Archived: Newcastle Medical Centre

Updated 10 December 2015

The practice is located in the centre of Newcastle upon Tyne within Boots the Chemist in the Eldon Square Shopping Centre. The practice serves the centre of Newcastle upon Tyne and some of the surrounding areas. The practice provides services from the following address and we visited here during this inspection:

Within Boots the Chemist, Hotspur Way, Eldon Square, Newcastle upon Tyne, NE1 7XR.

The practice provides all of its services to patients at lower-ground floor level within a large retail store in Eldon Square shopping centre. It can be accessed by the stairs, an in-store escalator or by a passenger lift. On-site parking is not available due to the practice’s city centre location; however public car parks are available within the city centre. The practice provides services to around 13,500 patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

The practice has a full time lead GP, and four regular locum GPs; one of whom is full time with the other three being part time. In total the practice has three male and two female GPs. The practice also has two nurse practitioners (one full time, one part time), one part time practice nurse, two full time healthcare assistants, a part time practice manager and ten full and part time administrative support staff.

The practice is open between 8.00am and 6.30pm Monday to Friday and on Saturdays between 8.30am and 5.30pm. The practice ran a walk-in clinic Monday to Friday. Every patient who presented at the surgery between 8am and 9am was guaranteed to see a GP that day. Appointments with the GP were also available at the following times during the week of the inspection:

• Monday – 9.20am to 11.50am and from 2.00pm to 4.30pm
• Tuesday – 9.00am to 11.30am and from 12.30pm to 4.30pm
• Wednesday – 9.00am to 11.30am and from 1.00pm to 3.30pm
• Thursday – 9.00am to 11.30am and from 1.00pm to 4.30pm
• Friday – walk-in clinic (am) and from 2.00pm to 4.30pm

Information taken from Public Health England placed the area in which the practice was located in the fifth 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 heavily towards a younger population than national averages. The practice has a significant number of students registered with it.

The service for patients requiring urgent medical attention out of hours is provided by the 111 service and Northern Doctors Urgent Care Limited.

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Newcastle Medical Centre on 13 October 2015. Overall the practice is rated as requires improvement.

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 and staff were assessed and managed.
• Data showed patient outcomes were below average for the locality. Although some audits had been carried out, we saw limited evidence that audits were driving improvement in performance to improve patient outcomes.
• Cervical screening and childhood immunisation rates were both below national averages.
• Results from the National GP Patient Survey showed patients were generally happy with how they were treated and that this was with compassion, dignity and respect. The practice was above or in line with local and national averages for its satisfaction scores on consultations with GPs and below local and national averages for nurses.
• Information about services and how to complain was available and easy to understand. The practice had received six formal complaints within the last 12 months.
• The practice held a walk-in surgery Monday to Friday. Every patient who presented at the practice between 8am and 9am were guaranteed to see a GP the same day.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity. The practice held regular meetings and issues were discussed at staff and clinical team meetings.
• There was a limited approach to obtaining the views of patients and other stakeholders. The practice did not have a patient participation group (PPG).
• The practice’s mission statement, as stated on the practice website, was not embedded among the staff who worked there.

The areas where the provider must make improvements are:

• The practice must ensure that patients identified as needing an agreed care plan have them in place and that it meets their specific needs. This includes patients with mental health needs and those with complex needs.
• The practice must take immediate action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff. Specifically, this includes completing Disclosure and Barring Service (DBS) checks for those staff that need them.

The areas where the provider should make improvements are:

• Ensure that fire drill procedures become embedded among staff and that staff complete fire safety training.
• Ensure that accurate records are maintained regarding prescription forms for audit trail purposes.
• Ensure records are maintained to demonstrate the maintenance, servicing and calibration of equipment in the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 10 December 2015

The practice is rated as requires improvement for the care of people with long-term conditions. The practice was rated as requires improvement for providing safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Staff had roles in chronic disease management. Longer appointments and home visits were available when needed. Patients were offered a structured review at least annually to check that their health and medication needs were being met. However, not all these patients had a personalised care plan or structured annual review to check that their health and care needs were being met.

Updated 10 December 2015

The practice is rated as requires improvement for the care of families, children and young people. The practice was rated as requires improvement for providing safe and effective care. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Immunisation rates were below local averages for most standard childhood immunisations. The systems the practice had in place to ensure children were immunised were not always effective. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. Patients we spoke with said the practice had told them to attend without an appointment if their child was unwell in the knowledge they would be seen.

Cervical screening rates for those patients who were eligible were low at 24.12%; compared to the national average of 81.88%. The lead GP said the practice’s performance in this area had been low historically and they had tried a number of initiatives to improve this. Based on the performance data we saw, these initiatives had not resulted in improvements in the delivery of preventative care for these patients.

Updated 10 December 2015

The practice is rated as requires improvement for the care of older people. The practice was rated as requires improvement for providing safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice had a lower than average percentage of older people registered. Nationally reported data showed that outcomes for patients were in line with national averages for conditions commonly found in older people. They offered care to meet the needs of the older people in its population. The practice was responsive to the needs of older people, including offering home visits and rapid access appointments for those with enhanced needs.

They offered flu vaccinations to older people. The percentage of people aged 65 or over who received a seasonal flu vaccination was lower than the national average.

Updated 10 December 2015

The practice is rated as requires improvement for the care of working age people (including those recently retired and students. The practice was rated as requires improvement for providing safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice population included a large number of students. The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice offered online services as well as a walk-in surgery in the mornings on Monday to Friday. Patients who registered with the practice were not routinely offered a new patient health check.

Updated 10 December 2015

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The practice was rated as requires improvement for providing safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice had identified patients experiencing poor mental health; however we were unable to see any evidence of care plans in place to support these people. They had 33 patients on a mental health register, of which 26 were eligible for care planning. We randomly sampled five patient records to review and saw that all five patient records were flagged with an alert that stated ‘mental health care plan outstanding’. We asked the practice to send us some redacted evidence of care plans in place for these patients within three working days of the inspection. The practice did not provide us with the information we requested. We were therefore unable to find any evidence of care plans the practice had in place for some of their most at risk patients.

Updated 10 December 2015

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The practice was rated as requires improvement for providing safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Three patients were on the learning disability register; however they did not receive annual health checks routinely. The practice offered longer appointments for people whose circumstances may make them vulnerable. The practice did not hold a register of patients with caring responsibilities; however the lead GP said they knew which patients were cared for and those who had caring responsibilities.

The practice had signposted 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. They 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.