We carried out an announced comprehensive inspection at Upper Eden Medical Practice on 15 March 2019 as part of our inspection programme. (Previous rating November 2014 – Outstanding).

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 good for 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 dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw an area of outstanding practice:

• Nurses at the practice had undergone extra training to be able to perform clinical interventions for patients at the practice or in their own homes to save them a journey to hospital. This included changing urinary catheters, flushing peripherally inserted central catheters (PICC lines) and emptying chest drains. These were services the practice was not commissioned for.

However, there were some areas where the practice should make improvements:

• Carry out an annual infection control audit for all practice sites;
• All staff should complete any overdue mandatory training;
• Prescription stationery should be stored in a locked cabinet at all sites in accordance with current guidance;
• The provider should improve the follow up for patients with a recent diagnosis of cancer and also improve the percentage of patients diagnosed with cancer who are referred by the practice via the two week wait route;
• Set up regular meetings or emails with the patient participation group in order to gather feedback.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected Upper Eden Medical Practice on 19 November 2014 and visited the surgery in Kirkby Stephen and one of the practice’s two branch surgeries in Brough. We did not visit the practice’s other branch surgery in Tebay as part of this inspection, however we did receive some CQC comment cards from patients who attended the branch. We inspected this service as part of our comprehensive inspection programme.

Overall, we rated the practice as outstanding. Our key findings were as follows:

• Patients reported good access to the practice and continuity of care, with urgent appointments available the same day. All appointments could be booked online, regardless of how far in advance of the appointment date they were released.
• Patients said, and our observations confirmed, they were treated with kindness and respect.
• Patient outcomes were in line with averages for the locality and good practice guidance was referenced and used routinely.
• The practice understood the needs of the local rural population and provided services from three sites, which helped patients to access the service locally.
• The main practice and branch surgery we visited were visibly clean and tidy.
• The practice learned from incidents and took action to prevent a recurrence.

We saw the following areas of outstanding practice:

• The practice was considered to be outstanding in terms of their safety. Patients were protected by a very strong safety system with a focus on openness, transparency and learning.
• There was a genuinely open culture in which all safety concerns raised by staff and patients were highly valued as being integral to learning and improvement. The impact of this was lessons were learned and improvements made to prevent reoccurrence when things went wrong.
• The practice had low referral rates to secondary and other community care services compared to other practices in the area. All the GPs we spoke with said this was as a direct result of their ability to complete in-house referrals to their GP colleagues within the practice. GPs in the practice had a number of special interests, including in the areas of ophthalmology, dermatology, diabetic and paediatric care. This reduced the length of time patients had to wait to see specialists in these areas.
• The practice was considered to be outstanding in terms of being well-led. The leadership, governance and culture had a positive impact on the delivery of care. The quality of care was high and very person centred.
• Constructive challenge from patients, the public and stakeholders was welcomed and seen as a vital way of holding the practice to account.
• There were strong governance and performance management arrangements which reflected good practice and were proactively reviewed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Upper Eden Medical Practice is situated in Kirkby Stephen and provides primary medical care services to patients living in and around the Kirkby Stephen, Brough and Tebay areas. At the time of the inspection the practice was providing services to 6676 patients from the main surgery at Kirkby Stephen and branch surgeries in Brough and Tebay. As part of the inspection the team visited the Kirkby Stephen, Brough and Tebay sites.

The service is registered with CQC to provide the regulated activities of; Diagnostic and screening procedures; Treatment of disease, disorder and injury; Surgical procedures; Maternity and midwifery services and Family planning.

Before the inspection we looked at a wide range of information we held about the practice and that the provider sent to us. We asked other organisations such as the local Clinical Commissioning Group (CCG) to share with us what they knew about the practice. We also asked patients prior to our visit to complete comment cards about their experiences of the service they had received. We spoke with thirteen patients who attended for appointments during the inspection.

We found that patients who used the service were mostly kept safe and protected from avoidable harm. However, we identified a concern regarding the management of medicines.

All the patients we spoke with, without exception were very positive about the care and treatment they received. We saw the results of patient surveys that showed that patients were consistently pleased with the service they received.

There was good collaborative working between the provider and other health and social care agencies which ensured patients received the best outcomes. The provider regularly met with the local clinical commissioning group (CCG) to discuss service performance and improvement issues.

The building was well-maintained and clean. Clinical decisions followed best practice guidelines. There were good governance and risk management measures in place. The leadership team were visible and staff we spoke with said they found them very approachable.