Archived: Alston Medical Practice

Updated 18 February 2016

The Alston Medical Practice is situated in Cumbria close to the centre of Alston. It sits within the locality district of Eden. Due to the rural nature of the practice boundary the practice provides a dispensing service to its patient population.

Alston is the highest market town in England and can be quite an isolated rural community especially in adverse weather conditions with the nearest A&E some distance away and journey times of over an hour for an emergency ambulance to reach the town. There is limited social care provision in the local community with no nursing home beds and difficulty recruiting carers due to travelling distances which can have an effect on the services provided by the practice in terms of them being able to manage medical and social care problems swiftly and locally.

The practice provides services to 2400 patients and to a diverse rural population. Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male and female life expectancy in the practice geographical area is on par with the England average for males at 79 years and 82 years for females (England average 79 and 83 respectively).

There is a very small percentage of the practice population whose first language is not English.

There are three partner GPs two male and one female. There is a practice nurse, a health care assistant, a practice manager, three receptionists and two dispensers. The practice is a GP training practice with the next GP Registrar starting on 03 February 2016. Dr Hanley is the GP trainer. Other healthcare professionals such as district nurses, health visitors, palliative care nurses and midwives are in regular contact with the practice, with the midwife undertaking an antenatal session once a week in the practice.

The practice is open between 8am and 6.30pm Monday Wednesday and Friday, and until 4.30pm Tuesday and Thursday. Appointments are from 9am until 11am and 2pm – 4pm daily, with appointments available until 6.30pm Monday, Wednesday and Thursday. On Tuesday and Friday from 4.30pm until 6.30pm a duty doctor from the practice is available for anyone who rings in needing to talk to or see a GP. The practice is very flexible with its opening times on top of this and will see patients before and after the last published appointment time if needed and goes out of its way to accommodate patients who may need an appointment early or late on in the day due to work commitments.

Out of hours provision is provided by the 111 service and Cumbria Health On Call (CHOC).

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Alston Medical Practice on 3 December 2015. Overall the practice is rated as outstanding.

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. The practice had clear evidence of the learning opportunities taken as a result of the monitoring of 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.
• Staff were encouraged to keep up to date and to take training opportunities whenever they came along.
• Patients said they found it easy to get through to the practice on the telephone, and felt they were treated with compassion, dignity and respect by all staff. Feedback from patients and stakeholders was continually positive about the way staff treated them.
• There was a clear leadership structure and staff felt well supported by the management team and GP’s.
• The provider had an effective policy in place for Duty of Candour and was open and transparent in its dealings with patients.
• The practice had a multi-skilled workforce with all staff being able to support each other flexibly in different roles as and when needed.
• A practice Patient Participation Group (PPG) had been in place since 2013 and had managed to attract a wide age range of members.
• Patients were truly respected and valued as individuals and were empowered as partners in their care.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 18 February 2016

The practice is rated as outstanding for the care of people with long-term conditions because two domains are rated as outstanding.

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Personalised care plans were in place to meet the needs of individual patients. These promoted self-management and empowerment to manage their conditions through education and information.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice completed a continuous review of appointments to ensure they were providing enough appointments to meet patient’s need.
• During a review of appointments the practice appointed of a Health Care Assistant to provide more nursing support to patients.
• The practice nurse arranged a DESMOND programme team to visit the surgery and provide sessions locally. (DESMOND is a programme for diabetes education and self-management for on-going and newly diagnosed patients). The practice found that the referral uptake to this team had been poor due to transport issues and the distance to travel. Since the team have been putting on sessions at the surgery the uptake by patients suffering from diabetes had improved with positive feedback from patients. These sessions were funded locally.

Updated 18 February 2016

The practice is rated as outstanding for the care of families, children and young people because two domains are rated as outstanding.

• New patient registration for children followed safeguarding guidelines – GPs understood the family structure and informed health visitors of new family registrations and systems were in place to identify and follow up children living in disadvantaged circumstances who were at risk.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Excellent feedback was received on collaborative working with midwives and health visitors.
• Childhood immunisation rates were comparable or higher than CCG averages.
• All GPs arrange suitable follow up for emergency contraception, termination of pregnancy and sexually transmitted diseases.

Updated 18 February 2016

The practice is rated as outstanding for the care of older people because two domains are rated as outstanding.

• The practice offered proactive, personalised care to meet the needs of the older people in its population with a named GP for over 75 year olds.
• Care plans and reviews were in place for the frail and elderly.
• Carers had been identified and referred to the local caring association.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• A health care questionnaire was completed for all patients over the age of 83 years.
• Emergency home delivery of medication and arrangement of blister packs through the dispensary was available.
• The community hospital and day care centre were on the same site as the practice with the practice GPs managing the day to day medical care. This enabled a good working relationship between staff and the doctors and day care patients having ease of access to the GP.
• Excellent working relationships with community teams to support patients living independently at home.
• The five year plan for health provision in the area contained a focus on the elderly population and developing services to support their growing needs. For example the practice was currently researching falls in older people. As a result of this they were developing an in-depth falls risk assessment and an algorithm to support this along with the establishment of a falls clinic in the practice.

Updated 18 February 2016

The practice is rated as outstanding for the care of working-age people (including those recently retired and students) because two domains are rated as outstanding.

• 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 reflects the needs for this age group.
• The practice website was accessible and very detailed.
• Nurses provided a full travel vaccine service (excluding yellow fever).
• GPs managed their own choose and book referrals so patients could usually leave the surgery with a booked appointment for a consultant without having to attend again to make a booking.
• GPs mostly did their own bloods and electrocardiograms (ECG’s) within an appointment time so that a quick assessment could be made, reducing the number of attendances necessary to get a diagnosis.
• Although extended access is not offered at the practice patients are accommodated as and when requested with early or late appointments.

Updated 18 February 2016

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia) because two domains are rated as outstanding.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice liaised with counselling services local the mental health team and the crisis team.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support people with mental health needs and dementia.
• Longer appointments were available when someone was in need of extra support.

Updated 18 February 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable because two domains are rated as outstanding.

• Longer appointments were offered for people with a learning disability, and learning disability health checks were able to be done in surgery or at home depending on the patient’s choice.
• Patients whose circumstances identified them as vulnerable were recorded in a register and recall systems were in place.
• 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. A multidisciplinary approach with community teams was embedded in practice in the case management of vulnerable patients and families.
• Carers were actively identified and referred to the local carers association.