Central Surgery

Updated 15 June 2016

Central Surgery provides Primary Medical Services to the town of South Shields. The practice provides services from one location, Cleadon Park Primary Care Centre, Prince Edward Road, South Shields, Tyne and Wear, NE34 8PS We visited this address as part of the inspection.

The surgery is located in purpose built premises which are shared with the local library. There is step free access at the front of the building and all facilities are on the ground floor with full disabled access. There is a large car park to the rear of the surgery including dedicated disabled parking bays.

The practice has five GP partners and eight salaried GPs. Six are female and seven male. The practice is a training practice who have GP trainees allocated to the practice (fully qualified doctors allocated to the practice as part of a three-year postgraduate general practice vocational training programme). There are two nurse practitioners, three practice nurses and three healthcare assistants. There is a practice manager, assistant practice manager, IT manager, and part-time pharmacist. There are fifteen reception and administration staff.

The practice provides services to approximately 14,500 patients of all ages. The practice is commissioned to provide services within a Personal Medical Services (PMS) contract with NHS England.

The practice is open from 8am until 7pm Monday and Tuesdays. 8am until 6pm Wednesday to Friday and there are extended hours on a Saturday morning from 8am until 12:45pm.

Consulting times with the GPs and nurses are from 8:30am to 12:30pm weekdays, then 2pm to 6:50pm on Mondays and Tuesdays and 2pm until 5:50pm Wednesday to Friday. There are pre booked appointments with the practice nurse on Saturday morning from 8:30am until 12:30pm.

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

Information taken from Public Health England placed the area in which the practice was located in the third least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The average male life expectancy is 77 years and the female is 82. The average male life expectancy in the CCG area is 77 and nationally 79. The average female life expectancy in the CCG area is 81 and nationally 83. The percentage of patients with a long-standing health condition is higher than the national average (practice population is 59% compared to a national average of 54%). The proportion of patients who are in paid work or full-time employment or education is 53.8% compared to the CCG average of 54.6% and the national average of 61.5%

Updated 15 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Central Surgery on 5 April 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 report incidents and near misses.
• Risks to patients were assessed and well managed.
• Outcomes for patients who use services were good.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.
• Staff throughout the practice worked well together as a team.
• The practice carried out a survey of staff in January 2016 using the CQC key questions.
• The practice was aware of and complied with the requirements of the duty of candour.
• The practice were innovative and moving towards further improvements to elderly care, young people and promoting self-care.

We saw one area of outstanding practice which included:

• The practice were one of the leading practices in the area for providing a substance misuse service to patients. One of the GP partners had a clinical interest in this area and was the lead on this for the practice with two other GPs, a recovery worker and an administrative member of staff and the practice pharmacist. The practice had 51 patients they provided opiate substitute medication to and 35 who were in GP shared care. The practice had carried out a repeat audit on substance misuse patients attending for review. The purpose was to set goals for reviews and to review prescribing with set review appointments as it was felt that this group of patient struggled to access appointments appropriately. They also wanted to ensure they were receiving the appropriate support. The criteria was set for 80% of all of the patients to be reviewed every year. The findings of the re-audit found that 88% of the patients had been seen by their GP at three month review stage rather than twelve month stage (previously 49%). The practice also implemented regular meetings to discuss these patients and encouraged them to have a named GP to deal with individual prescriptions.

The areas where the provider should make improvements are:

• Consider specific training for the infection control lead nurse and carry out a more comprehensive infection control audit.
• Consider carrying out a risk assessment as to why some administration staff did not have a DBS check.
• Consider a risk assessment around the emergency medicines which were available in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 June 2016

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

The practice had a register of patients with long term conditions which they monitored closely for recall appointments. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.

Flexible appointments, including extended opening hours and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review.

The nurse practitioner was trained in spirometry interpretation and the health care assistants were trained in performing spirometry.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example, performance for related indicators for patients with COPD were above the national average (100% compared to 96% nationally). The practice had increased the number of patients with COPD who had care plans by 92% from September 2014 to September 2015 (23 to 297). 

Updated 15 June 2016

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, accident and emergency visits were screened for harm factors. Childhood immunisation rates were in line with CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 92% to 100%, compared to the CCG averages of 84% to 99% and for five year olds from 90% to 98%, compared to CCG averages of 91% to 100%.

The practice’s uptake for the cervical screening programme was 81.9%, which was in line with the national average of 81.8%. Appointments were available outside of school hours and the premises were suitable for children and babies. Child immunisations were carried out on Wednesday afternoons between 1:30 and 4pm.

The practice had made young people one of their quality improvement areas. They were working with the local youth parliament to make the practice ‘youth friendly’.

Updated 15 June 2016

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

Nationally reported data showed that outcomes for patients were good for conditions commonly found in 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 local clinical commissioning group (CCG) average (98.9%) and above the England average (97.9%).

The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, patients at high risk of hospital admission and those in vulnerable circumstances had care plans in place, this included patients receiving palliative care. The practice were in the process of developing risk assessments for those at risk of falls and for frailty.

The practice was responsive to the needs of older people, including offering home visits. The practice offered longer appointments for patients over the age of 75 as a result of a survey of patients and they had a named GP. Prescriptions could be sent to any local pharmacy electronically.

The practice had recruited a new GP, to carry out an initiative with the Royal College of General Practitioners (RCGP) to improve care for older patients. One of the practice’s quality improvement areas led by one of the GP partners was elderly care.

The practice were the lead for one residential care home in the area. One of the GPs visited there every two weeks. Age UK held clinics in the surgery.

The practice maintained a palliative care register and end of life care plans were in place for those patients it was appropriate for. They offered immunisations for pneumonia and shingles to older people.

Updated 15 June 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 identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering online services which included appointment booking, test results and ordering repeat prescriptions. They had the highest electronic access in the CCG area at 25%. There was a full range of health promotion and screening that reflected the needs for this age group. Flexible appointments were available as well as extended opening hours. A ‘winter pressures surgery’ was available which was shared with other practices on a Saturday during winter months.

Updated 15 June 2016

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

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health. They carried out advanced care planning for patients with dementia. All clinicians were trained in dementia screening. 91% of patients identified as living with dementia had received an annual review in 2014/15 (national average 84%). The practice also worked together with their carers to assess their needs. Dementia friends training was available to all staff.

The practice maintained a register of patients experiencing poor mental health and recalled them for regular reviews. They told them how to access various support groups and voluntary organisations, such as talking therapies. Performance for mental health related indicators was better than the national average. For example, 97.9% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months 2014/15 compared to the national average of 88.4%.

Updated 15 June 2016

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

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. They carried out annual health checks for people with a learning disability.

The practice were one of the leading practices in the area for providing a substance misuse service to patients. One of the GP partners had a clinical interest in this area and was the lead on this for the practice with two other GPs, a recovery worker and an administrative member of staff and the practice pharmacist. The practice had 51 patients they provided opiate substitute medication to and 35 who were in GP shared care. The practice had carried out a repeat audit on substance misuse patients attending for review. The purpose was to set goals for reviews and to review prescribing with set review appointments as it was felt that this group of patient struggled to access appointments appropriately. They also wanted to ensure they were receiving the appropriate support. The criteria was set for 80% of all of the patients to be reviewed every year. The findings of the re-audit found that 88% of the patients had been seen by their GP at three month review stage rather than twelve month stage (previously 49%). The practice also implemented regular meetings to discuss these patients and encouraged them to have a named GP to deal with individual prescriptions.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. They had told vulnerable patients about how to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children, there were safeguarding summaries for staff in all consulting rooms. 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.

The practice’s computer system alerted GPs if a patient was a carer. There was a practice register of all people who were carers and were being supported, for example, by offering health checks and referral for social services support. There were 270 patients on the carer’s register which is 1.86% of the practice population. Carer’s packs with written information was available for carers to ensure they understood the various avenues of support available to them. Staff were aware to try and identify carers and offer help and support.