Tanfield View Medical Group

Updated 18 February 2016

Tanfield View Surgery is situated in Stanley. They have a Personal Medical Services (PMS) contract and also offer enhanced services for example; the childhood vaccination and immunisation scheme. The practice covers the town of Stanley which is an ex-mining community. The practice has higher levels of deprivation than national figures and higher levels of patients in care homes than national figures. The practice also has higher levels of patients claiming disability living allowance than national figures. There are 11555 patients on the practice list and the majority of patients are of white British background.

The practice is a purpose built premises which has recently been extended and is undergoing a period of improvement with painting, flooring and seating. There is an independent pharmacy attached to the practice.

The practice has struggled in the past with recruitment and retention issues following the retirement of three senior partners and the resignation of another partner in 2012. The practice has now managed to successfully recruit three salaried GPs and two more Nurse Practitioners. Presently the practice is a partnership with three partners, two female and one male. There are three salaried GPs, all female. There is one sessional GP who is male. There are four Practice Nurses, three Nurse Practitioners, two Specialist Practitioners and two Health Care assistants (all female). There is a Practice Manager, administration and secretarial team leaders and reception and administration staff. The practice has recently become a training practice of GP trainees and F2 doctors.

The practice is open between 8.30am and 6pm Mondays to Fridays. The practice also offers extended hours on Saturday mornings from 9am to 1pm.

Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service (111) provided by North Durham CCG.

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tanfield View Surgery on 19 January 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 found it easy to make an appointment, but not with a named GP, with urgent appointments available the same day. Routine appointments were available in two days.
• 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 management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw two areas of outstanding practice:

• The provision of a skin lesion clinic by a GP who had undertaken further training.This enabled patients to be treated closer to home and helped to reduce referrals to secondary care.

• The provision of an ‘unwell children’ clinic every day after school, with appointments with paediatric trained nurses employed by the practice.

The areas where the provider should make improvement are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure all statutory notifications to the CQC are sent in a timely manner (for example with regard to registration of manager).

• Ensure that learning from incidents and complaints is fully recorded and cascaded to maximise learning opportunities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 2016

GOOD

The practice is rated as good 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.

• The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months was 75% compared to a national average of 78%

• The percentage of patients with diabetes, on the register, who had the influenza immunisation was 99% compared to a national average of 94%

• Longer appointments and home visits were available when needed. Patients with more than one long term condition were able to be seen in one visit.

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

Updated 18 February 2016

GOOD

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.

• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months was 74% compared to a national average of 75%.

• 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.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 81% compared to a national average of 82%.

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

• As part of the Primary Care Outcomes Scheme, in conjunction with the CCG, the practice had set up an ‘unwell child clinic’, with dedicated appointments available every day with Practice Nurses. We were told if the clinic was full the duty GP would always see the children.

• The practice had adopted a toolkit to be used with children presenting with injuries – this ensured that a referral to other services was made if necessary.

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

Updated 18 February 2016

GOOD

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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• As part of the Primary Care 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 Nurse Practitioner contacted these patients to offer support and advice. In addition the practice held a register of frail elderly patients who they were in the process of visiting and assessing.

• The practice had liaised with health trainers to set up a stand in the waiting area to advertise classes in an effort to reduce social isolation and promote wellbeing.

Updated 18 February 2016

GOOD

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 as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice had recently changed its appointment system in response to feedback from patients and now offered telephone consultations each day with a GP of choice.

• As part of the Primary Care Outcomes Scheme in conjunction with the CCG the practice provided an acupuncture service and skin clinic which enabled patients to be treated closer to home.

• The practice offered a contraceptive service that included IUCDs (intrauterine contraceptive devices) that were fitted by the GP. Five of the nursing staff had completed extra training with regard to contraception in order to provide care closer to home for patients requiring this service.

Updated 18 February 2016

GOOD

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

• 97% of patients with physical and/or mental health conditions had a smoking status recorded in the preceding 12 months which was above the national average.

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

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 18 February 2016

GOOD

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.

• The practice offered longer appointments for patients who needed them.

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

• The practice informed vulnerable patients how to access various support groups and voluntary organisations.

• 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.