Archived: Orchard House Surgery

Updated 18 May 2017

Orchard House Surgery is registered with the Care Quality Commission to provide primary care services. It is located in the town of Workington in Cumbria.

The practice provides services to around 5,500 patients from one location: South William Street, Workington, Cumbria, CA14 2ED. We visited this address as part of the inspection. The practice has four GP partners (two male and two female), one salaried GP (female), two practice nurses (both female), a healthcare assistant, two practice managers, a medicines manager and 11 staff who carry out reception and administrative duties.

However, the practice’s CQC registration certificate shows that there are three male GP partners and one female GP partner; managers were aware of this and advised us that they would submit an application to amend the partnership details.

The practice is part of Cumbria clinical commissioning group (CCG). The practice population is in line with national averages, although the proportion of patients aged 65 and over is below average (19.7% compared to the national average of 22.4%). Information taken from Public Health England placed the area in which the practice is located in the third more deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The practice is located in a purpose built two storey building. There is a lift, on-site parking, disabled parking and a disabled WC. The main door to the building is automated, however, the door to access the practice is not and there is no doorbell or alternative way for patients to summon support to access the surgery.

Opening hours are between 8.30am and 6.30pm Monday to Friday. Patients can book appointments in person, on-line or by telephone. Appointments are available at the following times:

Monday - 9am to 11am; then from 3pm to 5.40pm

Tuesday – 9am to 11.30am; then from 3pm to 5.40pm

Wednesday – 9am to 11.20am; then from 3pm to 5.40pm

Thursday – 9am to 11.20am; then from 3pm to 5.40pm

Friday – 9am to 11.20am; then from 3pm to 5.40pm

Patients can also access urgent same day appointments at the local Primary Care Centre from Monday to Friday between 8am and 8pm.

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

The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Cumbria Health on Call Limited (CHoC).

Updated 18 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Orchard House Surgery on 10 May 2016. The overall rating for the practice was good, although the practice was rated as requires improvement for safety. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Orchard House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 10 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good for safe services, and overall the practice is rated as good.

Our key findings were as follows:

• The practice had taken action to address the concerns raised at the CQC inspection in May 2016. They had put measures in place to ensure they were compliant with regulations.
• Appropriate arrangements were now in place for the proper and safe management of medicines, including monitoring the temperatures of the refrigerators used to store vaccines, maintaining records of blank prescription form serial numbers in line with guidance issued by NHS Protect, and checks to ensure changes made to patients’ records are correct.

• Arrangements were in place to ensure there was a practice-wide approach to the review of any new or revised clinical guidelines.
• Appraisals had been carried out for all staff in the past 12 months.
• A clearly-signed call button had been put in place to enable patients to summon support to access the surgery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 June 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
• The practice had adopted the ‘Year of Care’ (YoC) approach, as their model for providing personalised care to patients diagnosed with some long term conditions. (The YoC approach aims to provide personalised care planning for patients by focussing on promoting self-management and educating them about their condition.)
• Longer appointments and home visits were available when needed. The practice’s electronic 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.
• Patients had regular reviews to check health and medicines needs were being met.
• For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 13 June 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 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.
• The practice’s uptake for the cervical screening programme was 80.9%, which was slightly below the CCG average of 82.5% and the national average of 81.8%.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 13 June 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 its population. For example, all patients over the age of 75 had a named GP and patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
• A local group of practices, including Orchard House Surgery had recently worked together and had introduced a FEAT team (Frail elderly and vulnerable adult team); with the aim of providing patients with bespoke support and preventing unnecessary hospital admissions.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.

Updated 13 June 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 and flexible. Urgent same day appointments at the local Primary Care Centre were available Monday to Friday between 8am and 8pm for working patients who could not attend during normal opening hours.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
• Additional services were provided such as health checks for the over 40s and travel vaccinations.

Updated 13 June 2016

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

• The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
• Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
• The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.

Updated 13 June 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.
• Large print and picture animated invitations were sent to patients with learning disabilities, to invite them to attend the practice for their health checks.
• Longer appointments for people with a learning disability were available, if required.
• The practice had effective working relationships with multi-disciplinary teams in the case management of vulnerable people.
• Vulnerable patients were provided with a dedicated telephone number to contact the practice; a different ring tone was assigned and the telephone screen showed the word ‘vulnerable’; this alerted staff that a vulnerable person was on the telephone and may have needed urgent assistance.
• 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.
• Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check and referred for a carer’s assessment.