Archived: Deneside Medical Centre

Updated 25 May 2017

Deneside Medical Centre provides care and treatment to around 4,700 patients in the town of Seaham, County Durham. The practice is part of Durham Dales, Easington and Sedgefield clinical commissioning group (CCG) and operates on a General Medical Services (GMS) contract agreement for general practice.

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

• The Avenue, Seaham, County Durham, SR7 8LF.

The practice is located in a purpose built two storey building. All patient facilities are on the ground floor. There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access.

Opening hours are as follows:

• 8am to 8.30pm every Monday
• 8am to 6pm Tuesday to Friday.

Patients can book appointments in person, on-line or by telephone. Telephones at the practice are answered from 8am until 6.30pm on Mondays and between 8am and 6pm Tuesday to Friday. Outside of these times a message on the telephone answering system transfers patients to the out of hours service.

Appointments with GPs are available at the following times:

• Monday – 9.10am to 12pm; from 1pm to 4pm; then from 6pm to 8.30pm
• Tuesday – 8.45am to 12.05pm; then from 2.30pm to 5.10pm
• Wednesday – 8.45am to 12.05pm; then from 2.30pm to 5.20pm
• Thursday – 8.45am to 12.05pm; then from 2.30pm to 5.10pm
• Friday – 8.45am to 12.05pm; then from 2.30pm to 5.10pm.

The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and the local GP federation.

The practice has:

• one GP (male)
• two nurse practitioners and one practice nurse (all female),
• two healthcare assistants,
• a practice manager, and
• seven staff who carry out reception and administrative duties.

The age profile of the practice population is in line with the CCG averages, but is made up of a slightly higher than average proportion of patients over the age 75 (10.6% compared to the national average of 8.7%). Information taken from Public Health England placed the area in which the practice is located in the fourth more deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

Updated 25 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Deneside Medical Centre on 27 April 2017. Overall the practice is rated as good.

Our key findings were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• 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.
• Most 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 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.

In addition, the provider should:

• Take steps to record the distribution of pre-printed prescription form stock within the practice.
• Take action to provide Mental Capacity Act training for relevant staff.
• Review the letter issued in response to complaints received to include details of the Parliamentary and Health Service Ombudsman.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 25 May 2017

The practice is rated as good for the care of patients 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 practice scored relatively well in the Quality and Outcomes Framework (QOF). This rewards practices for managing some of the most common long term conditions. For example, performance for asthma related indicators was better than the national average (100% compared to 97.4% nationally), although performance for diabetes related indicators was below the national average (87.2% compared to 89.9% nationally). Action had been taken over the past year to improve performance and practice data (unverified) showed that the practice had achieved an overall QOF score of 96.5% for 2016/2017.
• QOF exception rates were below average (the QOF scheme includes the concept of ‘exception reporting’ to ensure that practices are not penalised where, for example, patients do not attend for review, or where a medication cannot be prescribed due to a contraindication or side-effect).
• 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.
• All these patients 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.

Updated 25 May 2017

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 systems in place 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• 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.
• 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’s uptake for the cervical screening programme was 79.5%, which was slightly below the clinical commissioning group (CCG) average of 82.8% and the national average of 81.5%.

Updated 25 May 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. Clinicians worked closely with two local services; the Vulnerable Adults Wrap Around Service and the Advanced Nurse Practitioner Emergency Readmission Avoidance teams. Two advanced nurse practitioners worked throughout the Seaham area to carry out proactive home visits, including nursing homes to help manage long term conditions and prevent unnecessary admissions to secondary care services.
• The practice was responsive to the needs of older patients, and offered home visits by practice GPs and urgent appointments for those with enhanced needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 25 May 2017

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 identified and the practice had adjusted the services it offered to ensure these were accessible and flexible. Extended hours surgeries were offered on Monday between 6pm and 8.30pm for working patients who could not attend during normal opening hours.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
• Additional services were provided such as health checks for the over 40s and travel vaccinations.

Updated 25 May 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.
• 84.2% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 83.8%.
• Performance for mental health related indicators was above the national average (100% compared to 92.8% nationally). For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months, was 97.2%, compared to the national average of 88.7%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 25 May 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 homeless people and those with a learning disability.
• A buddy system had been introduced; this provided patients who may have communication difficulties with a named person at the practice who they could call and speak to, for example, when ordering repeat prescriptions.
• The practice held the contract for providing services to violent patients throughout the clinical commissioning group (CCG). Arrangements had been made to train staff so the practice could meet the patients’ needs.
• The practice had 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.
• Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check and referred for a carer’s assessment; 65 patients (1.4% of the practice list) had been identified as carers.