Archived: The James Cochrane Practice Also known as Maude Street Surgery

Updated 18 November 2016

The James Cochrane Practice provides Primary Medical Services to the town of Kendal and the surrounding areas to approximately a seven mile radius. The practice provides services from two locations;

• Helme Chase Surgery, Burton Road, Kendal, Cumbria, LA9 7HR,
• Maude Street Surgery, Maude Street, Kendal,Cumbria,LA9 4QE,

We visited both locations as part of the inspection.

The practice dispenses medicines from both locations. This means under certain criteria they can supply eligible patients with medicines directly.

Helme Chase surgery is located in converted residential premises in a residential area of Kendal. The branch surgery at Maude Street is closer to the town centre of Kendal and is located in purpose built premises. There is step free access at the front of both buildings and a bell for patients to attract attention if they cannot manage the front doors. Some patient facilities at Helme Chase are on the first floor; however there are several consulting rooms downstairs for patients who cannot manage the stairs. There is patient parking including disabled spaces at the Helme Chase. There is roadside parking at the Maude Street branch and arrangements can be made for patients who require disabled access to park in the staff car park at Maude Street.

The practice has seven GP partners and three salaried GPs. Two are female and five are male. Some GPs are part time, the whole time equivalent is 7.87 or 63 sessions per week. There are two nurse practitioners, three specialist nurses, three practice nurses and nine healthcare assistants. There is a practice manager, operations manager, information technology manager, patient service manager and an office manager. There are eight dispensary staff which includes two managers. There are eighteen reception and administration staff.

The practice provides services to approximately 16,580 patients of all ages. The practice is commissioned to provide services within a Personal Medical Services (PMS) contract with NHS England.

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 least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice has lower levels of patients between the ages of 20 to 44, when compared to national averages.

The Helme Chase surgery is open from 8am until 7.30pm Monday to Friday. The Maude Street surgery is open from 8am to 5pm Monday to Friday.

Consulting times with the GPs and nurses range from 8am to 12 noon, and 2pm until 7.20pm at Helme Chase, and 4.50pm at Maude Street.

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

Updated 18 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The James Cochrane Practice on 15 September 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.
• Some risks to patients were assessed and well managed.
• The arrangements for managing medicines, including emergency drugs and vaccinations, in the practice did not keep patients safe.
• 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 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 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.
• The practice was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had led a care home project for the elderly. The aim was to provide high quality care for patients in order to reduce the likelihood of acute admission to hospital. It also aimed to ensure that patients’ end of life plans were in place so that their preferences about their place of death could be met. The practice reported that almost all (92%) patients died in accordance with their known preferences.

The areas where the provider must make improvements are:

• The practice must assure the appropriate and safe storage of medicines and more effective management of repeat prescriptions for patients.

The areas where the provider should make improvements are:

• Consider Disclosure and Barring Service (DBS) checks for staff who carry out chaperoning duties, and carry out risk assessments for administration staff who have not received a DBS check.
• Consider carrying out a yearly fire evacuation drill.
• Review the system in place for the checking and reading of hospital discharge letters, and letters from out of hours services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 November 2016

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

The practice had a register of patient with long term conditions which they monitored closely for recall appointment for health checks. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example, performance for related indicators for patients with COPD were above the national average (100% compared to 96% nationally).

Flexible appointments, including extended opening hours and home visits were available when needed. There was an on the day phlebotomy clinic. The practice’s electronic system was used to flag when patients were due for review.

Patients with long term conditions were reviewed at a combined long-term conditions clinic where possible. Patients were encouraged to self-manage their conditions and the trainee assistant practitioners were utilised for simple reviews for hypertension and asthma.

The GPs had specialist clinical interests; for example, one of the GP partners was a speciality doctor in dermatology. Another GP specialist in ear nose and throat (ENT) services. Patients were encouraged to make an appointment with the relevant GP if they felt their expertise would be of benefit to them. 

Updated 18 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. An audit regarding safeguarding children had been carried out with learning points identified and improved upon.

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 84% to 99%, compared to the CCG averages of 83% to 96% and for five year olds from 70% to 98%, compared to CCG averages of 73% to 98%.

The practice had recently employed a specialist nurse to strengthen the sexual health team at the practice. Contraceptive and sexual health advice was promoted at a local college fresher’s fair. They were also in the process of establishing links with the local primary and secondary schools to deliver health promotion to children.

The practice’s uptake for the cervical screening programme was 84%, which was above the national average of 81.8%. Appointments were available outside of school hours and the premises were suitable for children and babies.

Weekly child immunisation clinics were run by the practice staff.

Updated 18 November 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 offered proactive, personalised care to meet the needs of the older people in its population. For example, 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 navigator who had links to a named social worker. They were employed by the local CCG. The role of the care navigator was 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 had led a care home project for the elderly. The aim was to provide high quality care to patients with advanced care planning to reduce acute admission to hospital and to have deaths in preferred place of care. The key outcomes were 92% of patients remaining in their care homes at end of life. The team working on the project were awarded nursing team finalist of the year by The General Practice Awards. They were also finalists in The British Medical Journal Awards for the project

The practice was responsive to the needs of older people, including offering home visits. Prescriptions could be sent to any local pharmacy electronically and the practice’s own dispensaries had a delivery service.

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 18 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 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. Flexible appointments were available as well as extended opening hours. 

Updated 18 November 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. 84.6% 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. The Alzheimer's Society carried out information sessions at the practice every six weeks.

Performance for mental health related indicators was better than national average. For example, 94.3% of patients with schizophrenia, bipolar affective disorder and other psychoses, had a comprehensive agreed care plan documented within the preceding 12 months. This compared to a national average of 88.5%.

The practice were the lead for a project called The Kendal Integrated Care Community. This was a team of health professionals who worked together for the health of the community. Patients were referred to them who were most vulnerable, for example, at high risk of hospital admission, frail, over age 75 or with enduring mental health needs. 

Updated 18 November 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 including those with a learning disability.

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.

The practice’s computer system alerted GPs if a patient was also a carer. There were 302 patients recorded on the practice’s computer system as a carer which was 2% of the practice population. There was a practice specific carers information leaflet with contact information for carers and the support which was available to them. For the last two years the practice had received an award from South Lakeland carers association in recognition of the high numbers of patients who are carers, which are referred to them for support from the practice.