St Albans Medical Group

Updated 6 April 2017

St Albans Medical Group is registered with the Care Quality Commission to provide primary care services to predominantly the Felling and other areas of Gateshead from Felling Health Centre, Stephenson Terrace, Felling, Gateshead, NE10 9QG. We visited this address as part of the inspection.

The practice provides services to just over 8,400 patients of all ages. They are part of the NHS Newcastle Gateshead clinical commissioning group (CCG). The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

The practice had previously provided services from a branch surgery in the Bede Centre in another area of Gateshead which closed following a flood, approximately a year ago; the practice was awaiting a decision from NHS England on the position of the closure.

The practice has four GP partners, who work 30 sessions per week between them; there are two salaried GPs both who work six sessions per week. Five are female and one male. There are three nurse practitioners whole time equivalent (WTE) 2.5, two practice nurses WTE 1.5 and two healthcare assistants 1.4 WTE. There is a community link worker attached to the practice. There is a practice development manager who is seconded to the practice for 20 hours per week until April 2017. There is a practice administrator and two reception supervisors. There are seven administration and reception staff. The practice is a training practice that has GP trainees allocated to the practice (fully qualified doctors allocated to the practice as part of a three-year postgraduate general medical training programme).

The surgery is open from 7:30am to 6pm, Monday to Friday. The consultation times are between 7:30am and 6pm Monday to Friday. Phone lines for appointments and other routine requests are open between 8:30am to 6pm each weekday.

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

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 average male life expectancy is 76 years and the average female life expectancy is 80 years, both of which are three years lower than the England average.

The percentage of patients reporting with a long-standing health condition is much higher than the national average (practice population is 71.9% compared to a national average of 56.9%). Higher numbers can indicate an increased demand for GP services.

Updated 6 April 2017

Letter from the Chief Inspector of General Practice

This announced comprehensive inspection was carried out on the 15 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified at our previous inspection on 1 March 2016. Overall the practice is now rated as good.

On 1 March 2016 we carried out an announced comprehensive inspection at St Albans Medical Group. The overall rating for the practice was requires improvement, having being judged as requires improvement for Safe and Well Led services. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for St Albans Medical Group on our website at www.cqc.org.uk.

After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

At our inspection of 15 February 2017 we found that:

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses; improvements had been made to the significant event reporting process.
• 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.
• The practice had reviewed access to appointments at the surgery, which included the introduction of telephone triage, extended access had been provided every weekday morning.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a 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 regulation.

We saw one area of outstanding practice which was:

• The community linking project at the practice enabled the GPs and nurses to refer patients to a range of local, non-clinical services which lead to positive health and well-being outcomes. The project is the only one in the clinical commisioning group area that has been classified as Gold Standard by NHS England, it had been set up by the practice. It had been awarded a NHS Alliance Trojan Mouse Award from the Kings Fund, for introducing changes in practice which leads to positive change in the life of a person or community. An evaluation of the project for the last six months of 2016 showed that 107 patients were referred from the practice and 72 were referred to other services which included, for example, citizen’s advice bureau, social services and voluntary services.

The areas where the provider should make improvements are:

• Include information in response to complaints and for the practice complaint information leaflet to explain the process of taking the complaint further such as to NHS England or The Parliamentary and Health Service Ombudsman.

• Have a system in place to ensure the shared Health Centre defibrillator is being checked correctly by NHS properties staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 April 2017

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

Nationally reported QOF data (2015/16) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. The practice had received maximum points for all 19 clinical domain indicator groups, which included asthma, heart failure, diabetes and chronic obstructive pulmonary disease (COPD) related indicators.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Effective call and recall systems were in place, which helped ensure patients with long-term conditions received an appropriate service, which met their needs. These patients all had a named GP and received an annual review to check that their needs were being met. For those people with the most complex needs, the named GP worked with other relevant health and care professionals to deliver a multidisciplinary package of care. Visits were available by practice nurses for housebound patients with long term conditions.

The year of care project, which provides personalised care to patients to provide shared goals and action plans to enable them to self-manage their condition, had been implemented across a range of long-term conditions and the practice were a pilot for this. One of the nurse practitioners was trained to deliver this approach to other nurses in the locality.

The practice provided enhanced services for the monitoring of prostate cancer, diabetes, rheumatology, heart failure and osteoporosis.

Updated 6 April 2017

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

Immunisation rates were in line with clinical commissioning group (CCG) and national averages. For example, the practice had achieved above the 90% target for all four sub-indicators for childhood immunisation rates for children up to age two.

Appointments were available outside of school hours and the premises were suitable for children and babies.

The community link worker who worked at the practice arranged for cards to be sent to patients on their 16th birthday which advised them of the services the practice could offer and that there was a young person’s representative working in the reception of the practice. The practice had recently recruited a patient who was their young person health champion to consult with and improve access for young people.

Updated 6 April 2017

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 and if appropriate were discussed at monthly multi-disciplinary meetings. There was a GP follow up telephone call (or visit if appropriate) to the patient within two days of hospital discharge. The practice had a complex care team of three GPs and three nurse practitioners. The practice had access to the community link worker, to support the care of complex elderly patients.

The practice maintained a palliative care register and end of life care plans were in place for those patients it was appropriate for. The practice was developing the use of Gold Standards Framework for patients with palliative care needs. One of the salaried GPs worked in a hospice one day per week and held a diploma in palliative care.

They offered immunisations for pneumonia and shingles to older people and in their own home where necessary. Prescriptions could be sent to any local pharmacy electronically.

The practice provided care to patients living in two care homes; one of the GPs was the link for this and carried out weekly ward rounds and care plans. They worked closely with senior carers and the management of the care homes. There was also link working with the older person's specialist nurse.

The practice provided care to a local intermediate care facility for the complex and frail elderly. There was a dedicated GP available every day to access any patient with acute medical need at the centre. The practice provided the medical component of the assessment for new patients at the centre. They attended a weekly multi-disciplinary team meeting. A discharge summary was provided to the patient's usual GP on their discharge from the centre.

Two of the GP partners were clinical advisors, working one session each per week, to the care home vanguard in the clinical commissioning group area and at national level. Vanguards are projects in pilot areas aimed at creating more integrated services between health and social care.

Updated 6 April 2017

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, including telephone consultations and early morning access.

Updated 6 April 2017

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

Nationally reported QOF data (2015/16) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. The practice had received maximum points for all 19 clinical domain indicator groups, which included dementia and mental health.

The practice maintained a register of patients experiencing poor mental health and recalled them for regular reviews including those patients experiencing dementia. Patients were advised how to access various support groups and voluntary organisations. Where appropriate patients with complex conditions were discussed amongst the clinicians at their regular MDT meetings.

Updated 6 April 2017

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

The practice regularly worked with multi-disciplinary (MDT) teams in the case management of vulnerable people. The community linking project at the practice enabled the GPs and nurses patients to a range of local, non-clinical services which lead to positive health and well-being outcomes.

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. Where appropriate, patients with complex conditions were discussed amongst the clinicians at their regular MDT meetings.

The practice held a register of patients living in vulnerable circumstances including patients with learning disabilities. Staff carried out annual health checks for patients who had a learning disability and offered longer appointments.

One of the GP partners was trained to level two for substance misuse and held a weekly joint clinic with the drug and alcohol abuse service in the practice.

The practice’s computer system alerted GPs if a patient was a carer. There were 243 coded on the practice system which was 2.9% of the practice population.