Duke Street Surgery

Updated 11 October 2016

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

The practice provides services to approximately 9,500 patients from one location at 4 Duke Street, Barrow in Furness, Cumbria, LA14 1LF. We visited this location on this inspection.

The practice is based in a large, historic building which was originally built as a doctor’s surgery and is owned by the practice. It has level access and all patient services for the surgery are on the ground floor. There is a designated parking area for patients, with disabled parking spaces available.

The practice has 31 members of staff, including three GP partners (one female, two male), four salaried GPs (three female, one male), one (female) nurse practitioner, three (female) practice nurses, three (female) healthcare assistants, a practice manager, two medicines managers and 14 reception and administration staff, including a clinical interface manager.

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 second most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. Health outcomes for people in Barrow in Furness are generally lower than national averages and vary significantly. The life expectancy in the most deprived areas for men is 13 years lower, and for women eight years lower, than people in the least deprived areas. The area also has higher-than-average rates of obesity, self-harm and smoking related deaths. The practice population profile is relatively similar to the national average, with slightly more patients than average between the ages of 65-69 and slightly fewer between the ages of 35-39.

The surgery is open from 8am to 6.30pm, Monday to Friday, with extended opening hours from 7.30am on Wednesday and Friday. The practice is closed at weekends. 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 (CHOC).

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

Updated 11 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Duke Street Surgery on 12 August 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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 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 one area of outstanding practice:

• The practice is rated outstanding for the care of people whose circumstances make them vulnerable. Strong safeguarding procedures were in place with safeguarding leads for nursing and administration staff in addition to the practice lead. Systems were in place to ensure information was shared effectively between services to keep patients safe. The practice was proactive in supporting multi-agency working with regard to safeguarding. Patients also had access to a mental health trained nurse who could offer physical and mental health reviews, medication reviews and specialist support.

The areas where the provider should make improvement are:

• Blinds with loop chords in patient areas should be risk assessed or secured.
• Consider keeping minutes of meetings held in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 October 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.
• Performance for diabetes related indicators was better than the national average. The practice achieved 100% of the points available in this area, compared to 89.2% nationally.
• One of the nursing team had developed a review form that patients who could not attend surgery could complete and submit to the nurses. This was available online and in reception, as well as being included in the letter that was sent to patients to invite them to their review.
• 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 11 October 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 11 October 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.
• Performance for indicators for diseases often suffered by older people was better than the national average. For example, the practice achieved 100% of the points available for chronic obstructive pulmonary disease (COPD), compared to 96% nationally.

Updated 11 October 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 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’s uptake for the cervical screening programme was 82%, which was identical to the CCG and national averages.

Updated 11 October 2016

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

• 72% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average.
• Performance for mental health related indicators was better than the national average. The practice achieved 100% of the points available in this area, compared to 92.8% nationally.
• The practice employed a nurse who was specialised in supporting patients experiencing poor mental health. They were able to undertake annual mental health reviews, medicine reviews of patients with poor mental health as well as working with other staff in the practice to improve support for patients.
• 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.
• 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 11 October 2016

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

• The practice was situated in an area of high safeguarding activity and had been involved in two serious case reviews in the past two years. (Serious case reviews are local enquiries into the death or serious injury of a child where abuse or neglect is known or suspected to be a factor. They are carried out by Local Safeguarding Children Boards so that lessons can be learned.)
• Vulnerable children and adults were protected by a strong comprehensive safeguarding system. One of the GPs was the lead member of staff for safeguarding at the practice. They were supported by safeguarding leads in the nursing and administrative teams also. Calls to the practice from external agencies seeking information in safeguarding cases were put on the lead GP’s urgent call list and responded to immediately.
• Systems were in place to ensure information was shared effectively between services to keep patients safe. The practice was proactive in supporting and leading multi-agency working with regard to safeguarding.
• 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.
• The practice offered longer appointments for patients who needed them, including those with a learning disability.
• 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