Bewick Road Surgery

Updated 6 December 2016

Bewick Road Surgery provides care and treatment to 6,032 patients of all ages, based on a General Medical Services (GMS) contract. The practice is part of the NHS Newcastle and Gateshead clinical commissioning group (CCG) and serves the Bensham Ward area. We visited the following location as part of our inspection: 10 Bewick Road, Tyne and Wear, NE8 4DP.

The practice serves an area where deprivation is higher than the England average. In general, people living in more deprived areas tend to have a greater need for health services. The practice has fewer patients aged over 65 years of age, and significantly more patients aged under 18, than the local CCG and national averages. Data supplied by the practice indicated that approximately 50% of the patient population came from the Orthodox Jewish community, making it one of the largest such communities in the country. Over 50% of the community was aged under 25 years of age, with 25% of these being under 15 years of age. The large number of under 25 year olds registered with the practice is in part as a result of the large Orthodox Jewish Training Colleges both male and female. It is also as a result of the high birth rate in the Orthodox Jewish Community.

The percentage of people with a long-standing health condition is higher than the England average, as is the percentage of people with caring responsibilities. Life expectancy for both men and women is lower than the England average. National data showed that 1% of the population have a mixed racial heritage, 3.8% are from an Asian ethnic group, 1% is black and 2% are from other non-white ethnic groups.

The practice occupies an Edwardian terraced house that has been adapted to meet patients’ needs. All treatment and consultation rooms are located on the ground floor. The practice has two GP partners (one male and one female), three salaried GPs (two female and one male), a GP registrar (female), a nurse practitioner and a practice nurse (female), a trainee healthcare assistant (female) and a team of administrative and reception staff.

The practice is a teaching and approved training practice, where qualified doctors and medical students can gain experience in general practice. A GP registrar was on placement at the time of our visit.

The practice is open Monday to Friday between 8am and 6pm. (The General Medical Services (GMS) contract stipulates that ‘core hours’ means the period beginning at 8am and ending at 6:30pm. The provider told us that the practice closed at 6pm each weekday. They said patients were able to access ‘essential services’ between 6pm and 6:30pm, via the extended hours service provision delivered by the GATDOC out-of-hours service. We were told this arrangement had been in place for more than 20 years and provided time for the Gateshead practices to handover to the out-of-hours service.

GP appointment times are Monday to Friday between 8am and 11:30am, and between 2:30pm and 17:40pm. The practice is closed at the weekend.

When the practice is closed patients can access out-of-hours care via the Queen Elizabeth Hospital and Blaydon Walk-in-Centre, known locally as GATDOC, and the NHS 111 service.

Updated 6 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Bewick Road Surgery on 14 October 2016. Overall, the practice is rated as good.

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

• Staff were very motivated to offer care that was kind, promoted patients’ dignity and respected cultural differences.

• Patients’ emotional and social needs were seen as being as important as their physical needs, and there was a strong, visible, person-centred culture. Patients said they were treated with compassion, dignity and respect and were involved in decisions about their treatment. Patients reported that they had 100% confidence and trust in the GPs and nurses who treated them.

• The practice was highly effective in working with other organisations, and the local community, to plan services which met patients’ needs, and which provided flexibility, choice and continuity of care.

• All staff were actively engaged in monitoring and improving quality and patient outcomes.

• Staff were committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. They had the skills, knowledge and experience to deliver effective care and treatment.

• Risks to patients and staff were assessed and well managed.

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events. The staff team took the opportunity to learn from all internal and external incidents.

• The practice had satisfactory facilities and was equipped to treat patients and meet their needs.

• The leadership, governance and management of the practice helped ensure the delivery of good quality person-centred care, supported learning, and promoted an open culture.

We also identified several areas of outstanding practice:

• The quality of the practice’s advance care planning processes was excellent, with careful thought having been given to the patient’s situation and their need for care and treatment. The practice thought carefully about what information would be needed by other agencies if they needed to treat their patients. They provided a well-structured summary that included the patient’s normal state, recent measurement, blood tests and likely problems out-of-hours healthcare professionals might encounter. By providing this information they were enabling members of the wider health care team to get to know their patients quickly and accurately in an urgent situation. This helped to ensure appropriate levels of response and good continuity of treatments.

• The practice was highly committed to improving access for patients from the Orthodox Jewish community. Staff used a variety of methods to reach the community, to help improve health outcomes and provide culturally sensitive care and treatment. These included advertising in the Orthodox Jewish Community local paper to reach those whose religious beliefs involved restrictions on the use of mobile telephones, the internet, and other types of social media. By being this flexible the practice was able to deliver well focused medical intervention to people who otherwise might not have been enabled to approach the service for help. A local religious representative told us patients from the community engaged well with the practice, and the services it provided, which reflected the effort staff had made to make their service more accessible and responsive.

• Staff were highly committed to improving children’s health by improving access to, and the take-up of, childhood immunisations. offering vaccinations at appropriate times, and in multiple venues, to fit in with Orthodox Jewish community customs. This had led to a marked improvement, with overall immunisation rates rising from 45% to over 90%. Staff had achieved this by offering vaccinations at appropriate times, and in multiple venues, to fit in with Orthodox Jewish community customs. By being this flexible in their approach to delivering their childhood immunisation programme, staff were able to demonstrate they had provided effective immunisation services to children who were members of a potentially hard to reach patient group, as well as the rest of their patient population.

We also identified an area where the provider should make an improvement:

• Review the standard 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 6 December 2016

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

• The QOF data, for 2014/15, showed the practice had performed above, or broadly in line with, most of the local CCG and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group. (Just before we published the report, the QOF data for 2015/16 was released. This showed that the practice had further improved their QOF performance, with an overall achievement of 94.9%, (local CCG average of 96.9%, and a national average of 95.3%), and an overall exception reporting rate of 7.3%.)

• The practice had piloted a new system for recalling patients for their long-term conditions (LTC) reviews. Following the successful completion of this pilot, the centralised patient ‘call’ and ‘recall’ system had been adopted by other practices within the local federation. Work was underway to launch the ‘Year of Care’ approach to managing patients with LTCs, to help provide them with more effective care and support.

• Longer appointments and home visits were available when needed. Patients at risk of an unplanned admission into hospital were identified as a priority.

• Community healthcare professionals told us clinical staff were very good at working with them, to deliver a multi-disciplinary package of care to patients with complex needs.

Updated 6 December 2016

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

• There were good systems in place to protect children who were at risk and living in disadvantaged circumstances. For example, regular multi-disciplinary safeguarding meetings were held where the needs of vulnerable children and families were discussed. Systems had been put in place to identify and follow up children who were at risk. All the clinical staff had completed appropriate safeguarding training. Appointments were available outside of school hours and the practice’s premises were suitable for children and babies.

• The practice offered contraceptive and sexual health advice, and information was available, about how patients could access specialist sexual health services.

• The practice had a comprehensive screening programme. Nationally reported data showed the practice’s performance was either above, or broadly in line with, the national averages. For example, the uptake of cervical screening by females aged between 25 and 64, attending during the target period, was higher at 82.3%, than the national average of 81.8%.

• Staff were highly committed to improving children’s health by improving access to, and take-up of, childhood immunisations. Staff had, over a period of five years, worked hard to improve their vaccination rates. This had led to a marked improvement, with overall immunisation rates rising from 45% to over 90%. Staff had achieved this by offering vaccinations at appropriate times, and in multiple venues, to fit in with Orthodox Jewish community customs.  By being this flexible in their approach to delivering their childhood immunisation programme, staff were able to demonstrate they had provided effective immunisation services to children who were members of a potentially hard to reach patient group, as well as the rest of their patient population.

Updated 6 December 2016

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

• Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed above, or broadly in line with, most of the local clinical commissioning group (CCG) and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group. (Just before we published the report, the QOF data for 2015/16 was released. This showed that the practice had further improved their QOF performance, with an overall achievement of 94.9%, (local CCG average of 96.9%, and a national average of 95.3%), and an overall exception reporting rate of 7.3%).

• The practice offered proactive, personalised care which met the needs of older patients. For example, all patients over 75 years of age had a named GP who was responsible for their care.

• Staff worked in partnership with other health care professionals to ensure that older patients received the care and treatment they needed, so that, where possible, emergency admissions into hospital could be avoided.

• Staff had completed emergency health care plans for patients identified as being at risk of an unplanned admission into hospital, and they reviewed these every six months. The quality of the practice’s advance care planning processes was excellent, with careful thought having been given to the patient’s situation, their need for care and the practicalities of treatment. The practice thought carefully about what information would be needed by other agencies, such as a visiting out-of-hours GP, if they needed to treat their patients. They provided a well-structured summary that included the patient’s normal state, recent measurement, blood tests and likely problems they might encounter. The practice was proactive in making sure this information was provided to the people and organisations who would need to see it.

• Older patients had access to influenza, shingles and pneumococcal vaccinations, either at the practice or in their own homes.

Updated 6 December 2016

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

• The needs of working age patients, had been identified, and the practice adjusted the services they provided, to ensure they were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services, as well as a full range of health promotion and screening that reflected the needs of this group of patients. Staff utilised other methods of communicating with their Orthodox Jewish community, to ensure they knew what services were available at the practice.

• The QOF data showed the practice had performed either above, or broadly in line with, most of the local CCG and England averages, in providing recommended care and treatment to this group of patients. (Just before we published the report, the QOF data for 2015/16 was released. This showed that the practice had further improved their QOF performance, with an overall achievement of 94.9%, (local CCG average of 96.9%, and a national average of 95.3%), and an overall exception reporting rate of 7.3%.)

• Extended hours appointments were routinely provided each morning, and patients were able to access out-of-hours care via local walk-in centres.

• Information on the practice’s website, and on display in their patient waiting areas, directed patients to the out-of-hours service. 

Updated 6 December 2016

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

• There were suitable arrangements for meeting the needs of patients experiencing poor mental health. Performance for the mental health related indicators was better than the England averages. For example, the percentage of patients with the specified mental health conditions, who had had a comprehensive, agreed care plan documented in their medical record, during the period from 1 April 2014 to 31 March 2015, was higher when compared with the England average (98.4% compared to 88.4%).

• Patients experiencing poor mental health had access to information about how to contact various support groups and voluntary organisations. The provision of in-house counselling and therapy meant patients were able to access these services in a familiar setting. A designated member of staff acted as the lead for armed services Veterans, to help raise awareness of the needs of this group of patients.

• The practice’s clinical IT system clearly identified patients with dementia and other mental health needs, to ensure staff were aware of their specific needs. Where appropriate, care plans had been put in place to meet patients’ needs.
• Clinical staff actively carried out opportunistic dementia screening, to help ensure their patients were receiving the care and support they needed to stay healthy and safe.

Updated 6 December 2016

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

• The practice held registers of patients living in vulnerable circumstances. For example, staff maintained a register of patients with learning disabilities which they used to ensure they received an annual healthcare review. Extended appointments were offered to enable this to happen.

• Systems were in place to protect vulnerable children from harm. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns, and they regularly worked with multi-disciplinary teams to help protect vulnerable patients. Staff were aware of how to contact relevant agencies in normal working hours and out-of-hours.

• Appropriate arrangements had been made to meet the needs of patients who were also carers.