Mansion House Surgery

Updated 23 May 2016

Mansion House Surgery is registered with the Care Quality Commission to provide primary care services. The practice is based in the centre of Whitehaven and provides care and treatment to 6425 patients from the Whitehaven area. The practice is part of the Cumbria clinical commissioning group and operates on a General Medical Services (GMS) contract.

The practice provides services from the following address:

Mansion House Surgery, 19/20 Irish Street, Whitehaven, Cumbria, CA28 7BU.

The practice is based in a listed restored Georgian mansion house. Disabled access is available at the rear of the property and the building provides fully accessible treatment and consultation rooms over three floors which are accessible by lift for patients with mobility needs. Although on-site parking is not available for patients, with the exception of one disabled car parking space, there is a pay and display car park near to the rear of the surgery. The practice is open between 8.00am to 6.30pm on a Monday to Friday. On one night per week (either a Monday, Tuesday or Wednesday) the practice is open until 8.15pm.

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

Mansion House Surgery offers a range of services and clinic appointments including chronic disease management clinics, family planning, maternity services, cervical screening, NHS health checks, immunisations, vaccinations, foreign travel advice and minor surgery. The practice consists of six GP partners (four male and two female), four practice nurses, two health care assistants, a practice manager, medicines manager, reception manager, assistant reception manager, finance administrator, care co-ordinator and eight administrative staff who provide reception, typing and secretarial services. The practice is a teaching practice and is involved in the training of GP trainees and foundation doctors (qualified doctors training to become a GP).

The Care Quality Commission (CQC) intelligent monitoring tool placed the area in which the practice is located in the fourth (out of ten) most deprived decile. In general people living in less deprived areas tend to have a lesser need for health services.

The practice’s age distribution profile showed higher percentages of patients in the 45 – 69 year old age groups than the national average. Average life expectancy for the male practice population was 79 (national average 79) and for the female population 82 (national average 83).

Updated 23 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mansion House Surgery 25 August 2015. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Some risks to patients and staff were not assessed and systems and processes were not fully implemented to keep patients safe. For example, there were no assurance systems in place to confirm cleanliness and infection control procedures were effective. Small patches of damp were evident in the building.
• Staff appraisals were not up to date for all staff groups
• Although some clinical audits had been carried out, we saw no evidence that audits were planned effectively or driving improvement in performance to improve patient outcomes.
• 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 on request and easy to understand; however this was not as readily accessible to patients as it could have been.
• Urgent appointments were usually available on the day they were requested; however patients said that they sometimes had to wait a long time for non-urgent appointments.
• The practice had a number of policies and procedures to govern activity and held regular scheduled meetings for all staff groups
• The practice had sought feedback from patients but did not have a patient participation group or website and was not included on the NHS Choices website.
• The practice did not have a documented vision or business plan for the future; however they had identified some of the challenges faced. There was a leadership structure and staff felt supported by management. However, some of the systems and processes which should have been in place to keep patients and staff safe were not established.
• The practice had been instrumental in the development of a Community Nursing scheme to ensure more co-ordinated care in the community for older patients. Although this was a clinical commissioning group (CCG) incentive the practice had been proactive in developing and piloting the scheme.
• The practice had employed a care co-ordinator to support elderly, frail and palliative care patients
• The practice hosted an on-site ultrasound and 24 hour ECG facility for the clinical commissioning group.

We saw one area of outstanding practice:

• The practice had employed a care coordinator whose role was to ensure that appropriate care and support was in place for frail and elderly patients and those with dementia   

However, there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Ensure that all staff are given the opportunity to have a regular appraisal.

In addition the provider should:

• Review the process for identifying, carrying out and reviewing areas for clinical audit.
• Continue with their plans to set up a patient participation group and practice website.
• Develop a business plan to reflect and record aims, objectives, risk and mitigating actions.
• Put in place appropriate arrangements to maintain a clean environment and assess the risk, detect, prevent and control the spread of infections by carrying out regular infection control audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 November 2015

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

The practice was able to demonstrate comprehensive and regularly reviewed care planning for patients with long-term or complex conditions and had a system in place to ensure patients were recalled for reviews when required. Medication reviews were routinely timed to coincide with a patients long term condition review.

GP leads had been identified for some of the more common long term conditions such as diabetes and respiratory problems and there was a dedicated chronic disease lead nurse. Chronic disease management clinics were held for patients with diabetes, respiratory problems, chronic obstructive pulmonary disease (COPD) and comorbidity. The practice worked with regard to the ‘Walking Away from Diabetes’ programme (a programme to reduce the likelihood of at risk patients developing type 2 diabetes) and encouraged diagnosed diabetics to self-manage their condition through DESMOND (diabetes education and self-management for ongoing and newly diagnosed diabetics) training.

The practice regularly reviewed and updated their protocols following the issue of new guidance from the National Institute for Health and Care Excellence (NICE) and ensured this information was cascaded to all clinical staff through weekly meetings.

The practice monitored how well it performed against key clinical performance indicators such as those contained within the Quality and Outcomes Framework (QOF) (QOF is a voluntary incentive scheme for GP practices in the UK which financially rewards practices for managing some of the most common long term conditions and for the implementation of preventative measures). The practice had achieved 99.9% of the points available to them in respect of QOF for 2013/14 which was 5% above the local CCG and 6.4% above the national averages.

Updated 12 November 2015

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 looked after children or children subject of a child protection plan. Two of the GPs had been identified as the safeguarding lead and deputy. Bi-monthly multi agency meetings were held to discuss children at risk which were attended by the GP leads, midwife and health visitor.

The practice had a recall system in place for childhood immunisations and rates were above or broadly in line with local averages for all standard childhood immunisations.

Appointments were available outside of school hours commencing at 8.00am daily and up to 8.15pm one night per week. Cervical screening rates for women aged 25-64 were above the national average at 85.5% (national average 81.9%; CCG average 82.9%).

The practice GPs carried out checks on newly born babies at 10 days old and used this as an opportunity to look for early signs of post natal depression or more serious mental health issues in the mothers.

Updated 12 November 2015

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

Nationally reported data showed the practice had achieved good outcomes in relation to the conditions commonly associated with older people. Patients over the age of 75 had a named GP and were routinely invited to attend an over 75 health check. The practice had been instrumental in identifying the need for and developing a Community Nursing Project with the local Clinical Commissioning Group (CCG) and had become a pilot for this project which had been running since November 2014. The aim of the project was to integrate services and deliver more coordinated patient care between community/district nurses, practice nurses and GPs to improve the service delivered to older patients, palliative care patients and those with long term conditions. This had led to numerous improvements including better end of life care, home visiting arrangements, medication reviews and care plans which the practice felt had led to a reduction in the number of patients admitted to hospital. The practice also employed a care co-ordinator whose role was to ensure that, with the consent of the patient or carer, appropriate care and support was in place for the frail and elderly and those experiencing dementia.

The practice actively identified and flagged palliative care patients to ensure they were supported appropriately and the palliative care nurse met with the clinical team on a weekly basis.

Home visits were routinely available and the community nursing team had developed a rolling programme to ensure reviews of long term conditions and annual assessments were carried out for housebound patients.

At 76.9% the percentage of patients aged 65 and older who had received a seasonal flu vaccination was higher than the national average of 73.2%.

Updated 12 November 2015

The practice is rated as good for the care of working age patients (including those recently retired and students).

Nationally reported data showed that 57% of the practice population either worked or was in full time education (national average 60.2%). In addition the practice had identified that only 17% of its patient population was aged 65 years or over. The practice was proactive in meeting the needs of these patients by offering online services such as being able to order repeat prescriptions, book appointments and view parts of their medical records. However, the practice did not have its own website so this service was hosted by an external provider. The practice was open until 6.30pm on a Monday to Friday and remained open until 8.15pm one night per week. Repeat prescriptions could be ordered at any time either online or by phone between 10am and 4pm on a Monday to Thursday and 10am to 3.30pm on a Friday. The practice was also involved in the Choose and Book scheme which enabled patients referred to a hospital or clinic to choose the provider of their choice and at date and time which is convenient. The practice was proactive in offering NHS health checks.

Updated 12 November 2015

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

The practice had exceeded the national average in ensuring comprehensive and agreed care plans were in place for patients with schizophrenia, bipolar affected disorder and other psychoses (97% compared to an England average of 86%) and was in line with the England average for ensuring patients diagnosed with dementia had received a face-to-face review within the preceding 12 months.

The practice was committed to proactively and opportunistically offering assessment to patients at risk of dementia and depression and to continually improving the quality and effectiveness of care provided to this group of patients. The practice had employed a care co-ordinator whose role included identifying elderly patients who may be living with dementia and ensuring the appropriate care package was discussed and agreed with the named GP as well as the patient or carer before implementation. Patients were assessed using a recognised toolkit (the Outcomes Star) which focuses on re-enablement and maximising independence and well-being. Dementia screening was also carried out on patients over 65 as part of their NHS Health Check and during appropriate long term condition reviews. The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the previous 12 months was 95% compared to a national average of 83.8% and CCG average of 84.8%.

The practice had developed effective working relationships with the local crisis, community mental health services and local authority social worker teams and supported self-referral to the Cumbria Partnership ‘First Step’ programme (an initiative developed to provide free talking therapies for depression, anxiety and other mental health related issues).

Updated 12 November 2015

The practice is rated as good for the population group of patients whose circumstances may make them vulnerable.

The practice had a register of patients aged 18 or over with a learning disability and had developed a god working relationship with the local learning disability home. A recall system was in place to ensure these patients were offered an annual health check and were encouraged, with their carers if appropriate to participate in the development of their care plan. Since implementing the inclusion of carers in the process the practice had seen an improvement in this area. For example that dietary advice had been adhered to effectively.

Staff knew how to recognise signs of abuse in vulnerable adults and children and how to raise safeguarding concerns with the relevant agencies. The practice had identified a clinical lead for dealing with vulnerable adult and vulnerable children cases and all practice staff had undertaken safeguarding training at a level appropriate to their role. Multi-disciplinary safeguarding meetings were held on a regular basis (bi-monthly).

The practice had identified a lead GP for drug and alcohol addiction. A drug counsellor from Unity Drug and Alcohol Recovery Service (who provide treatment and recovery support for patients and family members affected by substance misuse) attended the surgery on a fortnightly basis and joint clinics involving the lead GP and the councillor were held quarterly.

New mothers were routinely screened for post natal depression at their babies ten day check and their own six week check-up. Patients who had suffered bereavement were signposted to appropriate counselling services by the practice care co-ordinator. The practice was proactive in identifying carers and had developed an effective working relationship with the local carers association who had attended the surgery to deliver support and advice to patients.