Archived: Appleby Surgery

Updated 18 July 2016

Appleby Surgery is registered with the Care Quality Commission to provide primary care services. It is located in the town of North Shields, Tyne and Wear.

The practice provides services to around 6,000 patients from one location: Hawkeys Lane, North Shields, Tyne and Wear, NE29 0SF. We visited this address as part of the inspection. The practice has four GP partners (two female and two male), one salaried GPs (female), three practice nurses (all female), a healthcare assistant, a practice manager, and 10 staff who carry out reception and administrative duties.

The practice is a training practice and one of the GPs is an accredited GP trainer. At the time of the inspection there was one trainee GP working at the practice.

The practice is part of North Tyneside clinical commissioning group (CCG). The practice population is made up of a higher than average proportion of patients over the age 65 (24.1% compared to the national average of 18.9%). Information taken from Public Health England placed the area in which the practice is located in the fifth more deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The practice is located in a purpose built two storey building. The majority patient facilities are on the ground floor. A counselling room is located on the first floor; as the practice does not have a lift, appointments are available on the ground floor for any patients with mobility problems There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access.

Opening hours are between 8.30am and 6pm Monday to Friday and between 8.30am and 11.30am on alternate Saturday mornings. Patients can book appointments in person, on-line or by telephone.

Appointments were available at the following times:

• Monday to Friday - 8.30am to 11am; then from 3.30pm to 5.30pm (in addition, surgeries started at 7.40am two weekday mornings per week)
• Saturday – 8.30am to 11.20am.

A duty doctor is available each afternoon until 6pm.

The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

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

Updated 18 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Appleby Surgery on 14 June 2016. Overall the practice is rated as good.

Our key findings were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• The practice had very 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 proactively sought feedback from staff and patients, which they acted on.
• The practice had an effective governance framework which supported good quality care.
• Clinical and non-clinical staff had lead roles and staff throughout the practice worked very well together as a team. Staff retention was high and there had been only one change to the partnership over the past 15 years.
• Managers had a comprehensive understanding of the performance of the practice.
• The practice had effective arrangements for identifying, recording and managing risks, issues and implementing mitigating actions.

The areas where the provider should make improvements are:

• Continue to seek ways to identify carers within the practice population.
• Implement Patient Specific Directions to allow the practice’s healthcare assistant to administer flu immunisations to patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 18 July 2016

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

• Clinical staff had lead roles in chronic disease management, supported by named administrative staff.
• Patients at risk of admission to hospital were identified as a priority.
• One of the practice nurses was able to start diabetic patients on insulin, if required, with support and follow-up, rather than patients having to visit hospital.
• Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.
• Patients had regular reviews to check with health and medicines needs were being met.
• For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 18 July 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 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, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Combined six week mother and baby health checks were offered for convenience and to provide holistic care.
• The practice’s uptake for the cervical screening programme was 80.1%, which was slightly below the CCG average of 83.1% and the national average of 81.8%.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 18 July 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, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• Doctors carried out twice weekly ward rounds and had regular phone contact with staff at a local nursing home.
• A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.

Updated 18 July 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 and flexible. Extended hours surgeries were offered on alternate Saturday mornings between 8.30am and 11.30am. In addition, surgeries started at 7.40am two weekday mornings per week for working patients who could not attend during normal opening hours.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
• Additional services were provided such as health checks for the over 40s and travel vaccinations. Life expectancy varied across the practice population; with a difference of 10 years in the most extreme cases. The practice had taken steps to address these inequalities; and had increased capacity in the nursing team to allow further NHS health checks to be carried out.

Updated 18 July 2016

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

• The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
• One of the GPs had developed a weight loss protocol, so staff in the local nursing home knew when to report a patient’s weight loss to a GP, and what action the GP should take about certain levels of weight loss.
• Patients experiencing poor mental health were sign posted to various support groups and third sector organisations. The practice had strong links with the local talking therapies team. Patients could access an in-house counsellor and local social prescribing schemes.
• The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.

Updated 18 July 2016

The practice is rated as good for the care of people whose circumstances may 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 annual health checks and were offered longer appointments, if required.
• The practice had 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.
• Arrangements were in place to support patients who were carers. The practice had some systems in place for identifying carers and ensuring that they were offered a health check and referred for a carer’s assessment, although these could be improved. The practice had begun to make attempts to increase the number of carers; a carers champion had been appointed and staff had developed links with a local carers’ support group.