Archived: Dr Stephen Hilton Also known as Elvaston Road Surgery

Updated 4 August 2016

Dr Stephen Hilton is registered with the Care Quality Commission (CQC) to provide primary care services. The practice provides services to approximately 2,291 patients from one location and we visited this as part of the inspection:

• 7 Elvaston Road, Ryton Village, Tyne and Wear, NE40 3NT.

Dr Stephen Hilton is a small practice providing care and treatment to patients of all ages, based on a General Medical Services (GMS) contract. The practice is situated in the Ryton area of Gateshead and is part of the NHS Newcastle Gateshead clinical commissioning group (CCG.) The health of people who live in Gateshead is generally worse than the England average. Deprivation is higher than average and life expectancy for both men and women is lower than the England average.

The practice is located in an adapted residential building and provides patients with accessible treatment and consultation rooms on the ground floor. There is no lift to the first floor, so only mobile patients can access this area of the practice. The practice provides a range of services and clinics including services for patients with asthma and heart disease. The team consists of a GP locum (male) and a salaried GP (female.) Some clinical sessions are being covered by the new provider due to staff’s leave arrangements. The practice also has a practice manager, a practice nurse, a healthcare assistant, and a small team of administrative and reception staff.

The practice is open: Monday, Wednesday and Friday between 9am and 12pm and 2pm and 6pm; Tuesday between 9am and 12pm and 1:30pm and 7pm and Thursday between 9am and 12pm.

Appointment times are as follows:

Monday: 9am to 11am and 3pm to 5pm (one GP).

Tuesday: 9am to 11am (two GPs) and 5pm to 7pm (one GP).

Wednesday: 9am to 11am (one GP) and 2:30pm to 4:30pm (one GP).

Thursday: 9am to 10:30am (one GP).

Friday: 9am to 11am and 3pm to 5pm (one GP).

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

Updated 4 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced inspection of this practice on 15 January 2015. Breaches of legal requirements were found. Although the provider did not submit an action plan following the publication of our report of that inspection, they did tell us about the improvements they intended to make to address the breaches of legal requirements, as set out in the Health and Social Care Act (HSCA) 2008. The provider did give us an action plan during our follow up focused inspection on 07 December 2015.

The breaches we identified when we carried out the inspection on 15 January 2015 were in relation to:

• Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Cleanliness and infection control (which corresponds to Regulation 12 (2) (h) of the HSCA 2008 (Regulated Activities) Regulations 2014);

• Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines (which corresponds to Regulation 12 (f) & (g) of the HSCA 2008 (Regulated Activities) Regulations 2014.)

We undertook this focused inspection on 7 December 2015 to check whether the provider had taken steps to comply with the above legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Stephen Hilton on our website at www.cqc.org.uk.

Our key findings were as follows:

• Improvements to patient safety had been made following our last inspection on 15 January 2015. For example, action had been taken to improve the arrangements for assessing the risk of, and controlling and preventing the spread of infection. Suitable arrangements had been made for the safe handling of prescriptions. There was a more effective system for monitoring vaccine expiry dates and we found that vaccines held at the practice were all within their expiry dates. The provider had carried out a comprehensive review of the practice’s Legionella risk assessment. A business continuity plan had been prepared and staff had been provided with access to a child protection policy.

• However, we identified further concerns that some of the arrangements for protecting patients against the risk of receiving ineffective vaccines were not always reliable or effective. For example, the arrangements for protecting vaccines requiring refrigeration during transportation and storage off site were not adequate. Ineffective arrangements had been made to carry out daily temperature checks of the vaccines stored at the practice.

  The areas where the provider must make improvements are:

• Improve the arrangements for the storage and handling of vaccines, and ensure that national guidelines are fully implemented.

The areas where the provider should make improvements are:

• Make improvements to the quality of minute taking of meetings held within the practice.

• Consider using a second thermometer to check the accuracy of the temperature readings displayed on the thermometer installed in the dispensary refrigerator. The provider should also arrange for annual calibration checks to be carried out of the thermometers installed in the practice's refrigerator.

• Develop an adult safeguarding policy.

• Carry out a risk assessment to determine how often electrical equipment used at the practice should be checked for safety.

• The practice’s designated infection control lead should complete more advanced training to enable them to carry out this role more effectively.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 May 2015

The practice is rated as requires improvement for the care of patients with long-term conditions. There were aspects of the practice which required improvement and related to all population groups.

Nationally reported QOF data (2013/14) showed patient outcomes relating to the conditions commonly associated with this population group were mostly above the local CCG and England averages. QOF data showed the practice had achieved 96.9% of the total points available to them for providing patients with diabetes with the recommended care and treatment. This was 4.1 percentage points above the local CCG average and 6.8 points above the England average.

The practice had taken steps to reduce unplanned hospital admissions by improving services for patients with complex healthcare conditions. All the patients on the practice’s long-term conditions registers received healthcare reviews that reflected the severity and complexity of their needs. Person-centred care plans had been completed for patients with long-term conditions. Clinical staff had received the training they needed to provide good outcomes for patients with long-term conditions.

Updated 28 May 2015

The practice is rated as requires improvement for the care of families, children and young people. There were aspects of the practice which required improvement and related to all population groups.

Nationally reported data (2013/14) showed the practice had achieved 100% of the total points available to them for providing maternity services and child health surveillance. These were both above the England averages (i.e. 0.9 and 1.2 percentage points above respectively) and were in line with the local CCG averages.

Systems were in place for identifying and following-up children who were considered to be at risk of harm or neglect. Where comparisons allowed, we were able to see that the delivery of childhood immunisations was mostly higher when compared with the overall percentages of children receiving the same immunisations within the local CCG area. For example, MMR vaccination rates for five year old children were 94.9 % compared to an average of 91.5% in the local CCG area. All five childhood immunisations delivered to babies aged 24 months were above each local CCG average. Regular baby clinics were held by the practice nurse, and ante-natal classes were offered by an attached healthcare professional. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 28 May 2015

The practice is rated as requires improvement for the care of older patients. There were aspects of the practice which required improvement and related to all population groups.

Nationally reported QOF data (2013/14) showed patient outcomes relating to the conditions commonly associated with this population group were mostly above the local CCG and England averages. For example, QOF data showed the practice had achieved 100% of the total points available to them for providing patients with heart failure with the recommended care and treatment. This was 0.9 percentage points above the local CCG average and 2.9 points above the England average.

The practice provided proactive, personalised care to meet the needs of older people. They provided a range of enhanced services including, for example, allocating a named GP who was responsible for overseeing the care and treatment provided to older patients. Clinical staff had received the training they needed to provide good outcomes for older patients. The practice was responsive to the needs of older people, and offered home visits and access to urgent appointments for those who needed them.

Updated 28 May 2015

The practice is rated as requires improvement for the care of working-age patients (including those recently retired and students.) There were aspects of the practice which required improvement and related to all population groups.

Nationally reported QOF data (2013/14) showed patient outcomes relating to the conditions commonly associated with this population group were mostly above the local CCG and England averages. For example, the data showed the practice had achieved 100% of the total points available to them for providing care and treatment for patients with cardiovascular disease. This was 10 percentage points above the local CCG average and 12 points above the England average.

The needs of this group of patients had been identified and steps had been taken to provide accessible and flexible care and treatment. The practice was proactive in offering on-line services to patients. Patients could order repeat prescriptions and book appointments on-line. Extended hours appointments were available until 7:00pm one evening a week. Health promotion information was available in the waiting area and on the practice web site. The practice provided additional services such as smoking cessation and weight management.

Updated 28 May 2015

The practice is rated as requires improvement for the care of patients experiencing poor mental health (including people with dementia). There were aspects of the practice which required improvement and related to all population groups.

Nationally reported QOF data (2013/14) showed patient outcomes relating to the conditions commonly associated with this population group were mostly above the local CCG and England averages. For example, the data showed the practice had achieved 100% of the total points available to them for providing care and treatment for patients with mental health needs. This was 6 percentage points above the local CCG average and 9 points above the England average.

The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests. Patients were able to access specialist counselling and support at the practice. Where appropriate, care plans had been completed for patients who were on the register. Practice staff worked with other community healthcare professionals to help ensure patients’ needs were identified and met. However, outcomes for patients with dementia were below both the local CCG and England averages.

Updated 28 May 2015

The practice is rated as requires improvement for the care of patients whose circumstances may make them vulnerable. There were aspects of the practice which required improvement and related to all population groups.

Nationally reported data (2013/14) showed the practice had achieved 100% of the total points available to them for providing care and treatment for patients with epilepsy. This was 14.3 percentage points above the local CCG average and 10.6 points above the England average.

Staff worked with relevant community healthcare professionals to meet the needs of vulnerable patients registered with the practice. The practice sign-posted vulnerable patients to various support groups and other relevant organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, recording safeguarding concerns and contacting relevant agencies.