Leadgate Surgery

Updated 22 March 2016

Leadgate Surgery is situated in Leadgate, a village near Consett, Co Durham. They have a Personal Medical Services (PMS) contract and also offer enhanced services for example; extended hours. The practice covers the area of Leadgate and surrounding areas. Leadgate is an ex-mining and steelworks community. There are 5750 patients on the practice list and the majority of patients are of white British background.

The practice is a training practice and has one GP Registrar. The practice is a partnership with two partners. There are three GPs. There are two Practice Nurses, one Nurse Practitioner and one Health Care assistant. There is a Practice Manager, Deputy Practice Manager and reception and administration staff.

The practice at Leadgate is open between 8.30am and 5.30pm Mondays to Fridays and has extended hours from 5.30pm to 19.45pm on alternate Tuesdays and Wednesdays.

Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by North Durham CCG. They have an agreement with the CCG that care after 5.30pm will be provided by the out of hour’s service.

Updated 22 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leadgate Surgery on 2 February 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 to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. The practice had developed a clinical system that identified a wider range of patients at risk of harm including those at risk of domestic violence and those at risk of harming themselves.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned. For example, administration and reception staff had received extra training in answering the telephone and clinical staff in motivational interviewing.
• 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 about their care was consistently and strongly positive.
• Patients said they found it easy to make an appointment. There were urgent appointments available the same day for GPs and Nurses. Routine appointments were available to book in four days; telephone consultations were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by the management team. The practice proactively sought feedback from staff and patients, including the Patient Participation Group (PPG).
• Information about services and how to complain was available and easy to understand.

We saw several areas of outstanding practice:

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, one of the GPs had created the Derwentside Clinical System (DCS) in Primary Care which was a function in the computer system that bridged the gap between guidance and implementation. This system had been recognised nationally and adopted by 70 other organisations. The system ensured that patients received the right treatment at the right time. It eliminated duplication of tests and helped ensure patients did not miss any recalls.

• The practice encouraged a culture of innovation and improvement; staff were encouraged to increase their knowledge and skills. The apprentice at the practice had won an award from Derwentside College in November 2015; this was ‘Excellence in Business Administration Apprenticeship’.

• There was a strong focus on early identification and prevention of disease and long term conditions. The practice had proactively monitored patients at risk of diabetes since 2009 and had received funding from Public Health England following a proposal they made. This was to implement a more comprehensive system for diabetes prevention and began in May 2015 based on NICE guidance. This had demonstrated very significant results in identifying undiagnosed impaired glucose regulation (patients at risk of developing diabetes).This approach had now been rolled out to five other local practices with the support of the local Public Health Department and NHS England. Data showed that diabetes prevalence at the practice was lower than similar practices in the area but the register of patients at risk who were being monitored was much higher. Therefore these patients had the benefit of early identification and treatment if necessary.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Over 30% of the practice population (half were of working age) had a long term condition and the practice had devised a system that was based on patient priorities and was evidence based.

• The DCS was an integrated system that avoided duplication for patients and clinicians with prevention of development of long term conditions at the heart of the system.

• Data showed that outcomes had improved for patients with long term conditions following implementation of the DCS, including those with, bronchiectasis and pulmonary fibrosis and patients at high risk of diabetes. This was because patients at risk were regularly monitored and screened at appropriate intervals. The system was based on implementing national or local guidance.

Updated 22 March 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, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• We saw good examples of joint working with midwives, health visitors and school nurses.

• Appointments for children were always available as needed.

• The GP had devised a template on the computer that identified children who were at risk; this had been adopted by 70 other service providers. The safeguarding toolkit ensured that correct guidance and referral pathways were available for staff.

• The practice had been commended by the local safeguarding team for the implementation of the toolkit.

Updated 22 March 2016

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

• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in dementia and end of life care.

• As part of the ‘Improving Outcomes Scheme’ in conjunction with the CCG, the practice held a register of patients who were at risk of unplanned emergency admission to hospital.

• The practice had created a unified, evidence based system (DCS) for identifying and managing frailty and integrated this into other care such as in review appointments. They held a register of frail patients.

• Prior to implementation of the DCS the number of patients identified as frail in the medical record was two. As at 7/2/16 the number of frail patients on the ‘register’ was 76 (1.3% of the total list).

• The practice shared the information with other health and social care professionals.

• They were responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 22 March 2016

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

• The needs of this group had been identified and the practice had adjusted the services they offered to ensure these were accessible, flexible and offered continuity of care.

• Patient surveys results were consistently high.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The Practice Nurse had completed extra training in order to offer the contraceptive implant service to patients who needed it and this was available to book at any time.

• The practice had a high level of patients who were of working age with long term conditions and ensured that all care was provided in one review if possible and also opportunistically. These patients were part of an effective recall system in the DCS and were followed up by telephone if they did not respond to letter invitations. The DCS was an integrated system that prevented duplication of tests and appointments for working age people. Care given was based on up to date evidence based guidance within the system used.

• Care was provided at a time to suit the patient.

Updated 22 March 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 patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia. The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations. They had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

• Staff had received training on how to care for people with mental health needs and dementia.

• The DCS enabled all patients with poor mental health to be identified and all relevant care that needed to be provided was in the prompt area of the template.

• The DCS ensured that there was full integration of mental health issues into the LTC management system.

• The dementia diagnosis rates had consistently risen between August 2014 and March 2015 and 95% of patients in the at risk group had been diagnosed with dementia following action by the practice. This was the highest figure in the CCG.

Updated 22 March 2016

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

• The practice had carried out annual health checks for people with a learning disability.

• The practice held a register of patients living in vulnerable circumstances.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• 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 template produced by the GP had enabled streamlined information sharing with appropriate personnel and the ability to have guidance and implementation in one area.

• The template ensured that all relevant tests were undertaken in one visit.