Forsyth House

Updated 20 September 2018

Dr Piper House is a location of Primary Healthcare Darlington Ltd. It is in Darlington centre at King Street, Darlington, Co Durham, DL3 6JL. Primary Healthcare Darlington Ltd is a federation and all of the GP practices in Darlington are shareholders. The service offers a range of services including evening and weekend pre-bookable GP, Nurse & Healthcare Assistant appointments. It provides a service to approximately 107,000 patients. The service is commissioned by the Clinical Commissioning Group as part of the GP Forward view commitment to help to reduce the burden on primary and secondary care services. The service gives support to all the GP Practices in Darlington, providing training, for example; essential training such as basic life support. It also provides a Sexual Health service on behalf of County Durham & Darlington Foundation Trust for the population of Darlington. The Sexual Health service was not inspected as part of this inspection.

The services are delivered from a single point of access, Dr Piper House. Pre-bookable GP, Nurse and Health Care Assistant appointment clinics are provided at the following times:

Monday – Thursday: 6.30pm – 9pm

Friday: 6.30pm – 8.30pm

Saturday: 8am – 2pm

Sunday: 9am – 1pm

The service is for patients who are unable to attend during normal GP surgery hours and for patients who need a review over the weekend. A number of appointments for each clinic are retained for the use of the 111 out of hours service.

Patients requiring an appointment are booked remotely into Primary Healthcare Darlington’s clinical system by their own GP practice.

The 111 service book appointments directly into the Primary Healthcare Darlington clinical system for patients triaged by their service.

Patients are advised on booking that they may be seen by a GP, Nurse or HCA not from their own practice.

On arrival at the clinic, patients are asked verbally if they consent to the clinician viewing their GP records and to sharing their medical data input to the Primary Healthcare Darlington clinical system with their own GP practice.

Prescriptions and sick notes can be issued via this service.

Communication from clinic staff to patient’s home practice is made via the tasks within the clinical system including any ongoing referral requirements.

The service is staffed by clinical and reception staff from local practices, Primary Healthcare Darlington and local Out Of Hours provider GP’s.

The inspection took place on 22 August 2018 and was led by a CQC inspector who was supported by a GP specialist advisor.

We informed Healthwatch, Hartlepool, Stockton and Darlington Clinical Commissioning Group, Public Health England and County Durham & Darlington Foundation Trust that we were inspecting the service; however, we did not receive any information of concern from them. We received information from the provider and checked for any notifications received about the service. We also received 9 non-clinical staff questionnaires prior to the inspection.

During the inspection we interviewed staff, made observations and reviewed documents.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 20 September 2018

We carried out an announced comprehensive inspection on 22 August 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The service had not previously been inspected.

The service offers a range of services including evening and weekend pre-bookable GP, Nurse & Healthcare Assistant appointments. It also provides a Sexual Health service on behalf of County Durham & Darlington Foundation Trust for the population of Darlington.

One of the GP’s working in the service is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We obtained feedback through comment cards completed by patients prior to the inspection. Twenty-six people provided feedback about the service.

Our key findings were:

• The service had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service learned from them and improved their processes.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• Leaders had developed a culture of collaboration and support and were committed to sustainability of general practice.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

The service had offered to run flu clinics to enable all patients the opportunity to be immunised at a time that suited them. There was a strong desire to collaborate with and support local practices. Remuneration of flu clinics would benefit individual practices as they were tasked with the immunisation target.

As an early adopter of extended GP access, the service had been requested to support other areas nationally by NHSE. This ‘buddy scheme’ was delivered by national webinars.

The service led a provider forum for GP practices in Darlington, this had improved GP engagement and ensured information sharing and discussions about new emerging models of care to sustain general practice.