24 March 2016
Corbridge Medical Group is registered with the Care Quality Commission to provide primary care services. It is located in the town of Corbridge in Northumberland.
The practice provides services to around 6,900 patients from one location: Corbridge Health Centre, Newcastle Road, Corbridge, Northumberland, NE45 5LG. We visited this address as part of the inspection. The practice has five GP partners (two female and three male), one salaried GP (female), three practice nurses (all female), a healthcare assistant, a practice manager, and 16 staff who carry out reception, administrative and dispensing duties.
The practice is a training practice and three of the GPs are accredited GP trainers. At the time of the inspection there were three trainee GPs working at the practice.
The practice is part of Northumberland clinical commissioning group (CCG). The practice population is made up of a significantly higher than average proportion of patients over the age 65 (26.8% compared to the national average of 16.7%). Information taken from Public Health England placed the area in which the practice is located in the ninth less deprived decile. In general, people living in more deprived areas tend to have greater need for health services.
The practice is located in a purpose built two storey building. All patient facilities are on the first floor, accessible by a lift or ramp. There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access.
Opening hours are between 8am and 8pm every Monday; between 8am and 6pm Thursday to Friday. In addition, the practice opens at 7am on one Thursday each month. Patients can book appointments in person, on-line or by telephone. Appointments were available at the following times:
- Monday – 8.30am to 11.10am; then from 3.20pm to 7.30pm
- Tuesday – 8.30am to 11.10am; then from 3.20pm to 5.30pm
- Wednesday – 8.30am to 11.10am; then from 3pm to 5.30pm
- Thursday – 8.30am to 11.10am; then from 3.20pm to 5.30pm
- Friday – 8.30am to 11.10am; then from 3pm to 5.30pm
A duty doctor is available each afternoon until 6.30pm.
The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.
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).
24 March 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Corbridge Medical Group on 9 February 2016. Overall the practice is rated as outstanding.
Our key findings were as follows:
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met their needs and promoted equality.
- Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- Feedback from patients was very positive and the practice achieved high scores in the National GP Patient Survey.
- Staff were committed to working collaboratively with other services. The involvement of other organisations was integral to how services were planned and delivered.
- Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
- Extended hours surgeries were offered between 6pm and 7.30pm every Monday evening.
- The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example, an information leaflet for patients ‘what to expect at an outpatients appointment’ was developed in conjunction with the PPG.
- The practice had comprehensive policies and procedures governing their activities and there were very good systems in place to monitor and improve quality.
- 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.
- There was strong collaboration and support across all staff groups. Staff throughout the practice worked well together as a team.
We saw several areas of outstanding practice including:
- Staff were proactive in carrying out clinical audits to help improve patient outcomes. A significant number of audits had been carried out in the past year (15). There was an audit programme in place. An ‘audit club’ meeting was held every three months and was attended by members of the whole multi-disciplinary team (MDT). All the clinical audits we looked at were relevant, well designed, detailed and showed learning points and evidence of changes to practice.
- Staff were proactively supported to acquire new skills and share best practice. A monthly ‘journal club’ meeting was held to discuss new guidelines. This was attended by the GPs, practice nurses and medicines manager. One of the GP partners had set up a local GP club; this was a monthly education event attended by many GPs from other practices in the area.
- There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met their needs and promoted equality. The practice was the preferred practice for a number of students at a local college for young people with learning disabilities, autism spectrum conditions and complex needs (25 patients). Services were tailored to meet those patients’ individual needs. GPs spent a large proportion of their time carrying out home visits (between 15 and 20 each day), due to the high number of elderly and very elderly patients in the area.
- The local village was a designated dementia friendly village. The practice was part of this and signposted patients to the various support groups, including a café designed for patients with dementia. All staff within the practice had been trained as ‘dementia friends’.
However, there was also an area of practice where the provider needs to make improvements.
The provider should:
- Provide staff with guidance on the action to take if refrigerator temperatures are higher than the levels recommended by Public Health England.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
24 March 2016
The practice is rated as good for the care of patients with long-term conditions..
Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. For those people with the most complex needs, GPs worked effectively with relevant health and care professionals to deliver a multidisciplinary package of care.
Nationally reported QOF data (2014/15) showed the practice had achieved good outcomes in relation to some of the conditions commonly associated with this population group. For example, the practice had obtained 95.3% of the points available to them for providing recommended care and treatment for patients with diabetes, (compared to the CCG average of 95% and the national average of 89.2%.
24 March 2016
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 processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given were slightly below CCG averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 86% to 100% (CCG rates ranged from 97.6% to 98.1%) and five year olds from 89.1% to 96.4% (CCG rates ranged from 94.9% to 98.5%). The practice’s uptake for the cervical screening programme was 87.3%, which was above the CCG average of 83.5% and the national average of 81.8%.
Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
24 March 2016
The practice is rated as outstanding for the care of older people.
The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, all patients over the age of 75 had a named GP and patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
GPs spent a large proportion of their time carrying out home visits (between 15 and 20 each day), due to the high number of elderly and very elderly patients in the area. Several patients lived in local residential or nursing homes; there was a named GP for each home. They carried out regular visits and had regular phone contact with staff.
The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.
24 March 2016
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 evenings between 6pm and 7.30pm and from 7.30am one Thursday each month 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.
24 March 2016
The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia).
The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia. The local village was a designated dementia friendly village. The practice was part of this and signposted patients to the various support groups, including a café designed for patients with dementia. All staff within the practice had been trained as ‘dementia friends’.
Patients experiencing poor mental health were sign posted to various support groups and third sector organisations. The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.
Nationally reported QOF data (2014/15) showed the practice’s performance in relation to patients experiencing poor mental health was below average. For example, the practice had obtained 80.8% of the QOF points available to them for providing recommended care and treatment for patients with poor mental health, compared to the national average of 92.8% and the local clinical commissioning group (CCG) average of 96.5%. Managers were aware of this and had taken action to improve. We looked at the figures for the current year, these showed performance had improved.
24 March 2016
The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.
The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. Patients with learning disabilities were invited to attend the practice for annual health checks. The practice offered longer appointments for people with a learning disability, if required.
The practice was the preferred practice for a number of students at a local college for young people with learning disabilities, autism spectrum conditions and complex needs (25 patients). Services were tailored to meet those patients’ individual needs. We were told about several examples of how staff from the practice positively engaged with the patients. For example, one of the practice nurses visited the college at the start of each academic year, to meet the students, tell them about the practice and the services offered. The nurse also visited the college to carry out health checks for those students who preferred not to attend the practice.
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. The number of carers on the register was 106; this represented 1.5% of the practice register.