Thorntree Surgery

Updated 12 November 2015

Thorntree Surgery is situated on a housing estate in east Middlesbrough and provides services under a General Medical Services (GMS) contract with NHS England, Durham, Darlington And Tees Area Team to the practice population of 2259, covering patients of all ages.

The proportion of the practice population in the 65 years and over age group is lower than the England average. The practice population in the under 18 age group is higher than the England average. The practice scored one on the deprivation measurement scale, which is the lowest decile. People living in more deprived areas tend to have greater need for health services. The overall practice deprivation score is much higher than the England average, the practice is 61.5 and the England average is 23.6.

The practice has three GP partners and three associate GPs, three male and three female. The practice manager is also a partner. There is an assistant practice manager, three nurse practitioners, five practice nurses and three health care assistants. The practice has a team of secretarial, administration and reception staff.

The practice has opted out of providing out of hours services (OOHs) for their patients. When the practice is closed patients use the 111 service to contact the OOHs provider. The Out of Hours service is provided by Northern Doctors Urgent Care (NDUC). Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.

The practice is open between 8.30am to 5.30pm Monday to Friday. Appointments are from 9.00am to 4.50pm daily. Extended hours surgeries are provided on a Saturday morning once a month at Thorntree surgery and on a Tuesday and Thursday evening until 7.50pm at the provider’s Park Surgery site. The practice closes on a Wednesday between 12pm and 2.00pm for staff training or meetings, the phone line is transferred and is always answered so any urgent queries are dealt with. The practice, along with all other practices in the South Tees CCG area have a contractual agreement for NDUC to provide OOHs services from 6.00pm and this has been agreed with the NHS England area team.

Updated 12 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thorntree Surgery on 13 & 14 July 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Patients who used the service were kept safe and protected from avoidable harm. The building was well maintained and clean.

• All the patients we spoke with were positive about the care and treatment they received. Patients told us they were treated with dignity and respect and staff were caring, professional and helpful.

• There was good collaborative working between the practice and other health and social care agencies that ensured patients received the best outcomes. Clinical decisions followed best practice guidelines.

• The practice met with the local Clinical Commissioning Group (CCG) to discuss service performance and improvement issues.

• There were good governance and risk management measures in place. The leadership team were visible and staff we spoke with said they found them very approachable.

However there were areas of practice where the provider should make improvements

• Ensure the practice has a written strategy which outlines their vision and plans for the future.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 November 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 12 November 2015

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. The practice offered comprehensive vaccination programmes which were managed effectively. Immunisation rates were relatively high for all standard childhood immunisations. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns.

Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. There was a midwife clinic held at the practice and patients’ care was shared between the midwife and GPs.

The practice had worked to reduce the number of teenage pregnancies which had been on average six per year over the past eight years. There had only been one to date in 2015.

Updated 12 November 2015

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service and actively reviewed the care and treatment needs of these patients. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. Patients over the age of 75 had a named GP. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 12 November 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this population group 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 provided a range of options for patients to consult with the GP and nurse. The practice was proactive in offering online services. Useful information was available in the practice and on the website as well as a full range of health promotion and screening that reflected the needs for this age group. Extended hours were provided on a Saturday morning once a month at Thorntree surgery and on Tuesday and Thursday evenings at the provider’s Park Surgery site.

The practice offered an enhanced service to provide vasectomy surgery for their own patients and those from any practice in the South Tees area. They also provided a sexual health enhanced service at their Park surgery site.

Updated 12 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients who experienced mental health problems including dementia. The register supported clinical staff to offer patients an annual appointment for a health check and a medicines review. Data for 2013/2014 showed 83.3% of patients diagnosed with dementia had received a face to face review in the previous 12 months; this was 5.2% above the local CCG average and 5.4% 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. Information was available for patients on counselling services and support groups. A counsellor and an alcohol support worker attended the Park surgery site practice once a week which patients could access when needed.

Updated 12 November 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register where necessary, of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice offered these patients longer appointments. We found that all of the staff had a very good understanding of what services were available within their catchment area, such as supported living services, care homes and families with carer responsibilities.

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. They had access to the practices’ policy and procedures and discussed vulnerable patients at the clinical meetings.