Archived: Cartmel Surgery

Updated 8 July 2016

Dr S D Milligan and Dr H M Lovatt is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 2400 patients from one location at Cartmel Surgery, Haggs Lane, Cartmel, Grange-over-Sands, Cumbria, LA11 6PH. This is the location we visited on the day of our inspection.

The practice is based in a renovated, one-storey building owned and managed by the partners. There is level access to the building and a car park available for patients.

The practice has 16 members of staff, comprising two GP partners (one male, one female), one salaried GP (female), one GP registrar (female), one practice nurse (female), two healthcare assistants (both female), one dispensary manager and two dispensers, a practice manager, an IT manager/clinical interface manage and four administrative and reception staff.

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 ninth most deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The surgery is open from 8am until 6.30pm, Monday to Friday. Appointments with a GP are available from 9am to 11.15am from Monday to Friday, and from 3.30pm to 5.30pm on Monday, Tuesday, Wednesday and Friday. The practice is closed at weekends. The telephone lines operate at all times during opening hours. Outside of these times, a message on the surgery phone line directs patients to out of hours care, NHS 111 or 999 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. The practice population has higher-than-average numbers of patients in all age brackets from 50-54 upwards. All age brackets for people younger than 40 are below average, with the number of people aged 20-40 particularly low. 

Updated 8 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S D Milligan and Dr H M Lovatt on 19/04/2016. 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.
• The practice was rated first in the clinical commissioning group (CCG) area for the percentage of their patients who had had advanced care plans (ACP) discussed. Advance Care planning is key means of improving care for people nearing the end of life and of enabling better planning and provision of care.
• Patients said they were truly respected and valued as individuals and were empowered as partners in their care. Patient satisfaction with their care was much higher than local and national averages. For example, in the National GP Patient Survey 97% of patients said the last GP they saw was good at involving them in decisions about their care, compared to the national average of 82%.
• The involvement of other organisations and the local community was integral to how services were planned and ensured patients’ needs were met.
• 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. For example, 100% of patients said that the last time they wanted to see or speak to a GP or nurse from their GP surgery they were able to get an appointment (national average 76%).
• 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:

• There was a strong, person-centred approach to supporting carers and those they cared for. For example, people who were cared for were given a “hospital passport” for use in emergency admissions to hospital. This contained the carer’s contact details, as well as information which could assist staff in secondary care with personalised care planning.
• The practice worked with the local primary school to offer an annual “treat teddy” session to pupils to promote awareness about health issues and their treatment.
• The practice used key indicators based on guidance from the Scottish Intercollegiate Guidelines Network (SIGN) to measure and drive improvement in the care of diabetes. This was in reponse to data which showed the practice had a higher than local average prevalence of the disease, but that overall performance for diabetic patients was average. Data from 2015/16 showed improvements not only in each individual SIGN indicator, but also in the number of patients who were meeting all the identified targets.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 July 2016

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. For example, 100% of patients with diabetes, on the register, had received an influenza immunisation between August 2014 and March 2015 (national average 94.5%).
• The practice used key indicators based on guidance from the Scottish Intercollegiate Guidelines Network (SIGN) to measure and drive improvement in the care of diabetes. This was in reponse to data which showed the practice had a higher than local average prevalence of the disease, but that overall performance for diabetic patients was average. Data from 2015/16 showed improvements not only in each individual SIGN indicator, but also in the number of patients who were meeting all the identified targets.
• 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 8 July 2016

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 83%, which was comparable to the national average of 81%.
• 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 offered an annual “treat teddy” session to children in the Reception and Year One classes at the local primary school to promote awareness about health issues and their treatment.

Updated 8 July 2016

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 its 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 had initiated a weekly walk for patients and local people to improve their health and wellbeing. The walk was now run by volunteers and sponsored by the practice, who promoted it to their patients.

Updated 8 July 2016

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.

Updated 8 July 2016

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.

• 92% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.
• Performance for mental health related indicators better than the national average. For example, 100% 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) (national average 88.5%).
• 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 8 July 2016

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 travellers and those with a learning disability.
• The carers lead worked with local and national organisations to provide carers with support. Examples of this included helping to source financial advice, support acquiring equipment, and working with the local fire service to provide carers with fire safety checks at their homes.
• People who were cared for were given a “hospital passport” for use in emergency admissions to hospital. This contained the carer’s contact details, as well as information which could assist staff in secondary care with personalised care planning.
• The practice offered longer appointments for patients 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.