Blackhall & Peterlee Practice

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• 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 monitored people’s care and treatment and supported them to live healthier lives. 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.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. The provider supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff focused on identifying risks to people’s health, including those in the last 12 months of their lives and those with caring responsibilities. The provider supported national health priorities and initiatives aimed at improving population health, including weight management and smoking cessation. A smoking cessation service was available at the practice through the Nursing Associate, providing patients with direct access to support to stop smoking. Patients were also signposted or referred to relevant support services where appropriate.

The practice had access to a social prescriber who supported people with a range of non-clinical needs, including social isolation, housing difficulties and wider wellbeing concerns. In the 5 months preceding the assessment, 182 referrals had been made to the social prescriber, and all referred patients had been contacted. The social prescriber facilitated a weekly coffee morning at the neighbouring community centre, providing opportunities for social interaction, reducing social isolation, and signposting people to local providers and sources of support, including Citizens Advice. The practice also worked closely with the community centre, providing space within the grounds of Blackhall Practice for a community allotment and acting as a collection point for food donations to support local residents.

Additional support was available through the Primary Care Network (PCN), which employed a care coordinator, a wellbeing coach and 2 further social prescribers. This provided people with further access to a range of wellbeing and community-based support providers where required.

The practice was proud to be an Armed Forces accredited practice, to support serving and veteran patients in the area.

The provider routinely monitored people’s care and treatment in an attempt to continuously improve it. They ensured outcomes were positive, consistent and met the expectations of people themselves.

The practice exceeded 3 of the 5 national targets for childhood immunisation uptake. The indicators slightly below the target level of 95% were for children aged 5 who have received immunisation for measles, mumps and rubella (2 doses of MMR) and the indicator for children aged 1 year who have completed a primary course of immunizations. These were 88.7% and 93.8% respectively. Overall, performance demonstrated immunisation uptake could be improved. The practice had as a result changed the system in an attempt to improve the uptake of childhood immunisations.

The provider performed in line with the England average in relation to several cancer screening programmes, including screening for breast and bowel and cancer. However, performance for cervical screening among women aged 25 to 49 years at 72.5% and for women aged 50- 64 years at 71% was slightly below the target of 80%. This was based on the latest published data available to the practice at the time of the assessment from 2024.

In the previous 12 months, 101 of 102 patients (99%) aged 18 years and over with a learning disability had received an annual learning disability review, with all eligible patients invited to attend. The practice now had 111 registered patients with a learning disability, of whom 49 (44%) had already completed their annual review for the current year, with 7 months remaining in the reporting period.

Clinical audit and quality improvement activity was well established within the provider's governance arrangements and was used to improve the quality and safety of care. Staff had completed a wide range of clinical and prescribing audits, including audits of medicines safety, long-term condition management and medicines requiring enhanced monitoring. Audit outcomes were used to identify opportunities for improvement, inform action plans and monitor the effectiveness of changes made.

The practice had the second highest uptake of the shingles vaccine across the county. Staff told us they actively promoted shingles vaccination, including raising awareness of its role in reducing the risk of dementia. A monthly recall system was in place for patients turning 65, and nursing staff took opportunities to administer the vaccine during other appointments where appropriate. This supported an improved patient uptake and reduced the need for a separate appointment.

The practice had the lowest level of Accident and Emergency attendances in the federation within the 17 practices from March 2025 to April 2026.

The practice was 1 of 4 pilot practices in the county participating in a group consultation programme for people living with chronic pain. The programme was led by a GP and supported by the social prescriber and involved 8 patients. The first session was delivered online, followed by 2 face-to-face sessions. The initiative aimed to support people in managing their condition through shared learning and peer support and was being evaluated at the time of the assessment.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.