28 December 2016
The Medical Group provides Primary Medical Services to towns and villages in the West Durham area. Services are provided from five locations;
- The Surgery, Sawmills Lane, Meadowfield, Durham, DH7 8NH
- Esh Winning Surgery, Mackenzie House, Newhouse Road, Esh Winning, DH7 9LA.
- Langley Park Surgery, Sir Bobby Robson House, Rear Church Street, Langley Park, DH7 9XD.
- Tow Law Surgery, Charlton house, Rear High Street, Tow Law, DL13 4DH.
- Ushaw Moor Surgery, Millyard House, Durham Road, Ushaw Moor, DH7 7QH.
We visited all five practices on the day of the inspection.
The practice dispenses medicines from the Esh Winning Surgery; this means under certain criteria they can supply eligible patients with medicines directly.
The practice has a General Medical Services (GMS) contracts with NHS England and provides services to approximately 24,000 patients of all ages. All of the surgeries were purpose built. There was step free access to all of the premises and they all had a car park with marked disabled bays. Facilities were mostly on the ground floor, at Meadowfield Surgery there was a serviced lift to the first floor for patient use.
The practice has thirteen GP partners and four salaried GPs. Ten are male and seven female. Some of the GPs work part-time; the whole time equivalent (WTE) of GPs is 13.62 or 109 sessions per week. The practice is a training practice which has GP trainees allocated to them (fully qualified doctors allocated to the practice as part of a three-year postgraduate general practice vocational training programme). Four of the GPs are trainers. There are 15 nursing staff, some of which are part-time, which includes, one practice nurse lead, three nurse practitioners, six practice nurses, one mental health nurse and four healthcare assistants. The WTE is 11.96. There are two dispensary staff, WTE 1.33. There are twelve office staff which includes the practice manger, finance administrator, assistant managers, secretaries, and a courier which is 10.1 WTE. There are twenty reception staff, which includes, a reception manager and lead receptionists which equates to 18.19 WTE. There are six cleaners which equates to 2.02 WTE.
The practice is part of North Durham clinical commissioning group (CCG). Information taken from Public Health England placed the area in which the practice was located in the fifth most deprived decile. In general, people living in more deprived areas tend to have greater need for health services.
The practice opening and consulting hours are as follows;
- Meadowfield Surgery, open weekdays 8am Monday to Wednesday and Friday and until 6pm Wednesday and Friday and extended opening hours from 7am on Thursday and until 7.30pm on Monday Tuesday and Thursday. Consulting times run from 8am until 5.30pm and from 7am until 7.30pm on extended opening times.
- Esh Winning Surgery, open weekdays 8am Monday and Wednesday to Friday and until 5.30pm. On Tuesday there are extended opening hours from 7am. Consulting times run from 8.30am until 5.30pm and from 7am extended opening times.
- Langley Park Surgery, open weekdays 8am until 5.30pm Monday to Wednesday and Friday, the practice is closed on Thursday afternoon. Consulting times run from 8.30am until 5.30pm and to 11.30am on Thursday.
- Tow Law Surgery, open weekdays 8am until 5.30pm, the practice is closed on Thursday afternoon. There is extended opening hours Wednesday until 7.30pm. Consulting times run from 8.30am until 5.30pm and to 11am on Thursday and 7.30pm on extended opening hours.
- Ushaw Moor Surgery, open weekdays 8am and until 5.30pm Tuesday to Friday. On Monday there are extended opening hours to 7.30pm. Consulting times run from 8.30am until 5.30pm and to 7.30pm on extended opening times
The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service.
28 December 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at The Medical Group on 10 November 2016. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.
Risks to patients were assessed and well managed.
Outcomes for patients who use services were good.
Patients’ needs were assessed and care was planned and delivered following best practice guidance.
Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available
Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.
Patients we spoke with raised no concerns regarding making an appointment and only a small number of patients who completed CQC comment cards raised concerns (8%).
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 sought feedback from staff and patients, which they acted on.
The practice was aware of and complied with the requirements of the duty of candour.
The areas where the provider should make improvements are:
Review frequency of controlled drug checks in line with the practice standard operating procedures and maintain appropriate records of expiry checks within the dispensary. Review the arrangements for tracking pre-printed prescription stock through the practice.
Have a comprehensive system for planning and carrying out clinical audits.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
28 December 2016
The practice is rated as good for the care of patients with long-term conditions.
The practice had a register of patient with long term conditions which they monitored closely for annual call and recall appointment for health checks. There were longer appointments available for these clinics. Extended opening hours and home visits were available when needed.
The nursing staff had lead roles in chronic disease management, for example heart failure, chronic obstructive pulmonary disease (COPD), diabetes and palliative care. Patients at risk of hospital admission were identified and regularly reviewed by the nurse practitioner. In house diabetic clinics were managed by the diabetes specialist nurses. The practice were to launch a new model of diabetes care from April 2017, they were currently discussing this with the PPG.
There was an anticoagulation monitoring service provided by the practice which was an additional service the practice received funding for. This was for all patients in the area.
The clinical staff kept themselves updated with new guidance via educational meetings.
28 December 2016
The practice is rated as good for the care of families, children and young people.
There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. There were quarterly safeguarding meetings held at each practice.
The practice were awarded Investor in Children status in November 2015. A further review of this was underway. This involved being inspected by children who come to the surgery to ensure it is suitable for them. The practice had dedicated notice boards in each surgery with information for children and young people.
Childhood immunisation rates for the vaccinations given were in line with CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 96% to 98%, compared to the CCG averages of 98% to 99% and for five year olds from 97% to 99%, compared to CCG averages of 97% to 99%.
The practice’s uptake for the cervical screening programme was 80%, which was in line with the national average of 82%.
Appointments were available outside of school hours and the premises were suitable for children and babies, there were baby changing and breast feeding facilities. Mother and baby clinics were offered every week at each surgery. Child immunisations were carried out by making an appointment with the practice nurse.
There was a sexual health and family planning service, contraceptive implants could be arranged.
28 December 2016
The practice is rated as good for the care of older people.
Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example, performance for atrial fibrillation related indicators were above the national average (100% compared to 99.2% nationally).The practice offered proactive, personalised care to meet the needs of the older people in its population.
All patients over the age of 75 had a named GP. The practice offered home visits as required. Prescriptions could be sent to any local pharmacy electronically. There was a volunteer car scheme available to bring patients who were less mobile to the practice. The practice had a palliative care register which was discussed at the monthly palliative care meeting.
The practice reviewed patients at risk of unplanned admission to hospital and care plans were in place for the most vulnerable which were reviewed regularly. There was a frail elderly service provided to 225 patients. The aim of this was to provide physical and mental health care to patients with long-term healthcare needs who do not reside in a care home. All had received a personalised care plan in the last 12 months, which included falls assessment, nutritional assessment, medication review, depression screening and memory assessment. The service was managed by a nurse practitioner.
The nurse practitioners and community matrons worked closely with the local care homes to offer additional support to patients who lived there.
28 December 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, flexible and offered continuity of care.
The practice was proactive in offering online services which included appointment booking, test results and ordering repeat prescriptions. A text reminder service was used to advise patients of pre-booked appointments. There was a full range of health promotion and screening that reflected the needs for this age group. Flexible appointments were available, including telephone appointments as well as extended opening hours.
28 December 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health.
The practice maintained a register of patients experiencing poor mental health and recalled them for regular reviews. The registered mental health nurse at the practice managed the clinics. They told them how to access various support groups and voluntary organisations.
The practice were the only GP surgery providing services to a local 26 bed privately run hospital which specialised in mental health rehabilitation for women.
Performance for mental health related indicators was better than national average. For example performance for dementia indicators was above the national average (100% compared to 94.5% nationally). Some of the practice staff had received dementia friends training.
28 December 2016
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
The practice held a learning disability register of 120 patients; all patients were offered an annual review. The practice operated an enhanced learning disability service which was provided by the registered mental health nurse who worked at the practice. There were plans for a learning disability audit to be carried out at the practice to see if services for this group of patients could be improved.
Patients were able to access an interpreter when necessary. A member of the practice team was trained in British Sign Language.
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 normal working hours and out of hours.
The practice’s computer system alerted GPs if a patient was a carer. There was a practice register of all people who were carers and were being supported, for example, by offering health checks and referral for social services support. There were 498 patients on the carer’s register which was 2% of the practice population. Written information was available for carers to ensure they understood the various avenues of support available to them and there was a dedicated notice board in each surgery. The practice were soon to sign up to a carers charter and were due to meet with a representative from the local carers organisation.