Archived: Seascale Health Centre

Updated 15 November 2016

Seascale Health Centre is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 5,700 patients from two locations:

• Gosforth Road, Seascale, Cumbria, CA20 1PN
• Bootle Surgery, Chapel Lane, Bootle, Cumbria, LA19 5UE

We visited both sites as part of this inspection.

The main surgery site is based in a purpose-built surgery building, while the branch site is in a converted bungalow. Both buildings are owned and managed by the partners. Both have level-entry access and all patient services are on the ground floor. There is a designated parking area for patients at both sites.

The practice has 30 members of staff, including five GPs (three male, two female), two nurse practitioners (both female), a clinical pharmacist (female), six practice nurses (all female), two healthcare assistants (both female), a practice manager, an assistant practice manager and eight administrative/reception staff. There is also a dispensary manager and five dispensers. Some of the nurses and healthcare assistants at the practice also work as 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 eighth most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice population has fewer patients than average in all age brackets below the age of 45, with particularly lower than average numbers of patients between the ages of 25 and 29. There are more patients in each age bracket over 50, than the national average.

The main surgery is open for appointments from 8am to 6.30pm Monday to Friday, with extended opening until 7pm offered on Mondays. The dispensary at this site is open from 8.45am to 1pm Monday to Friday, and 3pm to 6pm on Monday, Wednesday and Friday, and 2pm to 6pm on Tuesday and Thursday.

The branch surgery at Bootle is open from 9am to 1.30pm Monday, Wednesday and Thursday, and occasionally from 2pm to 4.30pm on Thursdays. The dispensary operates during the morning opening hours.

The practice offers urgent and routine appointments, as well as telephone appointments and home visits. Telephones at the practice are answered from 8am to 6.30pm. 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 (PMS) contract agreement for general practice.

Updated 15 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Seascale Health Centre on 28 July 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 report incidents and near misses, and the system for doing so was regularly reviewed by all staff. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practiceFeedback from patients about their care was consistently and strongly positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, external specialists were regularly invited to the practice to appraise their systems and offer ideas for improvement.
• The practice implemented suggestions for improvements and made changes to the way they delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example, after consultation with the PPG, letters inviting patients to review included goals that patients could set themselves and then discuss with the nurse or GP
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw some areas of outstanding practice:

• The leadership and governance at the practice had allowed them to maintain their objective of offering high quality care despite the number of GPs at the practice reducing. The practice had introduced new models of leadership to help meet the challenge of recruiting in a remote rural area.
• The practice maintained a “weekly patient review” tool which gave them an at-a-glance overview of all the contacts any given patient had had with the practice or secondary care providers (such as out-of-hours providers) within a given timeframe. Data had been collected for the past six years and was updated weekly. All members of the practice and some of the allied healthcare team, such as health visitors, could add to the tool. It had been used to coordinate and manage the care of patients, such as those with long-term conditions, as well as provide evidence for safeguarding vulnerable adults and children.

The areas where the provider should make improvement are:

• The disposal records of medicines should include the signatures of the two people undertaking the disposal.
• The location of the prescriptions awaiting collection at the branch surgery should be reviewed to ensure patient confidentiality is not breached.
• Staff should complete child safeguarding training to a level relevant to their role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 November 2016

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

• Specialist nurses offered clinics in the area where they had specific expertise. The practice invited a national specialist in diabetes care to come to the practice to advise them on how these nurse-led clinics could be improved.
• Performance for diabetes related indicators was better than local and national averages. For example, 96% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months (April 2014 to March 2015) compared to the CCG average of 89% and the national average of 88%.
• All appointments were 15-minutes, but 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. These reviews were carried out by specialist nurses with support from a clinical pharmacist.
• The practice invited a team of clinical pharmacists to review their care of patients with long-term conditions. This resulted in 477 additional patients being added to registers related to QOF domains and invited for review.
• The practice used the “Weekly Patient Review” tool to coordinate care for patients with long-term conditions and enable them to attend appointments
• Letters inviting patients to reviews for their long-term conditions were used to encourage self-management in patients where this was appropriate.
• The practice also worked with the PPG to produce health promotional material and to encourage patients with long term conditions to be able to self manage these. As a result, letters inviting patients to review now included goals that patients could set themselves and then discuss with the nurse or GP.

Updated 15 November 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 15 November 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.
• The practice employed a care co-ordinator whose role was to support the practice’s patients who were over the age of 75 years. They worked closely with the practice pharmacist. As such the practice had managed to achieve the highest rate of medication review for this patient group in the locality (28% of eligible patients reviewed, with the second highest practice having achieved 12% of their eligible patients reviewed).

• The practice could use the “Weekly Patient Review” tool to identify patients who have suffered falls and who would benefit from being added to the care co-ordinator’s caseload.

Updated 15 November 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 81%, which was comparable to the CCG and national averages of 82%.

Updated 15 November 2016

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

• Performance for mental health related indicators was similar to the local and national average. For example, 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record in the preceding 12 months (April 2014 to March 2015) compared to the CCG average of 90% and the national average of 88%.
• 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.
• 72% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%.
• 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 15 November 2016

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

• The practice showed they provided effective support for patients who were also carers and had identified approximately 3% of their patients as being carers.
• The practice offered 15-minute appointments to all patients, and longer ones for those who required them.
• A wheelchair user had appraised the premises to identify ways to make the practice more wheelchair accessible, and changes had been made as a result.
• The practice was able to identify vulnerable patients from their “weekly patient review” tool. This data was useful for safeguarding vulnerable children by highlighting repeated attendances at accident and emergency departments or recurrent non-attendance of appointments, and had been used in safeguarding investigations carried out by the local children’s safeguarding board.
• The practice held a register of patients living in vulnerable circumstances 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.

• 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.