Archived: Park Lane Practice

Updated 17 March 2016

Park Lane Practice is a single handed GP practice located near to Sunderland City Centre, in an area South of the River Wear and within walking distance of Park Lane metro station. The practice provides care and treatment to 4,024 patients and is part of the NHS Sunderland clinical commissioning group (CCG). It operates on a General Medical Services (GMS) contract for general practice.

The practice provides services from the following address, which we visited during this inspection:

Park Lane Practice, 1-6 City Green, Sunderland, Tyne and Wear, SR2 7BA

The practice is located in purpose built premises on the ground floor of a modern apartment block building which was built in 2010. All reception and consultation rooms are fully accessible for patients with mobility issues. Limited on-site parking, including dedicated disabled parking bays, is available. Pay and display car parks and limited on street parking are available nearby.

The premises are leased from NHS Property Services Ltd who also lease accommodation on the same site to the community psychiatric nursing and warfarin teams, physiotherapists, local clinical commissioning group occupational therapy team and cognitive behavioural therapists.

The practice is open from 8.30am to 6.30pm on a Monday, Tuesday, Wednesday and Friday (appointments from 8.30am to 6.20pm) and from 8.30am to 6pm on a Thursday (appointments from 8.30am to 5.50pm).

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited (NDUC).

Park Lane Practice offers a range of services and clinic appointments including chronic disease management clinics, antenatal clinics, childhood health surveillance and immunisations, travel vaccinations, contraception and minor surgery. The practice consists of:

• One GP (male)
• An advanced nurse practitioner (female)
• A practice nurse (female)
• Eight non-clinical members of staff including a practice manager, phlebotomist, secretary, receptionists and administration staff

The area in which the practice is located is in the third (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The practice’s age distribution profile showed slightly more patients than the national average in the 20-34 and 40-59 year age groups. All other age groups were comparable to the national average. Average life expectancy for the male practice population was 75 (national average 79) and for the female population 80 (national average 83).

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Lane Practice on 13 January 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this. However, there did not appear to be a robust system in place to select topics for clinical audit based on the particular needs of their patient population.
• The majority of patients said they were treated with compassion, dignity and respect.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• The practice had proactively sought feedback from patients and had an active patient participation group.
• Information about services and how to complain was available and easy to understand.
• The practice had recently reviewed and changed their appointment system and was monitoring its effectiveness.

The areas where the provider should make improvements are:

• Implement a regular schedule of clinical meetings
• Follow the practice recruitment policy so that all necessary employment checks for staff are completed before commencement of employment
• Make arrangements for staff to receive the appropriate immunisations relevant to the roles they undertake.
• Review and update procedures and guidance
• Review their high Quality and Outcomes Framework (QOF) exception reporting rates in order to understand the reasons behind this and to be able to demonstrate they are providing patients with the care and treatment they require.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2016

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

Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.

Practice nurses were supported in undertaking additional training to help them understand and care for patients with certain long term conditions, such as diabetes. The practice had a proactive approach to treating patients with chronic obstructive pulmonary disease by working with patients to develop personalised self-management plans. Smoking cessation advice was available from the practice nurse.

The practice regularly referred patients to other services such as diabetes and pulmonary rehabilitation services, the local wellbeing ‘move to improve’ service and the recovery at home service. The recovery at home service supported patients who needed short term health or social care support at home rather than them having to stay in or be admitted to hospital or long term care facilities.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to some of the conditions commonly associated with this population group. For example:

• The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 2.9 percentage points above the local CCG average and 2.6 points above the national average.
• The practice had obtained 100% of the points available to them in respect of diabetes. This was 6.5 percentage points above the local CCG average and 10.8 points above the national average

Updated 17 March 2016

The practice is rated as good for the care of families, children and young people. The practice was rated as requires improvement for providing safe services and for being well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children varied with some results being comparable with national averages and other results being lower. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 87.2% to 97.9% (compared with the CCG range of 96.2% to 100%). For five year olds this ranged from 83.3% to 95.8% (compared to CCG range of 31.6% to 98.9%). Children who repeatedly failed to attend the practice for childhood immunisations were referred to a health visitor for follow up intervention.

Information from the National Cancer Intelligence Network (NICIN) published in March 2015 indicated that only 67.8% of the 596 females aged between 25 and 64 listed with the practice had attended cervical screening (compared to the CCG average of 77.2% and national average of 74.3%). The practice had identified that this had been due to a shortfall in availability for cervical screening appointments as these had only been available until 2.30pm each day. Following the appointment of an advanced nurse practitioner cervical screening appointments were now available until 6.30pm. The practice was confident that this would improve uptake of the cervical screening programme. Nursing staff offered ‘well women’ appointments and contraceptive services.

Pregnant women were able to access weekly antenatal clinics provided by healthcare staff attached to the practice. The practice offered flu and pertussis vaccinations to pregnant women and the GP carried out post-natal mother and baby checks. Children under the age of two were routinely given an urgent same day appointment.

Updated 17 March 2016

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

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 98.7% and the England average of 97.9%.

Patients aged over 75 had a named GP and the practice offered immunisations for pneumonia and shingles to older people. The practice had a palliative care register and held regular multi-disciplinary meetings to discuss and plan end of life care.

The practice was participating in an enhanced service to reduce unplanned admissions for patients most at risk of admission to hospital. It was also a member of the Sunderland GP Alliance. This is a federation of 40 GP practices representing approximately 85% of Sunderland’s patient population working collaboratively to achieve better health outcomes for the people of Sunderland.

Updated 17 March 2016

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 met. The practice was open from 8.30am to 6.30pm on a Monday, Tuesday, Wednesday and Friday and from 8.30am to 6pm on a Thursday. Appointments, including telephone consultations were available from 8.50am until 10 minutes before the practice closed. The practice was part of the City’s East locality extended access scheme which meant that the practice were able to book GP appointments for their patients at a local health centre from 6pm to 8pm and on Saturday mornings from 9am until 2pm.

The practice offered minor surgery, joint injections, sexual health screening, emergency contraception and NHS health checks (for patients aged 40-74).

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. Patients could opt to receive text message appointment reminders.

Updated 17 March 2016

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

The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 100%. This was higher than the national average of 84%.

The GP partner was an experienced approved mental health practitioner and held a clinic for patients with mental health issues on a Thursday afternoon when patients were given a 30 minute appointment slot. Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as local wellbeing, substance misuse and counselling services. This included services for asylum seekers, refugees, victims of torture and armed forces veterans.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice had been awarded the ‘Dementia Friends’ accreditation and staff had undertaken dementia awareness training. Patients with dementia, and their carers were regularly signposted to the Essence Service, run by Age UK for support and advice.

Updated 17 March 2016

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

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. Patients with learning disabilities were invited to attend the practice for annual health checks and were involved in developing personalised health action plans. They were also routinely offered longer appointments. The practice worked with the Sunderland People First initiative to improve access to services for patients with a learning disability. The practice had also signed up to a local ‘Safe Place’ scheme, which gave vulnerable people a short term ‘safe place’ to go if they were feeling threatened when out and about in the local community.

The practice had established effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.

The practice was participating in a carer’s incentive scheme. Good arrangements were in place to identify and support patients who were carers.