Distington Surgery

Updated 18 January 2017

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

The practice provides services to approximately 4,000 patients from one location at Hinnings Road, Workington, Cumbria, CA14 5UR. We visited this location on this inspection.

The practice is based in purpose-built practice which is owned by the partners. It has level access and patient services for the surgery are on the ground floor. The building has been extended a number of times since being built in 1965, with the most recent renovations taking place in 2010.

The practice team comprised four GP partners (two female, two male), three salaried GPs (all female), four practice nurses (all female), one healthcare assistant, a practice manager plus 10 admin/reception staff including a clinical interface manager, a patient liaison manager and an apprentice. In the dispensary there is a manager, a senior dispenser/medicines manager and five dispensers.

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 fifth most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The life expectancy for men and women was 78 and 81 years respectively, which reflected the local (79 years for men, 82 years for women) and national averages (78 years for men, 83 years for women). The practice had 62.2% of patients who reported living with a long-term condition, which was slightly higher than the local average of 56.3% and national average of 54%. The practice population profile is relatively similar to the national average, with slightly more patients than average over the age of 50 and slightly fewer under the age of 40.

The surgery is open from 8am to 6.30pm, Monday to Friday and closed at weekends. Extended opening times are offered until 7pm on Tuesdays and Wednesdays. 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 General Medical Services (GMS) contract agreement for general practice.

Updated 18 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Distington Surgery on 20th October 2016. 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.
• 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 several areas of outstanding practice:

• The practice worked closely with local organisations to support the 7% of their patient list who they had identified as carers. Feedback from people who used the service, those who were close to them, and stakeholders was continually positive about the way staff treated people. We received an exceptionally high number of patient Care Quality Commission comment cards (174), all of which were positive about the service experienced. Results from the National GP Patient Survey showed how highly patients rated the care they received, for example 98% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 90% and the national average of 85%.
• The involvement of other organisations and the local community was integral to how services were planned. The practice had worked with the local council and other groups to help create a “health walk” in the village. They operated a service with the local post office to allow patients to collect their prescriptions from there, in response to cuts to public transport affecting patients’ ability to collect them from the surgery. They had started a fitness club which was now community run but which continued to be part funded by the practice.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality, person-centred care. The practice had undertaken training on personality testing, which they believed had increased productivity and reduced workplace conflict. Staff told us that the personality tests had given them a better understanding of why people worked the way they did, and also about how they worked themselves, and felt that it had improved working relationships at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 January 2017

The practice is rated as outstanding for the care of people with long-term conditions, as the practice is rated as outstanding overall.

• 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. They achieved 100% of the points available compared to the CCG average of 95.2% and the national average of 89.1%.
• 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.

• The practice had run a “ditching diabetes” scheme which led to 17 out of a sample of 29 patients no longer being at risk of developing diabetes.

Updated 18 January 2017

The practice is rated as outstanding for the care of families, children and young people, as the practice is rated as outstanding overall.

• 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.
• The practice’s uptake for the cervical screening programme was 84%, which was comparable to the CCG and national averages of 82%.
• 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 18 January 2017

The practice is rated as outstanding for the care of older people, as the practice is rated as outstanding overall.

• 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.
• A care coordinator worked at the practice and helped to plan the care and identify support for older patients. They visited patients in their own homes and worked with them on care plans to ensure that they received the support they needed. There were plans for them to be included in the formation of a “Frail Elderly Team” with a GP and practice nurse.
• Performance for indicators related to conditions commonly associated with older patients, such as chronic obstructive pulmonary disease (COPD) was better than the national average. They achieved 100% of the points available (CCG average 98.7%, national average 95.9%).
• A practice nurse had been employed with experience of district nursing to offer services to patients who fell just outside of the threshold for receiving district nursing care. They were able to manage wound care and visit patients at home who were unable to come to the practice.

Updated 18 January 2017

The practice is rated as outstanding for the care of working-age people (including those recently retired and students), as the practice is rated as outstanding overall.

• 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.
• There were extended opening hours for patients who could not attend during working hours.

Updated 18 January 2017

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

• 82% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.
• Performance for mental health related indicators was better than the national average. They achieved 99.2% of the points (CCG average 95.1%, national average92.8%).
• 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 18 January 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• 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.
• The practice worked closely with the local carers’ organisation and had identified 7% of their practice list as carers.
• 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.