We carried out an announced comprehensive inspection at Central Lakes Medical Practice on 7 March 2019. We had previously inspected the practice in May 2015; this inspection had resulted in an overall rating of Good. The full comprehensive report following the inspection in May 2015 can be found on our website here: https://www.cqc.org.uk/location/ 1-549363386.

We carried out our most recent inspection in order to ensure the practice was continuing to maintain good standards.

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 requires improvement overall and good for all population groups.

We rated the practice as requires improvement for providing safe services because:

• The risk of fire was not properly mitigated at Hawkshead branch surgery.
• Risks in relation to recruitment processes and pre employment checks were not always comprehensively mitigated.
• Infection control audts had not been fully completed at Hawkshead branch surgery.
• The provider had nor assured itself that processes around the management of incoming correspondence were safe.
• It was not possible to tell who had received what training from the training records.

We rated the practice as requires improvement for providing well-led services because:

• The practice governance arrangements had failed to note that recruitment processes were not sufficiently robust, audits were incomplete and risk assessments had not been carried out.

However, we also found that:

• Patient feedback was strongly and consistently positive about the standard of care and treatment received. The practice’s results from the national GP patient survey were higher than local and national averages.
• 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 areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

In addition, the provider should:

• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Improve communication so staff are aware of leadership roles within the practice team.

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 Ambleside Health Centre on 7 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive 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 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.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• The majority of 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 offered pre-bookable early evening appointments one day per week, 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.
• Staff throughout the practice worked well together as a team.

We saw the following area of outstanding practice:

• The senior GP partner had undertaken to lead a 2 year pilot of ‘Mindfulness’ training in the local area, funded by Public Health England. The project aimed to train both patients and local teachers to deliver Mindfulness sessions across the local area, so helping to address high levels of anxiety and mental health issues. Although still at an early stage, this project will directly influence the management of mental health issues in the practice and represents an example of outstanding commitment to support both practice patients with mental health issues and the locality as a whole.

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

Importantly the provider should:

• Review the systems in place to measure the implementation or effectiveness of any changes to practise made as a result of significant events.
• Seek to improve storage arrangements for blank prescription forms at the branch surgery in Grasmere.
• Review and improve the systems in place to record the maintenance and calibration of equipment within the practice.
• Ensure that clinical audits include at least two cycles. The practice should aim to demonstrate an on-going audit programme where they have made continuous improvements to patient care in a range of clinical areas as a result of clinical audit.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Ambleside Health Centre registered the Rydal Road surgery with CQC, as responsible for providing primary care, which included access to GPs, minor surgery, family planning, ante and post natal care. They also provided a satellite service in Grasmere. We visited both sites. Ambleside provided a weekday service for over 5000 patients in the Windemere area. The Grasmere Surgery was open most weeks for two hours on a Monday, Wednesday and for one hour on a Friday. Ambleside provided extended services so opened at 07:30 most days. It closed at 18:30 most evenings and at least once a week at 21:30. Cumbria Health on Call (CHOC) provided an out of hours service for patients who used the Ambleside Health Centre.

The patients we spoke with and who completed our comment cards were extremely complimentary about the care provided by the clinical staff; the overall friendliness and behaviour of all staff. Patients reported that they felt that all the staff treated them with dignity and respect.

We found that the provider had listened to patient comments and taken action to improve their service.

A range of appointments were available, including telephone and email consultations. People could book appointments either in person, over the phone or on-line.

The building was well-maintained and very clean. Effective systems were in place for the oversight of medication. Clinical decisions followed best practice.

Governance and risk management measures were in place but we found that the overall governance arrangements of these needed strengthening.

We found that the provider needed to take action to meet one of the regulations. They needed to improve the quality assurance systems. The services were safe and effective.