NPC North Tyneside – Spring Terrace

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice assessed and reviewed people's health, wellbeing and wider support needs to help ensure they received appropriate care and treatment. Feedback from people using the service was positive. In the 2026 National GP Patient Survey (GPPS), 94% of respondents said their needs were met during their last general practice appointment, compared with the national average of 90%.

The practice took a proactive approach to identifying people who may require additional support. This included targeted work to identify and support unpaid carers and young carers. Across NPC North Tyneside, the number of identified carers increased from 820 in April 2025 to 1,168 in July 2026, helping to ensure carers were identified to enable them to receive appropriate support, signposting and access to services.

NPC North Tyneside also implemented a community frailty strategy to support people living with frailty, housebound patients and care home residents. This included dedicated frailty leadership, multidisciplinary working, advanced care planning, continuity of care through named GPs, proactive long-term condition management and closer working with community and rehabilitation services. At Spring Terrace, this approach supported housebound patients to receive personalised long-term condition reviews, helping to improve care coordination and identify emerging health needs at an earlier stage.

Staff also used population health data and community engagement to better understand the needs of different population groups. For example, a health inequalities assessment of the local Bangladeshi population identified 33 patients with Type 2 diabetes, of whom only 45.5% had completed an annual diabetes review, and flu vaccination uptake of 36.2% amongst eligible patients.

Findings informed targeted interventions, including translated health information, interpreter support, culturally responsive care and targeted preventative health initiatives.

The practice planned and delivered care and treatment in line with current legislation, evidence-based guidance and recognised standards. Clinical audit and quality improvement activity was embedded across all 4 sites and was used to review care, improve patient outcomes and strengthen governance. Audit activity covered a range of areas including medicines safety, long-term condition management, frailty, mental health, prescribing optimisation and end-of-life care.

Examples of improvement included a quality improvement project for frail, housebound patients at 1 site, which increased access to medication reviews from 54 patients (84%) to 69 patients (96%), GP reviews from 33 patients (52%) to 55 patients (76%), and improved advance care planning documentation.

A repeat audit of testosterone prescribing demonstrated improvements in monitoring arrangements. Baseline monitoring increased from 50% to 86%, 3-month follow-up monitoring increased from 50% to 92%, and systems were introduced to support ongoing annual monitoring.

The practice reviewed the prescribing of specialist infant formula for babies with cow's milk protein allergy, identifying 5 of 21 children receiving a formula that was not appropriate for their age. Following the introduction of a prescribing protocol and strengthened monitoring arrangements, a re-audit demonstrated improved compliance with prescribing guidance, with only 1 child remaining on the original formula in line with parental preference. In addition, an audit of non-medical prescriber practice across all 4 sites found prescribing to be clinically appropriate, within scope of competence and aligned with current guidance.

The practice also had arrangements in place to assess and support people's nutritional needs. These included a nutritional care pathway, policies and procedures for the management of eating disorders, identification and monitoring of patients at risk of malnutrition, and clinical oversight from a GP with a special interest in this area. The practice maintained recognised accreditation schemes, including Pride in Practice Gold accreditation and Veteran Friendly GP Practice status, demonstrating a commitment to inclusive, evidence-based care. Systems were in place to ensure staff remained up to date with evidence-based guidance, legislation and changes to clinical best practice.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

Multidisciplinary team (MDT) meetings supported joined up working across the practice and wider community services.

The practice supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff encouraged people to make informed decisions about their health and supported them to access preventative care and health promotion services.

Patients were supported to self-manage their health through access to self-assessment facilities, including blood pressure monitoring and other routine health measurements. These facilities helped people to monitor their health and seek advice or treatment when required.

The practice was a registered Parkrun Practice and actively supported Parkrun through staff volunteering and community engagement.

Staff also used targeted recall systems, long-term condition reviews and preventative health interventions to identify risks to patients' health and support the early identification and management of health conditions.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

We were told the provider undertook a range of initiatives to improve cervical screening uptake, including personalised invitations, additional reminders, direct follow-up by the Primary Care Network (PCN) Cancer Care Co-ordinator, text message booking links and additional screening clinics. Prior to the merger in April 2025, cervical screening performance varied across the 4 practices, with some age groups not achieving the national 80% target. Unverified Quality and Outcomes Framework (QOF) data for 2025/26, supplied by the provider following the merger, showed cervical screening coverage of 81.9% for women aged 25 to 49 and 81.6% for women aged 50 to 64, meeting the national target in both age groups.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriately documented, supported by a clear clinical rationale, discussed with people and/or their representatives where appropriate, and reviewed in line with relevant legislation and guidance.