We carried out an announced comprehensive inspection at Shap Medical Practice on 31 January 2019 as part of our inspection programme. (Previous rating August 2015 – Good)

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected;
• information from our ongoing monitoring of data about services and;
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall, and outstanding for responsive and all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff treated patients with kindness and respect and involved them in decisions about their care.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We rated the practice as outstanding for providing responsive services because:

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
• There were innovative approaches to providing integrated person-centred care.
• The practice had identified areas where there were gaps in provision locally and had taken steps to address them.

We saw some areas of outstanding practice:

• The practice had scored above local and national averages for every question in the most recent National GP Patient Survey, released in July 2018. They showed us a report which ranked the practice’s performance in the survey at 107th out of all GP practices in England. Locally they ranked in the top three for many questions, especially those related to access to appointments.
• The practice carried out a number of services above those they were commissioned to perform, in order to benefit local patients and reduce pressure on other services. These included basic life support training for patients, carrying out catheter changes for patients, and identifying and monitoring patients with coeliac disease.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shap Medical Practice on 13 August 2015. Overall the practice is rated as good.

Specifically, we found the practice to be outstanding for providing responsive services and good for providing safe, effective, caring and well-led services. It was also good for providing services for the following population groups: Older people; People with long-term conditions; Families, children and young people; Working age people (including those recently retired and students); People whose circumstances may make them vulnerable; People experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Scores in relation to this were high in the National GP patient Survey (July 2015). 83% said the last GP they saw or spoke to was good at involving them in decisions about their care (national average 74%) and 75% said the last nurse they saw or spoke to was good at involving them in decisions about their care (national average 65%).
• 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.
• The practice scored very highly in relation to access in the National GP Patient Survey. The most recent results (July 2015) showed 90% (compared to 73% nationally and 78% locally) of respondents were able to get an appointment or speak to someone when necessary.
• The practice offered pre-bookable appointments on alternate Monday evenings with GPs and nurses, which improved access for patients who worked full time.
• 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 proactively sought feedback from staff and patients, which they acted on. For example, following suggestions from patients, a calibration service for patients own blood pressure monitors had recently been arranged.
• Information about services and how to complain was available and easy to understand.
• Staff retention was high and clinical and non-clinical staff worked effectively as a team.

We saw several areas of outstanding practice including:

• GPs preferred to see their own palliative care patients out of hours and carried out proactive visits at weekends and on evenings. Patients and their relatives were given the doctors personal telephone numbers so they could contact them at any time. A recent audit showed that over the past five years 43% of deaths occurred at the patient’s own home, this was in comparison to 22% nationally and 23% locally (data taken from Public Health England).
• The practice made use of their IT facilities and premises to access support from community organisations. For example a ‘TellyTalk’ service at the practice enabled patients to contact Age UK, Citizens Advice or Carlisle Law Centre. (TellyTalk is a video conferencing facility which enables a patient visiting the practice to see, hear and speak to an officer based in various locations). Patients were able to use TellyTalk within the practice to access free information and advice.
• Due to the rural area covered by the practice, all of the doctors carried oxygen and defibrillators in their cars. All of the doctors had winter tyres for their vehicles so in the event of severe weather staff could still visit patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice