Talbot Medical Centre

Updated 21 November 2016

Talbot Medical Centre provides Primary Medical Services to the central area of the town of South Shields. The practice provides services from one location; Stanley Street, South Shields, Tyne and Wear, NE34 0BX. We visited this address as part of the inspection.

The surgery is located in a purpose built premises. There is step free access at the front of the building and all facilities are on the ground floor with full disabled access. There is car parking at the side of the surgery including dedicated disabled parking bays and also street parking.

The practice has five GP partners and one salaried GP. Four are female, who are part-time and two are male who are both full time; there are 33 sessions per week. The practice teaches stage one, two, three and five medical students. There are two nurse practitioners and two practice nurses. There is a practice manager, assistant practice manager and seven administration and nine reception staff of which some are part-time.

The practice provides services to approximately 8,200 patients of all ages. The practice is commissioned to provide services within a General Medical Services (GMS) contract with NHS England.

The practice is part of South Tyneside clinical commissioning group (CCG). Information taken from Public Health England placed the area in which the practice was located in the second most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice population had similar numbers of patients comparable with the national average other than patients between the ages of 30 and 44 where there were less than the average number of patients.

The practice is open from 8.30am and until 6pm Monday, Thursday and Friday. There is extended opening hours on Tuesday and Wednesday evenings until 7.30pm. The practice is closed at weekends.

Consulting times with the GPs and nurses range from 8.45am – 11.50am and 2.20pm – 5:40pm. On extended opening days consulting times run to 7.15pm.

The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Vocare, known locally as Northern Doctors Urgent Care Limited.

Updated 21 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Talbot Medical Centre on 6 October 2016. Overall the practice is rated as good. We have rated the population group of families, children and young people outstanding.

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.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were below local clinical commissioning group (CCG) and national averages. However the practice were able to demonstrate that data for the 2015/16 period which were not yet published had improved to 96.3 from 88.5% in 2014/15.
• 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.
• The practice had reviewed their appointment system, following feedback from patients and staff.
• 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.
• Staff throughout the practice worked well together as a team.
• The practice was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice;

• The practice were the first organisation in South Tyneside to be awarded the Change for Life young people’s award. This is an NHS organisation dedicated to the health and well-being of the public. In addition, the practice carried out work with young people to improve their awareness of what general practice can offer and their rights regarding access and consent. This involved giving a lesson to year eight pupils at a local secondary school. This was delivered by GPs, nurses and NHS staff. At the start of the lesson 38% of students knew what confidentiality meant and at the end 96% felt they knew the meaning. 14% at the start of the lesson knew there was no age limit to see a GP or nurse on their own, by the end 82% knew this. The practice put forward a paper to the CCG Informal Executive committee to see if this work could be offered to all young people in South Tyneside involving other practices as well as theirs.

The areas where the provider should make improvements are:

• Carry out regular comprehensive infection control audits.

• Produce a consent policy which complies with the guidance from The General Medical Council.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 November 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 recall appointment for health checks. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.

Flexible appointments, including extended opening hours and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review.

Care plans were in place for the practice’s most vulnerable 2% of patients at high risk of hospital admission including patients with long term conditions. The practice nurse led on the chronic disease reviews and self-care and management was encouraged and supported. Spirometry was carried out in the practice.

Updated 21 November 2016

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

The practice had good arrangements were in place to safeguard adults and children from abuse. There was a monthly child safeguarding meetings and clinicians met informally on a daily basis to discuss patients for whom they had concerns, this included safeguarding concerns. We were provided with examples of follow up action from these meetings. For example, from the child safeguarding meeting there was a follow up of children who had not attended primary or secondary care appointments.

The practice were the first organisation in South Tyneside to be awarded the Change for Life young people’s award. This is an NHS organisation dedicated to the health and well-being of the public. The practice in addition carried out work with young people to improve their awareness of what general practice can offer and their rights regarding access and consent. This involved giving a lesson to year eight pupils at a local secondary school. This was delivered by GPs, nurses and NHS staff. At the start of the lesson 38% of students knew what confidentiality meant and at the end 96% felt they knew the meaning. 14% at the start of the lesson knew there was no age limit to see a GP or nurse on their own, by the end 82% knew this. The practice put forward a paper to the CCG Informal Executive committee to see if this work could be offered to all young people in South Tyneside involving other practices as well as theirs.

Letters were sent to patients when the attained the age of 14 explaining more about the practice, for example, making appointments, confidentiality and young carers information.

Immunisation rates were comparable with CCG/national averages. For example, childhood immunisation rates for the vaccinations given to five year olds ranged from 96% to 99%, compared to CCG averages of 81% to 95%.

The practice’s uptake for the cervical screening programme was 80%, which was comparable to the national average of 82%.

Specialist Clinics were provided which included intrauterine device (IUD also known as coil) fitting and removal service. Sexually transmitted infection screening was offered which included blood tests for blood borne viruses. The practice offered the C card service to patient aged between 14-25 years where they could receive free condoms.

Mother and baby clinics were offered by the health visiting team in the same building as the practice. Child immunisations were carried out by making an appointment with the practice nurse. Appointments were available outside of school hours; all children under the age of two where a request was made for a same day appointment were given one, this would be as an extra for a GP if none were available. The premises were suitable for children and babies.

Updated 21 November 2016

The practice is rated as good 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, patients at high risk of hospital admission and those in vulnerable circumstances had care plans in place.

The practice was responsive to the needs of older people, including offering home visits. All patients over the age of 75 had a named GP. If the patient was over the age of 75 the practice had a policy that they would ring the patient back if there was a request for an urgent appointment within 2 hours. There was a proactive search of the over 75s who did not attend the practice regularly to offer health checks or visit if appropriate. Prescriptions could be sent to any local pharmacy electronically.

The practice maintained a palliative care register and end of life care plans were in place for those patients it was appropriate for. They offered immunisations for pneumonia and shingles to older people. Age UK attended the influenza clinics held to give energy and benefits advice to patients.

The practice had quarterly palliative care meetings and clinicians meet informally daily to discuss patients for whom they had concerns. This included palliative care / end of life patients and allowed the practice to be responsive to patient’s needs as they arose.

Updated 21 November 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. There was a full range of health promotion and screening that reflected the needs for this age group.

Flexible appointments were available as well as extended opening hours.

Updated 21 November 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. In house counselling was available. They told them how to access various support groups and voluntary organisations. Performance for mental health related indicators was better than national average. (95.7% compared to 92.8% nationally).

They carried out advanced care planning for patients with dementia. This included discussions about the future, usually in their own homes, with their carers present. 89% of patients identified as living with dementia had received an annual review in 2014/15 (national average 84%). The practice also worked together with their carers to assess their needs. The practice had in the waiting area an example of ‘twiddle mitts’ which were knitted or crocheted hand muffs with interesting items with textures attached, sensory items, such as button and beads, which were for patients with dementia. The practice staff had been collecting items and making these for the local community.

Updated 21 November 2016

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

The practice had a register of patients with a learning disability. The nurse practitioner recently began to offer reviews in the home for patients. This was primarily aimed at patients with dementia and learning disabilities. The visit would include compiling a personalised care plan and would cover health needs, ensure all reviews were up to date, carer’s assessment, referrals to other services as necessary, emergency care plan and consent to share information with other agencies.

The practice offered an enhanced drug and alcohol worker service and worked with a local drug and alcohol treatment service.

The practice had good arrangements in place to safeguard adults and children from abuse. There was a quarterly vulnerable adult safeguarding meeting. Community health care staff, for example, health visitor and school nurse attended along with the local integrated care team. We were provided with examples of follow up actions from these meetings. For example, where elderly patients in poor living conditions were referred to social services for assessment.

The practice had identified a carer’s lead in the last year who was a member of the reception team. The local carers association had given a presentation to staff regarding carers support in May 2016. The practice had 167 patients identified as a carer (2% of the overall practice population) and the lead member of staff was in the process of contacting the carers personally to offer support. They had spoken to 64 patients so far. The practice had two separate carers packs, one for patients in general and the other for young carers which set out the definition of a carer, the type of support available and the details of the practice carer’s lead. This information was available in the waiting area of the practice.