The Gables Medical Group

Updated 21 April 2016

The Gables Medical Group provides care and treatment to approximately 6318 patients from Bedlington and the surrounding areas from two sites. It is part of the NHS Northumberland Clinical Commissioning Group (CCG) and operates on a Personal Medical Services (PMS) contract.

The practice provides services from the following addresses, which we visited during this inspection:

Main Surgery:

The Gables Medical Group, The Gables Health Centre, 26 St Johns Road, Bedlington, NE22 7DU

Branch Surgery:

The Gables Medical Group, Miner’s Welfare Institute, Ridley Terrace, Cambois, NE24 1QS

The main surgery is located in purpose built premises which it shares with a dentist and podiatry service. All patients registered with the practice are able to access services at the main surgery. All reception and consultation rooms are fully accessible for patients with mobility issues and there is a large on-site car park with dedicated disabled parking bays.

The branch surgery is located in a room within the Miners Welfare Institute building in Cambois which is leased from the local authority. The reception and consultation room are fully accessible and on street parking is available nearby. Only patients registered with the practice who live in Cambois were able to request an appointment or collect a prescription at the branch surgery.

The main surgery is open from 8.30am to 12.30pm and from 1.30pm to 6.00pm on a Monday to Friday. Appointments ran from 8.30am to 12.20pm and from 1.30pm to 5.20pm. The branch surgery was open from 9am to 11.30am on a Monday to Friday. However, this was mainly to enable patients living in the Cambois area to collect prescriptions. The practice operated a surgery at the branch surgery approximately once per month.

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

The Gables Medical Practice offers a range of services and clinic appointments including chronic disease management clinics, antenatal clinics, childhood health surveillance and immunisations and travel vaccinations. The practice is a teaching and training practice and provides training to GP registrars (fully qualified doctors with experience of hospital medicine who are training to become a GP) and medical students.

The practice consists of:

• Two GP partners (both male)
• Five salaried GPs (all female)
• One practice nurses (female)
• A health care assistant (female)
• Two dispensers
• 13 non-clinical members of staff including a practice manager, medicines manager, administration manager, medical secretaries, administration and reception staff

The area in which the practice is located is in the fourth (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The practice’s age distribution profile showed slightly more patients than the national average in the 65-69 year age group. Average life expectancy for the male practice population was 76 (local clinical commissioning group and national average 79) and for the female population 79 (local clinical commissioning group and national average 83).

62% of the practices patient population were reported to have a long standing health condition compared to the CCG average of 59% and national average of 54%. A higher percentage of patients with long term health conditions could lead to an increased demand for GP services.

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Gables Medical Group on 17 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.
• Risks to patients were assessed and generally well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• The majority of patients said they were treated with compassion, dignity and respect.
• Urgent appointments were usually available on the day they were requested. The practice had introduced a daily open surgery as a result of increased demand for appointments and were continually monitoring its effectiveness.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice had proactively sought feedback from patients and had a ‘virtual’ patient participation group.
• Information about services and how to complain was available and easy to understand.
• The practice had effective systems in place to support patients with long term conditions and were proactive in their treatment of patients with diabetes.

However there were areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Carry out a risk assessment detailing why it is not felt to be appropriate or necessary to have a defibrillator or oxygen at the branch surgery
• Purchase spillage kits and ensure staff are aware of their location and how to deal with spillages of body fluids
• Consider having a formal written business plan
• Consider developing an ‘actual’ as well as ‘virtual’ patient participation group

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 April 2016

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

Patients with a long term condition had a named GP and were able to request longer appointments and longer appointments were routinely offered to patients with more than one long term condition. Home visits were available when needed. The practice’s computer system was used to flag when patients with a long term condition were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. Patients who did not attend for their review were regularly recalled to ensure their needs were being met.

Practice nurses were supported in undertaking additional training to help them understand and care for patients with certain long term conditions, such as chronic obstructive pulmonary disease (COPD) and asthma. The practice had a proactive approach to treating patients with diabetes by offering in-house access to a diabetic dietician and by sending diabetic patients a personalised letter detailing test results.

Nationally reported Quality and Outcomes Framework (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 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 0.7 percentage points above the local CCG average and 2.6 points above the national average.
• They had obtained 100% of the points available to them in respect of hypertension (0.3 percentage points above the local CCG average and 2.2 points above the national average).
• They had obtained 97.7% of the points available to them for diabetes (2.7 percentage points above the local CCG average and 8.5 points above the national average).
• The practice had obtained 100% of the points available to them for ischaemic heart disease and stroke and chronic obstructive pulmonary disease.

Updated 21 April 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. A protocol was in place to ensure children who failed to attend for GP or hospital appointments were followed up.

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. Vaccination rates for 12 month and 24 month old babies and five year old children were comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 95% to 100% (compared with the CCG range of 95.3% to 98.1%). For five year olds this ranged from 91% to 100% (compared to CCG range of 95.4% to 100%).

Information from the National Cancer Intelligence Network (NCIN) published in March 2015 indicated that 76.8% of the 1145 female patients aged between 25 and 64 listed with the practice had attended cervical screening (compared to the CCG average of 79.1% and national average of 74.3%).

Pregnant women were able to access antenatal clinics provided by healthcare staff attached to the practice. A drop in baby clinic was delivered by a health visitor attached to the practice.

The practice was working towards the ‘You’re Welcome’ accreditation (a national quality accreditation scheme delivered by the Department of Health which assesses how young people friendly health care services are).

Updated 21 April 2016

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

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 98.9% and the England average of 97.9%.

Patients aged over 75 had a named GP and the practice offered immunisations for pneumonia and shingles to older people. The practice had a palliative care register and held monthly multi-disciplinary meetings to discuss and plan end of life care. Elderly patients at high risk of admission to hospital were offered frail and elderly assessments and their care was also reviewed at monthly multidisciplinary meetings.

The practice had ensured that there was a named GP for each local care home and operated a ward round approach to visiting patients resident in these homes.

Updated 21 April 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 met. The main surgery was open from 8.30am to 12.30pm and from 1.30pm to 6.00pm on a Monday to Friday with appointments running from 8.30am to 12.20pm and from 1.30pm to 5.20pm. The branch surgery was open from 9am to 11.30am on a Monday to Friday to enable patients living in Cambois to collect prescriptions. The practice operated a surgery from the branch surgery approximately once per month. In addition to pre bookable appointments and telephone consultations the practice also offered an open surgery and same day appointments following a telephone triage with a practice GP.

The practice offered contraceptive services, travel immunisations, new patient and NHS health checks (for patients aged 40-74).

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

Updated 21 April 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 81.8% (CCG average 85.1% and national average 84%).

There was a lead GP for patients experiencing dementia or mental health issues who worked with these patients and/or their carers where appropriate to develop care plans. GPs had undertaken training on their roles and responsibilities under the Mental Capacity Act and one of the GPs had undertaken training to help understand and care for patients with Alzheimer’s.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. They were in the process of training a member of the administration staff to be a Dementia Friend.

Updated 21 April 2016

The practice is rated as good for the care of people whose circumstances 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 an annual health check.

The practice had established 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.

GPs had received training in recognising the signs of, and caring for patients who had experienced, domestic abuse. The practice regularly hosted counsellors from a local service dedicated to providing help and support to anyone aged over 18 from the Northumberland area that was experiencing problems with drugs or alcohol.

The practice was proactive in identifying and supporting carers. A carer’s champion had been identified and carers were offered a flu vaccination and referral to the local carers centre.