Captain French Surgery

Updated 14 July 2016

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

The practice provides services to around 9,500 patients from one location:

• The Gillinggate Centre, Gillinggate, Kendal, Cumbria, LA9 4JE.

We visited this this address as part of the inspection.

Captain French Surgery is based in purpose built premises that are shared with external and local support services. The services for patients are on one level. There is on-site parking, disabled parking, a disabled WC and access is step-free. There is sufficient room for wheelchairs to move easily around the surgery.

The practice has five GP partners and two salaried GPs (three male, four female). The practice employs a practice manager, an assistant practice manager, an assistant practitioner, four practice nurses, two healthcare assistants and two medicines managers. The practice also employs 10 staff that undertake reception or secretarial duties, and two administrators. The practice provides services based on a General Medical Services (GMS) contract agreement for general practice.

The practice is an approved training practice where qualified doctors gain experience in general practice.

Captain French Surgery is open at the following times:

• Monday to Friday 8:30am to 6:30pm.

The telephones are answered by the practice Monday to Friday 8am to 6:30pm.

Appointments are available at Captain French Surgery at the following times:

• Monday to Friday 8:30am to 12:30pm and 1:30pm to 6pm.
• Extended hours appointments are available from 7:30am on Tuesday, Wednesday and Thursday mornings, and until 7pm each Tuesday.

The practice is part of NHS Cumbria clinical commission group (CCG). Information from Public Health England placed the area in which the practice is located in band eight for deprivation where one is the highest deprived area and ten in the least deprived. In general, people living in more deprived areas tend to have greater need for health services. Average male life expectancy at the practice is 79 years which is the same as the national average. Average female life expectancy at the practice is 83 years, which is the same as the national average.

The proportion of patients with a long-standing health condition is below average (42% compared to the CCG average of 56% and the national average of 54%). The proportion of patients who are in paid work or full-time employment is above average (67% compared to the CCG average of 59% and the national average of 62%). The proportion of patients who are unemployed is below average (0.6% compared to the CCG average of 4% and national average of 5%).

The NHS 111 service and Cumbria Health on Call Limited provide the service for patients requiring urgent medical care out of hours. Information about these services is available on the practice’s telephone message, website and the practice leaflet.

Updated 14 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Captain French Surgery on 21 April 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. Lessons were learned when incidents and near misses occurred.
• Most risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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. Data from the National GP Patient Survey published in January 2016 showed that patients rated the practice highly for the care they received. For example, 100% patients said they had confidence and trust in the last GP they saw or spoke to compared to the CCG average of 97% and the national average of 95%.
• Information about services and how to complain was available and easy to understand.
• Patients said they were able to get an appointment with a GP when they needed one.
• Urgent appointments were available on the day they were requested.
• Extended hours appointments were available with a GP, nurse or healthcare assistant three mornings and one evening a week.
• 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.
• The practice was responsive to the needs of the population and worked with the local clinical commission group and other local practices to ensure services were provided that met the needs to the population.
• Staff offered care that supported patient centred end of life care; the practice was ranked second in the locality for this provision.

The areas where the provider should make improvement are:

• Review the arrangement for training at the practice to include regular fire training for staff.
• Review the arrangements for clinical audit; demonstrate a clear link between audits and quality improvement.
• Complete a risk assessment of the window blinds used at the practice to reduce potential hazards for children and vulnerable adults.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 14 July 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Patients at risk of hospital admission were identified as a priority for care and support by the practice, comprehensive care plans were in place and regularly reviewed.
• Nationally reported data showed the practice had achieved good outcomes in relation to most of the conditions commonly associated with this population group. For example, the practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with hypertension. This was 0.4% above the local CCG average and 2.1% above the national average. The practice had achieved 91% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 2.6% below the local CCG average and 1.8% above the national average.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition had a named GP and were offered 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 held regular clinics for long terms conditions, for example, for patients with diabetes.

Updated 14 July 2016

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

• There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
• Appointments were available outside of school hours and the premises were mostly suitable for children and babies. However, we found that the window blinds in some areas accessible to patients were a potential hazard for children and vulnerable adults, as no cleat secured the looped cord.
• There were arrangements for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 80% to 100% (CCG average 83% to 97%) and for five year olds ranged from 68% to 95% (CCG average 73% to 98%).
• Urgent appointments for children were available on the same day.
• Pregnant women were able to access an antenatal clinic provided by the midwifery service who use a room in the practice.
• Nationally reported data showed that outcomes for patients with asthma were good. The practice had achieved 98% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 0.1% below the local CCG average and 1% above the national average.
• The practice provided contraceptive and sexual health services.

Updated 14 July 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.
• All patients over the age of 75 had a named GP and patients over the age of 75 were offered an annual health check.
• The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs.
• The practice worked closely with the local care home, the lead GP visited weekly.
• Nationally reported data showed that outcomes for patients with conditions commonly found in older people were good. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 0.4% above the local clinical commissioning group (CCG) average and 2.1% above the national average.
• The practice maintained a palliative care register and offered immunisations for pneumonia to older people.

Updated 14 July 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.
• Patients could order repeat prescriptions and book GP appointments online.
• Telephone appointments were available.
• A text message reminder service was available.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group.
• The practice’s uptake for cervical screening was 81%, comparable to the CCG and national average of 82%.
• Additional services such as new patient health checks, travel vaccinations and minor surgery were provided.
• The practice website provided a good range of health promotion advice and information.

Updated 14 July 2016

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

• The practice held a register for patients experiencing poor mental health.
• Nationally reported data showed that outcomes for patients with mental health conditions were above average. The practice had achieved 98% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 2.7% above the local CCG average and 5.3% above the national average.
• Nationally reported data showed that outcomes for patients with dementia were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 4.3% above the local CCG average and 5.5% above the national average. However, only 74% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which is below the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 14 July 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.
• The practice held a register of patient with learning disability; patients with learning disabilities had been invited to the practice for an annual health check. 65 patients were on this register and 49% had a health check in the last 12 months.
• Nationally reported data showed that outcomes for patients with a learning disability were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with a learning disability. This was the same as the local CCG average and 0.2% above the national average.
• The practice offered longer appointments for patients with a learning disability if required.
• The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Local support services were available at the surgery, the practice had in in-house counselling service that was also available for staff. A local support group that supports people with mental health problems through horticulture met regularly at the practice.

• All patients at risk of hospital admission were identified by the practice as ‘VIP’s’, this included vulnerable patients. These patients were identified as a priority for care and support by the practice.

• 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.
• Patients with no fixed abode could register with the practice and the practice had close links to a local organisation that supported people with housing issues.
• Good arrangements were in place to support patients who were carers.
• The practice had set up a support group for patients with neurological conditions.