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Archived: Erimus Practice

Overall: Good read more about inspection ratings

The Cleveland Health Centre, 20 Cleveland Square, Cleveland Centre, Middlesbrough, Cleveland, TS1 2NX

Provided and run by:
Dr Anita Karn

Latest inspection summary

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Background to this inspection

Updated 19 September 2017

The Erimus Practice 20 Cleveland Square. Middlesbrough, is situated in the centre of Middlesbrough and provides services under a General Medical Services (GMS) contract with NHS England, Durham, Darlington and Tees Area Team to the practice population of 6707, covering patients of all ages.

The proportion of the practice population in the 65 years and over age group is lower than the England average. There is a slightly higher percentage in the under 18 age group than the England average.

The practice has two GP partners and 2 long term locum GP’s. One female and three males and a practice manager. There is one nurse practitioner, one specialist nurse for patients with mental health problems, four practice nurses and one phlebotomist. There is also a Pharmacist one day a week and a Midwife. The practice has a team of secretarial and reception staff.

The practice has opted out of providing out of hours services (OOHs) for their patients. When the practice is closed patients use the 111 service to contact the OOHs provider. The practice, along with all other practices in the South Tees CCG area has a contractual agreement for ELM Alliance Ltd to provide OOHs services from 6.00pm.

Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.

The practice is open between 8.00am to 6.00pm Monday to Friday. Appointments are from 9.00am to 12md and 2.00pm to 5.30pm daily. Extended hours surgeries are offered Tuesdays and Thursdays from 7.00am to 8.00am.

The Erimus Practice 20 Cleveland Square. Middlesbrough, is situated in the centre of Middlesbrough and provides services under a General Medical Services (GMS) contract with NHS England, Durham, Darlington and Tees Area Team to the practice population of 6707, covering patients of all ages.

The proportion of the practice population in the 65 years and over age group is lower than the England average. There is a slightly higher percentage in the under 18 age group than the England average.

The practice has two GP partners and 2 long term locum GP’s. One female and three males and a practice manager. There is one nurse practitioner, one specialist nurse for patients with mental health problems, four practice nurses and one phlebotomist. There is also a Pharmacist one day a week and a Midwife. The practice has a team of secretarial and reception staff.

The practice has opted out of providing out of hours services (OOHs) for their patients. When the practice is closed patients use the 111 service to contact the OOHs provider. The practice, along with all other practices in the South Tees CCG area has a contractual agreement for ELM Alliance Ltd to provide OOHs services from 6.00pm.

Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.

The practice is open between 8.00am to 6.00pm Monday to Friday. Appointments are from 9.00am to 12md and 2.00pm to 5.30pm daily. Extended hours surgeries are offered Tuesdays and Thursdays from 7.00am to 8.00am.

Overall inspection

Good

Updated 19 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Erimus Practice on 25 July 2017. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

The practice had recently commenced carrying out a C-reactive protein (CRP) test for patients who present with a chest infection. This blood test is used to help diagnose conditions that cause inflammation and aims to differentiate those patients who really need antibiotics from those with a respiratory tract infection.

The areas where the provider should make improvement are:

The clinical lead for infection control should have training specific to this role. A full infection control audit should be undertaken.

All staff who chaperone patients should have a DBS check. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

People with long term conditions

Good

Updated 19 September 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months, was 58%, which was lower than the local average of 76% and the national average of 78%.

  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 73%, which was comparable to the local average of 78% and national average of 77%.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

  • Patients with a long term condition had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 19 September 2017

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

  • From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • The practice provided support for premature babies and their families following discharge from hospital.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

  • The practice offered a range of sexual health services where patients could get advice and treatment, for example contraception. Information and testing kits for sexually transmitted diseases were available in the practice.

Older people

Good

Updated 19 September 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Where older patients had complex needs, the practice shared summary care records with local care services.

Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Good

Updated 19 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and telephone consultations for minor problems.

  • The practice had early morning appointments from 7am to enable patients to have blood taken, and long term disease monitoring.
  • The practice was proactive in offering online services such as appointments and electronic prescribing as well as a full range of health promotion and screening that reflect the needs for this age group. For example a cardiovascular health check risk assessment was offered and following the results either medication or advice about weight loss or exercise was given.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 September 2017

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

  • The practice carried out advance care planning for patients living with dementia.

  • 81% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 83%.

  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. The practice offered annual health checks sending appointment letters, texts and opportunistic appointments.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs and Medipacks were proactively arranged for this group to reduce the risk of overdose or missed medications.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 19 September 2017

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

  • The practice held a register of patients living in vulnerable circumstances including, travellers and those with a learning disability.

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

  • The practice offered 30 minute appointments for patients with a learning disability. There was a dedicated nurse for annual health checks for patients and for carers.

  • For patients where English was not their first language an interpreter service was booked and appointments were for 20 minutes.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. 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.