Archived: Dr William Paul Arnett Also known as Roker Family Practice

Updated 22 December 2016

Dr William Paul Arnett, Roker Family Practice is a single handed GP practice and provides care and treatment to approximately 2,240 patients from the area north of the River Wear in Sunderland. It is part of the NHS Sunderland Clinical Commissioning Group (CCG) and operates on a general medical services (GMS) contract.

The practice provides services from the following address, which we visited during this inspection:

Roker Family Practice,

51-52 Roker Avenue

Sunderland, SR6 0HT

The practice is located in two converted terraced houses which have been combined to make one property. The reception area, waiting and consultation rooms are all located on the ground floor and disabled access is available to the rear of the building. On street parking is available nearby.

The practice is open from 7.30am to 6pm on a Monday; 8am to 6pm on a Tuesday, Wednesday and Friday and from 7.30am to 1pm on a Thursday. The GP remained ‘on-call’ on a Thursday afternoon until 6pm to deal with requests for emergency appointments or advice. Appointment availability with the GP was as follows:

Monday

Face to face appointments from 7.30am to 9.30am; 10.30am to 11.30am; 1pm to 2.40pm and 3.30pm to 4.30pm.

Telephone appointments and urgent appointment request triage from 11.30am to 1pm.

Tuesday

Face to face appointments from 9.30am to 11.40am and 4pm to 5.30pm.

Telephone appointments and urgent appointment request triage from 11.50am to 1pm and 1.30pm to 2.40pm.

Wednesday

Face to face appointments from 9.30am to 11.40am

Telephone appointments and urgent appointment request triage from 11.50am to 12.50pm,1pm to 2.40pm and 3.30pm to 4.30pm.

Thursday

Face to face appointments from 7.30am to 9.30am and 1.30am to 11.30am.

Friday

Face to face appointments from 9.30am to 11.40am

Telephone appointments and urgent appointment request triage from 11.50am to 12.50pm and 2.30pm to 3.30pm

Appointments with the practice nurse were available from 8.30am to 11.30am and 1.30pm to 4.30pm on a Monday and a Wednesday and from 8.15am to 11.30am on a Tuesday and Thursday.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Vocare, known locally as Northern Doctors Urgent Care Limited. As part of an extended access scheme patients registered with the practice were also able to access pre bookable appointments at some local health centres from 6pm to 8pm on weekdays.

Roker Family Practice offers a range of services and clinic appointments including chronic disease management and long term condition clinics, smoking cessation, weight management, family planning, childhood immunisations, travel vaccinations and minor surgery. The practice consists of:

• One GP partner (male)
• One practice nurse (female)
• One apprentice health care assistant (female)
• Four non-clinical staff members including a practice manager, senior receptionist, receptionist and cleaner

The area in which the practice is located is in the fourth most deprived decile. In general people living in more deprived areas tend to have greater need for health services. The practice’s age distribution profile showed that the practice had a higher percentage of male patients (59%), particularly in the 20 – 64 year age groups, than the national average.

The average life expectancy for the male practice population is 77 (CCG average 77 and national average 79) and for the female population 82 (CCG average 81 and national average 83).

The percentage of the practice population reported as having a long standing health condition was 67.7% (CCG average 59.7% and national average 54%). Generally a higher percentage can lead to an increased demand for GP services. The percentage of the practice population recorded as being in paid work or full time education was 36.4% (CCG average 55.5% and national average 61.5%). Deprivation levels affecting children were lower than the local CCG average but higher than national averages. Deprivation levels affecting adults were higher than both the local CCG and national averages.

Updated 22 December 2016

Letter from the Chief Inspector of General Practice

We carried out a previous announced comprehensive inspection of Dr William Paul Arnett on 2 November 2015 when breaches of legal requirements were found. Overall we rated the practice as inadequate and the practice was placed into special measures. After the inspection, the practice wrote to us to say what action they intended to take to address the identified breaches of regulation.

We undertook this comprehensive inspection on 27 September 2016 to check that the practice had taken this action and to confirm that they now met legal requirements. You can read the

report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr William Paul Arnett on our website at www.cqc.org.uk

Overall, the practice is now rated as good.

Our key findings across all the areas we inspected were as follows:

• The practice had enlisted support from the local clinical commissioning group to make improvements following the previous inspection in November 2015. We found that the practice had made good progress and had either addressed or were in the process of addressing all of the issues previously identified.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice had implemented a schedule of clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• Feedback from patients about their care was consistently positive. Patients reported that they were treated with compassion, dignity and respect.
• Urgent appointments were usually available on the day they were requested. Pre- bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice had implemented a patient participation group and responded appropriately to feedback from patients.
• Information about services and how to complain was available and easy to understand.
• The practice had developed a clear vision with staff to prioritise quality and safety.

We saw an area of outstanding practice:

• As the practice were aware that they a high number of asylum seekers and refugees on their patient list they had established links with other relevant service providers such as the refugee council and an organisation dedicated solely to the treatment and rehabilitation of torture survivors. The practice nurse was undertaking training in improving access to healthcare for migrants.

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

Importantly, the provider should:

• Implement a robust system to monitor the performance of the practice, including regular monitoring of Quality and Outcomes Framework (QOF) attainment.

• Maintain a record of whether staff are up to date with routine immunisations and that staff at risk of injury from blood contaminated sharps are offered a Hepatitis B and influenza vaccination in line with recommended guidance.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service. However, we are aware that NHS England have terminated their contract with this provider since our inspection and that services for patients registered with this practice have now transferred to an alternative provider.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 December 2016

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

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. The practice was in the process of ensuring patients with multiple long term conditions were offered one joint annual review in their birthday month. The practice had taken steps to ensure patients prescribed certain drugs by secondary providers were appropriately monitored through the use of shared care agreements.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved mixed outcomes in relation to the conditions commonly associated with this population group. For example:

• The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 2.9% above the local CCG average and 2.6% above the national average.
• The practice had obtained 100% of the points available to them in respect of hypertension (0.5% above the local CCG average and 2.2% above the national average).
• The practice had obtained 77.4% of the points available to them in respect of diabetes (16.1% below the local CCG average and 11.8% below the national average.
• The practice had obtained 80.3% for chronic kidney disease (15.5% below the local CCG average and 14.4% below the national average).

QOF results provided by the practice for the period 2015/16 (not yet published) showed that the practice had improved slightly and had obtained 78% of the points available for diabetes and 100% of the points available to them for chronic kidney disease.

Updated 22 December 2016

The practice is rated as good for the care of families, children and young people.

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 91.7% to 100% (compared with the CCG range of 93.7% to 96.9%). For five year olds this ranged from 85.7% to 95.2% (compared with CCG range of 94.7% to 98.9%).

At 80.5%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was comparable with the CCG average of 81.7% and national average of 81.8%.

Updated 22 December 2016

The practice is rated as good for the care of older people.

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 98.7% and the England average of 97.9%.

Patients aged over 75 were offered an annual health check and influenza, pneumococcal and shingles immunisations when appropriate. The practice had a palliative care register and held and attended regular multi-disciplinary meetings to discuss and plan end of life care. This involved the development of personalised emergency health care plans in conjunction with patients and their families and carers.

Updated 22 December 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 met. The surgery was open from 7.30am to 6pm on a Monday, 8am to 6pm on a Tuesday, Wednesday and Friday and 7.30am to 1pm on a Thursday. The GP remained ‘on-call’ on a Thursday afternoon up to 6pm to deal with emergency appointment requests.

The practice offered smoking cessation and weight management advice, minor surgery, NHS health checks (for patients aged 40-74) and long term condition clinics.

The practice offered online services as well as a full range of health promotion and screening which reflected the needs for this age group. A text messaging service was available to remind patients of their appointments.

Updated 22 December 2016

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

Nationally reported QOF data for 2014/15 showed the practice had achieved 76.9% of the points available to them for caring for patients with dementia (CCG average 95.5%, national average 94.5%) and 100% of the points available to them for depression (CCG average 95.7%, national average 92.3%). They had achieved 73.7% for patients with mental health conditions which was below the CCG average of 91.8% and national average of 92.8%. However, the practice were able to provide evidence to demonstrate they had improved and that they had obtained 88% of the QOF points available to them for dementia, and 81% of the points available for mental health conditions for 2015/16 (results not yet published).

Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as local wellbeing and psychological support services.

The practice had undertaken an audit to establish how dementia friendly they were which had resulted in alterations to the patient toilet and the addition of illustrated door and wall signs. A member of staff had been identified as a dementia champion.

Updated 22 December 2016

The practice is rated as good for the care of people whose circumstances make them vulnerable.

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. Longer appointments were available on request for patients with a learning disability, who were also offered an annual flu immunisation and health review.

The practice had established effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.

The practice pro-actively identified carers and ensured they were offered flu vaccinations, health checks, appropriate advice and support. At the time of our inspection they had identified 62 of their patients as being a carer (approximately 2.8% of the practice patient population). Of these patients 52 had received an annual flu vaccination (84%) and 38 had received a carer’s assessment (61%).

As a high number of asylum seekers and refugees were registered with the practice they had established links with relevant service providers such as the refugee council and an organisation dedicated solely to the treatment and rehabilitation of torture survivors. The practice nurse was undertaking training in improving access to health care for migrants.