Archived: Crowhall Medical Group

Updated 24 March 2017

Crowhall Medical Group is a medium sized practice providing care and treatment to approximately 6,596 patients of all ages, based on a General Medical Services contract. The practice is part of NHS Newcastle Gateshead Clinical Commissioning Group (CCG). We visited the following location as part of the inspection:

• Crowhall Medical Group, Felling Health Centre, Stephenson Terrace, Felling, Gateshead, Tyne and Wear, NE10 9QG.

The area in which the practice is situated is in the third most deprived decile. Figures show that 60.8% of practice patients were in paid work or full-time education, compared with the England average of 62.5%. The percentage of patients with a long-standing health condition is higher than the national average, 54.9% compared to 53.2%. There are more patients with caring responsibilities than the England average, 19.5% compared to 17.8%. Life expectancy for patients is lower than the local CCG and England averages.

Crowhall Medical Group is located in a purpose built health centre which provided patients with access to ground floor treatment and consultation rooms. (The building also accommodates a second practice and other community based healthcare services.) The practice offers a range of chronic disease clinics, as well as other services aimed at promoting patients’ health and wellbeing. There are three GP partners (female.) The practice has a practice manager, three nurse practitioners (female), three practice nurses (one of whom is also a nurse prescriber) (female), two healthcare assistants (one of whom is also a phlebotomist) (female), and a team of administrative and reception staff.

The practice’s opening hours are Monday, Tuesday, Wednesday and Thursday from 7:30am to 6pm, and on Fridays between 8am and 6pm.

GP appointment times are Monday, Tuesday, Wednesday and Thursday between 7:30am and 5:50pm, and on Fridays between 8am to 5:50pm.

Information about how to access urgent out-of-hours care is available on the practice’s website and in its patient information leaflet.

When the practice is closed patients can access out-of-hours care via Vocare (known locally as Northern Doctors Urgent Care Limited) On-Call service, and the NHS 111 service.

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crowhall Medical Group on 15 March 2016. The overall rating for the practice was good. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Crowhall Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 27 February 2017 to the breach in regulation that we identified in our previous inspection on 15 March 2016. This report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings from this inspection were as follows:

• The provider had complied with the requirement notice we set following our last inspection visit. In particular, we found that Disclosure and Barring Service checks had been completed for all newly employed clinical staff.

In addition, the provider had also addressed most of the improvements we asked them to make. In particular, the provider had:

• Where relevant, arranged for staff to complete training in fire safety, infection control and the use of the Mental Capacity Act.

• Carried out an infection control audit and prepared an action plan to help drive improvements.

• Introduced a log to record the checks staff carried out to make sure emergency medicines were within their expiry date.

• Assured themselves that the defibrillator located in the healthcare centre was being appropriately serviced and calibrated.

• Actively considered what action they should take to introduce a system which would ensure that, where relevant, appropriate action was taken in relation to new clinical guidelines, or changes to existing ones.

• Reviewed their decision that GPs did not need to carry a range of emergency medicines for use in acute situations, when on home visits. The provider had reviewed their original risk assessment regarding this decision. Following this review, they had re-affirmed their decision that GPs should not carry emergency medicines on home visits.

However, there was also an area where the provider should make improvements. The provider should:

• Put a system in place which helps to ensure that, where relevant, new clinical guidelines, or changes to existing ones, are reviewed to see whether any changes are required to the practice’s systems, policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 June 2016

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

Nationally reported data showed the practice had performed well in providing recommended care and treatment, for the clinical conditions commonly associated with this population group. For example, the practice had achieved 100% of the total QOF points available to them, for providing recommended clinical care to patients diagnosed with diabetes. This was 8% above the local CCG average and 10.8% above the England average. Staff had adopted the ‘Year of Care’ approach, as their model for providing personalised care to this group of patients. Patients received appropriate support and education to help them manage any long-term conditions they had. Staff had identified those patients with the most complex needs and put care plans in place to help reduce unplanned emergency admissions into hospital.

Updated 24 June 2016

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

Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data, for 2014/15, showed the practice had obtained 100% of the overall points available to them, for providing contraceptive services. This was 3.7% above the local CCG average and 3.9% above the England average. The practice provided a range of services for families and younger patients, including contraceptive advice and child health advice and support. The practice provided families with access to a full programme of childhood immunisations. Publicly available information showed they had performed well in delivering these immunisations. For example, the nationally reported data that was available to us showed that the immunisation rates, for 16 of the 17 childhood immunisations, were over 90%. The data available to us also showed the practice’s uptake of cervical screening was higher, at 83.01%, than the national average of 81.83%. A good range of health promotion leaflets was available in the patient waiting area, including information about the practice being breastfeeding friendly. A good level of information was also provided on the practice’s website. Monthly multi-disciplinary safeguarding meetings were held where the needs of vulnerable children and their families were discussed. All staff had completed safeguarding training that was relevant to their roles and responsibilities.

Updated 24 June 2016

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

Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. For example, the practice had obtained 100% of the total Quality and Outcomes Framework (QOF) points available to them, for providing recommended clinical care to patients who had cancer. This was 3.6% above the local clinical commissioning group (CCG) average and 2.1% above the England average. Patients over 75 years of age had a named GP who was responsible for their care. Emergency care had been put in place for patients considered to be at high risk of an unplanned admission into hospital. The practice had developed strong links with a local support organisation for older people and had recently been successful in obtaining funding, to set up a project aimed at supporting older people to socialise and exercise. Weekly clinics were held at the two care homes supported by the practice, in line with national priorities to enhance the health of people living in care homes. The support provided to one of these care homes had helped to significantly reduce admission rates to the local hospital, and contacts with the out-of-hours and community nursing teams.

Updated 24 June 2016

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

Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data, for 2014/15, showed the practice had obtained 100% of the overall points available to them, for providing care and treatment to patients who had chronic kidney disease. This was 4.6% above the local CCG average and 5.3% above the England average. The practice had assessed the needs of this group of patients and had developed their services to make sure they were accessible, flexible and provided 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 of this group of patients. NHS health checks were offered to help promote the wellbeing of patients aged between 40 and 75 years of age.

Updated 24 June 2016

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

There were good arrangements for supporting patients with mental health needs. The QOF data, for 2014/15, showed the practice had performed well by obtaining 100% of the overall points available to them, for providing recommended care and treatment to these patients. This was 7.3% above the local CCG average and 7.2% above the England average. Of those patients with the mental health conditions covered by the QOF, 91.4% had had their care reviewed, face-to-face, in the preceding 12 months. This was 17.5% above the local CCG average and 14.2% above the England average. Patients with mental health needs were offered an annual health review and were provided with advice about how to access various support groups and voluntary organisations. Clinical staff carried out opportunistic dementia screening and completed care plans, to help make sure patients with dementia received appropriate support and treatment. The QOF performance of the practice in relation to patients with dementia was also very good. For example, 92.9% of patients who had been diagnosed with dementia had had their care reviewed, face-to-face, in the preceding 12 months. This was 11.5% above the local CCG average and 15.2% above the England average.

Updated 24 June 2016

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

There were good arrangements for meeting the needs of vulnerable patients. Systems were in place to help reduce unplanned emergency admissions into hospital. The practice maintained a register of patients with learning disabilities which they used to ensure these patients received an annual healthcare review. Extended appointments were offered to enable this to happen. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns. Staff actively collaborated with other health and social care professionals to meet the needs of vulnerable patients. The practice informed vulnerable patients, including those with addictions, about how to access various support groups and voluntary organisations. The practice had good arrangements in place for supporting the large group of patients who misused substances who were registered with them. Clinical staff worked in partnership with the local drug and alcohol recovery service to help ensure their patients’ needs were met. Good arrangements had been made to meet the needs of patients who were also carers. Monthly multi-disciplinary meetings were held to review the needs of patients with palliative or end of life needs.