Archived: Lowther Medical Centre

Updated 13 December 2017

Lowther Medical Centre is based in the centre of Whitehaven, Cumbria, and provides services to patients from one location: 1 Castle Meadows, Whitehaven, Cumbria, CA28 7RG. We visited this address as part of the inspection.

The practice is located in a purpose built building and provides services to patients at ground and first floor levels. They offer on-site parking including disabled parking, accessible WC’s and step-free access. A passenger lift is available for patients to use to access the consulting rooms on the first floor. They provide services to approximately 10,000 patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

The practice has two GP partners plus three salaried GPs (two male, three female). There are also two nurse practitioners (both female), three practice nurses (all female), one healthcare assistant (female), two phlebotomists, a practice manager, a deputy practice manager, a care co-ordinator, a clinical interface manager and 13 full and part-time support staff.

Opening times are 7.30am to 6.30pm Monday to Friday. Telephones are answered from 8am until 6.30pm on these days. Outside of these times, a pre-recorded message directs patients to 999 emergency services, NHS 111 or out-of-hours providers, as appropriate.

Information taken from Public Health England places the area in which the practice is located in the fourth more deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice’s age distribution profile is weighted towards a slightly older population than national averages. There are more patients registered with the practice over the age of 65 years than the national average.

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

Updated 13 December 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection March 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Lowther Medical Centre on 2 November 2017 as part of our inspection programme.

At this inspection we found:

• 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 generally well-managed, although some risk assessments and policies were overdue for review.

• 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.

• 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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• 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 areas where the provider should make improvements are:

• Review risk assessments and policies which are due for renewal and update them as required.

• Make sure documentation for Patient Group Directions and Patient Specific Directions is signed as directed.

• Continue to monitor and improve access to appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 June 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.
• Performance for diabetes related indicators was better than the national average. For example, 95% of patients with diabetes, on the register, had a last blood pressure reading (measured in the preceding 12 months from April 2014 to March 2015) of 140/80 mmHg or less, compared to a national average of 78%.
• 92% of patients with asthma, on the register, had had an asthma review in the preceding 12 months (April 2014 to March 2015) that includes an assessment of asthma control using the 3 RCP questions, compared to the national average of 75%. At inspection in August 2015 the practice was below average for their performance related to asthma.
• 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 30 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, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were comparable to local and national averages for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 85.6% to 100% and five year olds from 79.5% to 100% (CCG averages 83.3% to 96.7% and 72.5% to 97.9% respectively).
• The practice operated a “sick child protocol” which allowed clinical staff to assess patients in a standardised way and to ensure that they received appropriate care quickly.
• 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.
• Children and babies could be seen urgently and appointments were available outside of school hours. The premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 30 June 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice employed a care co-ordinator. Emergency admissions and accident and emergency attendances of patients on the care co-ordinator’s caseload had dropped in the past 12 months, while the number of referrals to other healthcare providers for these patients had risen from 96 to 143.

Updated 30 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 they offered to ensure these were accessible, flexible and offered continuity of care.
• Appointments were available outside of regular working hours, and a nurse-led triage system was operated from 7.30am from Monday to Friday.
• 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.
• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the national average of 82%. 

Updated 30 June 2016

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

• 93% of patients diagnosed with dementia had their care reviewed in a face-to-face review in the preceding 12 months (April 2014 to March 2015) compared to a national average of 84%.
• 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 30 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 including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients who needed them. Annual reviews for patients with learning difficulties could be held on Saturdays to help those in day care to attend.
• 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.