Village Medical Group

Updated 6 February 2017

The Village Medical Group provides care and treatment to 9,300 patients of all ages, based on a Personal Medical Services (PMS) contract. The practice is part of the NHS Northumberland clinical commissioning group (CCG) and provides care and treatment to patients living in Cramlington and the surrounding areas. We visited the following location as part of the inspection:

The Village Surgery, Dudley Lane, Northumberland. NE23 6US.

The practice serves an area where deprivation is lower than the England average. In general, people living in more deprived areas tend to have a greater need for health services. The Village Surgery has fewer patients aged under 18 years of age, and more patients over 65 years, than the England average. The percentage of people with a long-standing health condition is above the England average, but the percentage of people with caring responsibilities is below. Life expectancy for women is higher than the England average, but lower for men. National data showed that 1.2% of the population are from non-white ethnic groups.

The practice occupies premises that have been purpose built to meet the needs of patients with disabilities. It is located at the south-east corner of the Manor Walks Shopping Centre. The premises are owner occupied, and had been extended on four occasions, to enable the delivery of a wider range of services in a better clinical environment. There are consultation and treatment rooms on both the ground and first floors.

The practice has two GP partners (female) and a non-clinical partner, the managing director (male). The managing director was responsible for the operational and strategic running of the surgery. There were also six salaried doctors (four female and two male). Two GP registrars (trainee doctors) were on placement at the time of our visit. The practice also had a lead practice nurse and a research nurse (both female), three healthcare assistants (female), a trainee physician’s associate (female), a medicines manager (female) and a large team of administrative, reception and domestic staff.

The practice is an approved training and teaching practice, and is affiliated with Newcastle Medical School. It is also a research ready practice, which means it is able to get involved in primary care research.

The practice is open Monday between 8:15am and 8:30pm, and Tuesday to Friday between 8:15am and 6:30pm. The practice is closed at the weekend.

GP appointment times are:

Monday: 8:30am to 11:30am and 3:30pm to 8:10pm.

Tuesday to Friday: 8:30am to 11:30am and 3:30pm to 6:20pm.

When the practice is closed patients can access out-of-hours care via Vocare, known locally as Northern Doctors, and the NHS 111 service.

Updated 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Village Medical Group on 25 November 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 for reporting and recording significant events.

• Risks to patients and staff were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. They had the skills, knowledge and experience to deliver effective care and treatment.

• The practice used the information collected for the Quality and Outcomes Framework (QOF), and their performance against national screening programmes, to monitor and improve outcomes for patients. The practice’s overall achievement, for 2015/16, was better than the local clinical commissioning group (CCG) and England averages.

• All staff were actively engaged in monitoring and improving quality and patient outcomes.

• Staff were highly committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion. The practice had a comprehensive screening programme, and had performed above, or similar to, the national averages in relation to breast, bowel and cervical screening.

• The practice worked closely with other organisations, in planning how services were provided to ensure they met patients’ needs. Services were tailored to meet the needs of individual people and were delivered in a way that provided flexibility, choice and continuity of care.

• Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their treatment. Data from the NHS National GP Patient Survey of the practice, published in July 2016, showed high levels of patient satisfaction with the quality of GP and nurse consultations.

• Information about services and how to complain was available and easy to understand.

• 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 well supported by the management team. Rigorous and effective governance arrangements were in place, which focussed on delivering good quality care.

• Staff had a clear vision and strategy for the development of the practice and were committed to providing their patients with good quality care and treatment.

We also saw an area of outstanding practice:

• The practice provides an Intermediate Musculoskeletal (muscle and joint) and Treatment Service (IMATS). This service provides patients registered with the practice, as well as those registered with other local GP surgeries (a patient population of approximately 69,000), with access to an assessment service provided by specialist physiotherapy practitioners. Without this service, these patients would need to be referred to orthopaedics and rheumatology secondary care services. Current data indicates the IMATs service will reduce referrals to the local care trust by more than 2600, during 2016/17.

• The practice participated in primary care research to help improve patient outcomes. They had obtained Research Ready accreditation with the Royal College of General Practitioners, which demonstrated they had met the necessary regulatory requirements for carrying out research. To help assist with the delivery of their research programme, the practice had employed a research nurse, who also provided research support to other practices in the locality. This position was funded by the practice. The practice provided evidence that they were the most proactive research practice within their local clinical commissioning group, with one hundred and forty eight patients participating in 13 studies, during the previous two years.

However, there were also areas where the provider should make improvements. The provider should:

• Use a standardised form to document significant events, to help promote consistent recording. The practice should also carry out a yearly review of significant events, to help identify common trends, themes and areas for improvement.

• Continue to review the practice’s carers’ register to make sure it accurately reflects the number of patients registered who are also carers.

• Revise the standard letter issued in response to complaints received, to include details of the Parliamentary and Health Service Ombudsman.

• Continue to take action to improve patient satisfaction levels in relation to telephone access and appointment waiting times.

• Provide all non-clinical staff with adult safeguarding training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 February 2017

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

• The QOF data, for 2015/16, showed the practice had performed very well, and was above all of the local CCG and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

• Patients with long-term conditions were offered annual reviews, to check that their health needs were being met and they were receiving the right medication. Longer appointments and home visits were available when needed. Patients at risk of an unplanned emergency admission into hospital were identified as a priority.

• Patients were able to access the Intermediate Musculoskeletal (muscle and joint) and Treatment Service (IMATS). This service provided patients registered with the practice, as well as those registered with other local GP surgeries (a patient population of approximately 69,000), with access to an assessment service provided by specialist physiotherapy practitioners. Without this service, these patients would need to be referred to orthopaedics and rheumatology secondary care services.

Updated 6 February 2017

The practice is rated as good for the care of families, children and young people.

• There were good systems in place to protect children who were at risk and living in disadvantaged circumstances. For example, regular multi-disciplinary safeguarding meetings were held, where the needs of vulnerable children and families were discussed. Systems had been put in place to identify and follow up children who were at risk. All the clinical staff had completed appropriate safeguarding training. Appointments were available outside of school hours and the practice’s premises were suitable for children and babies.

• The practice offered contraceptive and sexual health advice, and information was available about how patients could access specialist sexual health services.

• The practice had a comprehensive screening programme. Nationally reported information showed the practice’s performance was either above, or broadly in line with, the national averages. For example, the uptake of cervical screening by females aged between 25 and 64, attending during the target period, was in line with the national average, 80.8% compared to 81.8%.

• The practice offered a full range of childhood immunisations and had performed above the local CCG averages in the delivery of these. For example, the immunisation rates for the vaccinations given to children under two years old, ranged from 97.3% to 100% (the local CCG averages ranged from 93.6% to 98.6%). For five year olds, the rates ranged from 94% to 100% (the local CCG averages ranged from 91.9% to 98.7%).

Updated 6 February 2017

The practice is rated as good for the care of older people.

• The Quality and Outcome Framework (QOF) data, for 2015/16, showed the practice had performed very well, and was above all of the local clinical commissioning group (CCG) and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

• The practice offered proactive, personalised care which met the needs of older patients. For example, all patients over 75 years of age had a named GP who was responsible for their care. Home visits were provided for patients who were unable to attend the surgery.

• The practice was aligned to a local nursing home, and nursing staff received allocated time to enable them to monitor the ongoing care needs of the patients living there.

• Emergency care plans were in place for patients identified as being at risk of an unplanned admission into hospital. GPs had dedicated time set aside to enable them to complete these care plans.

• Monthly multi-disciplinary meetings were held to help ensure that the needs of patients with the most complex needs were met. The practice also held quarterly palliative care meetings, with other local healthcare professionals, to help manage the treatment needs of patients requiring palliative care.

Updated 6 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice was proactive in offering online services, as well as a full range of health promotion and screening that reflected the needs of their patients.

• The QOF data, for 2015/16, showed the practice had performed very well, and was above all of the local CCG and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

• Working age patients had access to a greater range of services ‘under one roof’ to enable them to receive treatment closer to home. For example, patients could access extra services such as the IMATS, physiotherapy, chiropody, the community anticoagulation clinic and retinal screening at the practice. The practice had set up a scheme, in collaboration with a national on-line pharmacy service, to enable their patients to have their repeat prescriptions delivered direct to their chosen address, at no extra cost.

• Extended hours appointments were offered each morning from 8:15am onwards, and each Monday evening until 8:30pm. Patients were able to use on-line services to access appointments and request prescriptions.

Updated 6 February 2017

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

• There were good arrangements for meeting the needs of patients experiencing poor mental health. The QOF data, for 2015/16, showed the practice had performed very well, and was above all the local CCG and national averages, in relation to providing care and treatment for this population group. For example, the percentage of patients with the specified mental health conditions, who had had a comprehensive, agreed care plan documented in their medical records, during the period from 1 April 2015 to 31 March 2016, was higher when compared with the England average (100% compared to 88.8%).

• The practice’s clinical IT system clearly identified patients with dementia and other mental health conditions to ensure staff were aware of their specific needs.

• Patients experiencing poor mental health had access to information about how to access various support groups and voluntary organisations.

• Patients with mental health needs were able to access on-site mental health practitioners and counsellors, to help provide care and treatment within a local setting.

Updated 6 February 2017

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

• The practice held registers of patients living in vulnerable circumstances, so clinical staff could take this into account when providing care and treatment to these patients. Patients with learning disabilities were provided with access to an annual healthcare appointment to review their needs and ensure they were being met. The practice offered a home visiting service for patients with learning disabilities who were housebound.

• Systems were in place to protect vulnerable children and adults from harm. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns, and they regularly worked with multi-disciplinary teams to help protect vulnerable patients. Staff were aware of how to contact relevant agencies in normal working hours and out-of-hours.

• Appropriate arrangements had been made to meet the needs of patients who were also carers.