Station House Surgery

Updated 24 June 2016

Station House Surgery provides Primary Medical Services to the town of Kendal and the surrounding areas. The practice provides services from one location, Station Road, Kendal, Cumbria, LA9 6SA. We visited this address as part of the inspection.

The surgery is located in the converted railway station building adjacent to Kendal railway station, with consulting areas for patients on the ground and first floors. There is parking for patients at the front of the building with dedicated disabled parking bays and staff parking at the rear. There is step free access at the front of the building and a lift to take patients to the first floor.

The practice has six GP partners and four salaried GPs. Six are female and four male. All of the salaried GPs and two of the partners work part time. The practice is a training practice who have GP trainees allocated to the practice (fully qualified doctors allocated to the practice as part of a three-year postgraduate general practice vocational training programme). There are four practice nurses and a research nurse. There are two assistant practitioners and a phlebotomist. There is a practice manager, patient services manager and IT manager. There are twelve administrative members of staff. There is a medicines manager who works in the dispensary with five dispensing staff, some of whom work part time.

The practice provides services to approximately 10,600 patients of all ages. The practice is commissioned to provide services within a General Medical Services (GMS) contract with NHS England.

The practice is open from 8am until 6.30pm Monday to Friday. There are extended opening hours Wednesday to Friday morning and on occasional Tuesday mornings from 7.30am.

Consulting times with the GPs and nurses range from 8.30am – 11:30am and 2pm – 5pm. On extended opening days consulting times run from 7:30am.

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

Information taken from Public Health England placed the area in which the practice was located in the ninth least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The average male life expectancy is 80 years and the female is 83. The average male life expectancy in the CCG area and nationally is 79. The average female life expectancy in the CCG area is 82 and nationally 83. The practice has a higher percentage of patients over the age of 40+ upwards to age 85+ and lower numbers of patients from birth to the age of 35, when compared to national averages. The percentage of patients reporting with a long-standing health condition is slightly higher than the national average (practice population is 57% compared to a national average of 54%). The proportion of patients who are in paid work or full-time employment or education is 68% compared to the CCG average of 59% and the national average of 62%

Updated 24 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Station House Surgery on 5 May 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.
• Risks to patients were assessed and well managed.
• Outcomes for patients who use services were good.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice were involved in a care home project for the elderly with the three GP practices in Kendal. The aim was to provide high quality care to patients with advanced care planning, low admission rates to hospital, prescribing savings and deaths in a preferred place of care.
• The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.
• Patients said they were able to get an appointment with a GP when they needed one, 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 in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.
• Staff throughout the practice worked well together as a team and they received opportunities for development.
• The practice was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 June 2016

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

The IT manager co-ordinated the long term condition registers and the nurse administrator called the patients in for yearly review. Patients were seen for all conditions in one appointment where possible. Flexible appointments, including extended opening hours and home visits were available when needed.

The practice had introduced the ‘year of care’ approach for diabetic patients. The year of care project provides personalised care to patients to provide shared goals and action plans to enable them to self-manage their condition. Patients received their results prior to their appointment with their doctor. There was a protocol in place for the review of these patients. If patients are overdue a medication review this was highlighted on their prescription and if they still did not attend the dispenser would prompt the GP to take action.

Updated 24 June 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. There was a bi-monthly safeguarding meeting at the practice. Community health care staff, for example, health visitor and school nurse attended the meetings where possible. The IT manager carried out a monthly search for new children registered at the surgery and ensured that the health visitor knew about them.

Childhood immunisation rates for the vaccinations given were in line with CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 85% to 99%, compared to the CCG averages of 83% to 96% and for five year olds from 92% to 96% (with one exception for PVC booster at 63% out of 10 other vaccinations), compared to CCG averages of 73% to 98%.

The practice had a cervical screening programme. The practice’s uptake for the cervical screening programme was 79.4%, which was below the national average of 81.8%; however the practice told us that the data for 2015/16 year, which was not yet published, had improved to 81%. The practice offered minor surgery which included intrauterine device (IUD), contraceptive coil fitting. They also offered contraceptive advice.

Appointments were available outside of school hours and the premises were suitable for children and babies. Ante natal clinics were offered twice weekly in the practice. There was also a baby and child immunisation clinic every Tuesday afternoon.

Updated 24 June 2016

The practice is rated as good for the care of older people.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice was responsive to the needs of older people, including offering home visits. The practice had urgent appointment slots late morning put aside for the elderly as they felt they sometimes had difficulty attending early morning appointments. Fifteen minute appointments were also available for patients who required them. All patients had a named GP. Prescriptions could be sent to any local pharmacy electronically and the practice dispensed medication to those who were eligible for this service or delivered to their homes where appropriate. Elderly patients could be referred to additional organisations such as Age UK for additional support.

Patients who were at high risk of hospital admission or who had recently had contact with the out of hours service or had unplanned hospital admissions were referred to the local care co-ordinator. The role of the care co-ordinator is to support those patients over 75 who are identified as at the greatest risk of a hospital admission. So they maintain their independence and stay in their own homes longer when it is appropriate and safe to do so.

The practice were involved in a care home project for the elderly with the three GP practices in Kendal. There was a multi-disciplinary team involved including a nurse practitioner, community pharmacist and care coordinators. The aim was to provide high quality care to patients with advanced care planning, a high rate of deaths in preferred place of care (in the last year 90% were managed in the home), low admission rates to hospital and prescribing savings. The team working on the project had been nominated for an award by the British Medical Journal.

The practice maintained a palliative care register and end of life care plans were in place for those patients it was appropriate for. They offered immunisations for pneumonia and shingles to older people.

Updated 24 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, flexible and offered continuity of care. The practice was proactive in offering online services which included appointment booking, test results and ordering repeat prescriptions. There was a full range of health promotion and screening that reflected the needs for this age group, this included travel vaccinations. Flexible appointments were available as well as extended opening hours. Phlebotomy was available until 5.30pm one evening a week.

Updated 24 June 2016

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

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health. They carried out advanced care planning for patients with dementia. 84% of patients identified as living with dementia had received an annual review in 2014/15 (national average 84%). The practice also worked together with their carers to assess their needs. Staff had received dementia awareness training.

The practice maintained a register of patients experiencing poor mental health and recalled them for regular reviews. They told them how to access various support groups and voluntary organisations. Reception staff had attended a mental health awareness course. The community psychiatric nurse attended multi-disciplinary meetings every two months.  Qualified counsellors held sessions weekly. Patients were referred to these services by their doctor.

Updated 24 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; all were made aware of their named GP through their care plan which was reviewed on at least an annual basis. The practice had produced letters specifically for patients with learning disabilities, for example, there was one for a reminder for their annual health check which was pictorial.

The practice had a dedicated mobile phone used by patients who had difficulty hearing which was held on reception so that they could communicate easily with the practice.

The practice provided services to a local care home for approximately 15 patients with autism. One of the GP partners was the practice lead for the care home.

The practice’s computer system alerted GPs if a patient was a carer. There was a practice register of all people who were carers and were being supported, for example, by offering health checks and referral for social services support. There were 275 patients on the carer’s register which is 2.59% of the practice population. Written information was available for carers to ensure they understood the various avenues of support available to them.