipment.
• Store all controlled drugs in accordance with relevant legislation.
• Consider adding the discussion/implementation of NICE guidelines as a standard agenda item to clinical meetings.
• Review the arrangements in place for bringing the availability of the chaperoning service to the attention of their patients
• Continue with their plan for all clinical staff to receive training in the requirements of, and their responsibilities in relation to, the Mental Capacity Act
• Consider writing a more formal business plan
• Review their meeting schedule so that all staff are given the opportunity to attend practice meetings

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 July 2016

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

Longer appointments and home visits were available when needed. The practice’s computer 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. A system was in place to follow up on patients who failed to attend review appointments.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved some good outcomes in relation to the conditions commonly associated with this population group. For example:

• The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 1.5% above the local CCG average and 2.6% above the national average.
• The practice had obtained 97.7% of the points available to them in respect of chronic obstructive pulmonary disease. This was 0.1% above the local CCG average and 1.7% above the national average
• The practice had obtained 100% of the points available to them in respect of hypertension (1.1% above the local CCG average and 2.2% above the national average).

However, some results were lower than local and/or national averages:

• The practice had obtained 92% of the points available to them in respect of diabetes (1.6% below the local CCG average but 2.8% above the national average).
• The practice had obtained 91.2% of the points available to them in relation to dementia (4.5% below the local CCG average and 3.3% below the national average.

Patients with diabetes and chronic obstructive pulmonary disease (COPD) were able to benefit from expert chronic disease nurses who worked on a town wide basis. Two of the practice GPs had expertise and special interest in caring for diabetic patients and one of the practice nurses had extended knowledge and skills in dealing with the diagnosis and management of patients with COPD and asthma.

Updated 29 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 processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies.

A town wide childhood immunisation service was in operation which served all of the GP practices in Workington and was staffed by two experienced children’s nurses. Practice vaccination rates for 12 month and 24 month old babies and five year old children were comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 91.3% to 98.4% (compared with the CCG range of 83.3% to 96%). For five year olds this ranged from 83.3% to 96% (compared to CCG range of 72.5% to 97.9%).

At 80.3%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was comparable with the local CCG average of 82.5% and national average of 81.8%.

One of the practice GPs had extensive paediatric experience. The practice had recently changed their policy to ensure that all newborn babies are registered with the practice as soon as possible and that young children who are unwell are seen in a timely manner either at the practice or local access centre regardless of whether they were registered with the practice or not. Practice staff had undertaken paediatric resuscitation training.

Pregnant women were able to access antenatal clinics at Workington Community Hospital provided by healthcare staff attached to the practice. The practice GPs carried out post-natal mother and baby checks.

The practice offered a comprehensive contraception service including the insertion of intrauterine devices, contraceptive implants and contraceptive injections. One of the practice GPs had undertaken additional training in contraception and sexual health.

Updated 29 July 2016

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

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 99.6% and the England average of 97.9%.

The practice had worked with other GP practices in the area to develop the Workington Primary Care Access Centre to deal with same day/emergency appointment requests. This had enabled them to increase their standard appointment time to 15 minutes and dedicate more time to caring for patients with multiple, chronic and complex conditions.

They were nominated GPs for each of the town’s residential homes and a practice GP visited the local nursing home on a weekly basis. The practice had a palliative care register and held monthly multi-disciplinary meetings to discuss and plan end of life care.

The practice had been instrumental in developing Workington’s Frail Elderly Assessment Team who delivered targeted, proactive and reactive care to elderly patients to enable them to stay in their own homes and avoid unplanned admission to hospital.

Updated 29 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 met. The practice is open from 8am to 6.30pm on a Monday to Friday (appointments from 8.30am to 6pm). Patients unable to attend the surgery during normal opening hours were able to access pre bookable appointments with a nurse practitioner and/or GP at an extended hours service located in the local primary care centre on a Tuesday (from 6.30pm to 7.30pm), Wednesday and Thursday (from 6.30pm to 7pm) and a Saturday (from 9am to 10am and 2.30pm to 3.30pm). Patients could also access a walk in service at the access centre from 8am to 8pm seven days per week.

The practice offered minor surgery, cervical screening, travel immunisation advice and various chronic disease management clinics.

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. A text messaging appointment confirmation and reminder service was available.

Updated 29 July 2016

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

Nationally reported QOF data for 2014/15 showed the practice had achieved the maximum points available to them and higher than local and national averages for caring for patients with depression and mental health conditions. However, at 74.4% the percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 9.3% below the local CCG and 9.6% below the national averages. Practice staff we spoke to were unable to explain the reason for this but were able to demonstrate that there had been an improvement to 79% for the period 2015/16. This data was yet to be verified or published. They also told us that patients with dementia were the subject of weekly meetings between the locality Frail Elderly Assessment Team and members of the Community Mental Health Team. The practice was able to demonstrate a reduction in the use of antipsychotic medication and benzodiazepines in their elderly patients as a result of an ongoing audit programme. For example, in the first quarter of 2013/14 the practice had prescribed 1750 of these items compared to 841 items for quarter four of 2015/16.

The practice hosted the local primary mental health service at the surgery where they provided counselling and other psychological therapies. They also hosted the local substance misuse service and ensured that appointments were available with a health care assistant when the substance misuse practitioner was in attendance so that patients could access blood pressure checks and blood tests.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice undertook shared care of patients on psychotropic drugs with the local Community Mental Health Team.

Updated 29 July 2016

The practice is rated as requires improvement for the care of people whose circumstances 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 not routinely offered an annual health review. Practice staff told us this was an area they were keen to improve. Their intention was that practice nurses would visit patients with a learning disability in their own homes equipped with all the diagnostic equipment necessary to carry out a fully comprehensive health review. However, this system was not in place at the time of our inspection.

The practice had established 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.

The practice was proactive in their identification of carers. A carer's pack was available and newly identified carers were discussed at practice meetings to ensure they were supported appropriately. They had identified 76 of their patients as being a carer (approximately 0.8% of the practice patient population).