Fulwell Medical Centre

Updated 12 September 2016

Fulwell Medical Centre provides care and treatment to 9,558 patients of all ages, based on a General Medical Services (GMS) contract. The practice is part of the NHS Sunderland clinical commissioning group (CCG) and provides care and treatment to patients living in the Fulwell area of Sunderland. We visited the following location as part of inspection: Fulwell Medical Centre, Ebdon Lane, Fulwell, Sunderland, SR6 8DZ.

The practice had a mostly white British population, with high numbers of older people and families. There were lower levels of significant social deprivation, drug and alcohol problems. Nationally reported data showed the practice had a significantly higher prevalence rate for many of the key chronic diseases when compared to the national averages. National data showed that 1.1% of the population are from an Asian ethnic minority background.

The practice was located in a purpose built building. There were four GP partners (one male and three female), four salaried GPs (all female), three practice nurses, including two nurse prescribers (all female). There were three healthcare assistants (female), a practice manager, a deputy practice manager and a large team of administrative and reception staff.

The practice is open Monday, Tuesday, Thursday and Friday between 8:30am and 6pm, and on a Wednesday between 7am and 6pm. The practice is closed at weekends.

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

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

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Fulwell Medical Centre on 14 June 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 a highly effective system for reporting and recording significant events. The staff team took the opportunity to learn from all internal and external incidents.

• 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. Action was being taken to address gaps identified in the practice’s staff training plan.

• Outcomes for patients were consistently good. Data from the Quality and Outcomes Framework (QOF) showed that the practice’s performance was above the local clinical commissioning group (CCG) and England averages in most of the indicators covered.

• There was a strong, visible, person-centred culture. Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their treatment.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Services were tailored to meet the needs of individual patients and were delivered in a way that ensured flexibility, choice and continuity of care. All staff were actively engaged in monitoring and improving quality and patient outcomes. Staff were committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

• The leadership, governance and management of the practice assured the delivery of good quality person-centred care, supported learning, and promoted an open and fair culture.

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

• Provide non-clinical staff with regular updates to their basic life support.

• Ensure staff identified in the practice’s training plan complete outstanding mandatory training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2016

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

Nationally reported QOF data, for 2014/15, showed the practice had performed well in relation to providing care and treatment for the clinical conditions commonly associated with this population group. For example, the practice had obtained 100% of the total points available to them, for providing care and treatment to patients with diabetes. This was 6.5% above the local CCG average and 10.8% above the England average. Staff were taking steps to improve the quality of support provided to diabetic patients. For example, one of the practice nurses had worked with a diabetic nursing specialist, and had completed additional training, to enable them to provide services closer to home for patients with diabetes. There was a multi-disciplinary team approach to managing long-term conditions, so that patients with several medical conditions did not have to attend the practice more often than necessary. The practice had a good ‘call and recall’ system, which helped ensure that all patients who needed a healthcare review received an invitation to attend. There was a designated lead GP and nurse for each of the main long-term conditions (LTCs.) This helped to ensure that information relating to the key LTCs was disseminated to the practice team. Arrangements had been made which helped to ensure that patients with LTCs received a pneumococcal vaccination.

Updated 12 September 2016

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

The practice had made good arrangements to meet the needs of children, families and younger patients. For example, community midwives ran a weekly antenatal clinic, and health visitors provided a weekly child health clinic. Appointments were available outside of school hours and the practice premises were suitable for children and babies. Plans were being made to invite the local primary care reception class to the practice, to provide guidance relating to healthy eating. The practice offered a full range of immunisations for children. Publicly available information showed they had performed very well in delivering childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two years old ranged from 96.4% to 98.8% (the local CCG averages were between 96.2% to 98.9%). For five year olds, the rates ranged from 96.6% to 98.9% (the local CCG averages were between 31.6% to 98.9%). The practice offered contraceptive and sexual health advice, and information was available about how to access specialist sexual health services. Nationally reported data showed the uptake of cervical screening was, at 80%, comparable with the national average of 81.7%. There were good systems in place to protect children who were at risk and living in disadvantaged circumstances. All clinical staff had completed safeguarding training that was relevant to their roles and responsibilities.

Updated 12 September 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed very well in relation to providing care and treatment for the clinical conditions commonly associated with this population group. For example, the practice had obtained 100% of the total points available to them, for providing care and treatment to patients who had heart failure. This was 1.3% above the local clinical commissioning group (CCG) average and 2.1% above the England average. 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, and were invited to attend an annual healthcare review. Patients on the practice’s housebound register were provided with an annual health review in their own home, to help make sure they had contact with the surgery, and were aware of how to access support services.

Updated 12 September 2016

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 this group of patients. Nationally reported data showed the practice had performed well in providing recommended care and treatment to 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 hypertension. This was 0.5% above the local CCG average and 2.2% above the England average. Extended hours appointments were provided one day a week, to help working patients access suitable appointments. Information on the practice’s website, and on display in their patient waiting area, directed patients to the out-of-hours service.

Updated 12 September 2016

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

The practice had made good arrangements for meeting the needs of patients with mental health conditions. Nationally reported data, from the QOF for 2014/15, showed the practice had performed well in obtaining 100% of the total points available to them, for providing recommended care and treatment to this group of patients. The data showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses, who had had a comprehensive care plan documented in their records, in the preceding 12 months, was good by comparision to other practices, (93.1% compared to the national average of 86.9%). Patients experiencing poor mental health were provided with advice about how to access various support groups and voluntary organisations. Practitioners from the local community mental health team ran twice weekly clinics at the surgery, for patients with a variety of mental health needs.

There were also good arrangements in place for meeting the needs of patients who had dementia. The QOF data showed the practice had performed well in obtaining 100% of the total points available to them, for providing recommended care and treatment to this group of patients. However, the practice’s performance, regarding the carrying out face-to-face reviews of patients diagnosed with dementia, was lower, at 74.4%, than the national average of 84%. Staff kept a register of these patients, and the practice’s clinical IT system clearly identified them to help make sure clinical staff were aware of their specific needs. Clinical staff actively carried out opportunistic dementia screening, to help ensure their patients were receiving the care and support they needed to stay healthy and safe. Some staff acted as Dementia Friends, and most staff had attended dementia awareness training, to help them understand the needs of these patients and improve the care they received at the practice.

Updated 12 September 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 and those who were nearing the end of their lives. There were also good systems in place to help reduce the number of emergency admissions to hospital. The practice maintained a register of patients with learning disabilities which they used to ensure they received an annual healthcare review. Extended appointments were offered to enable this to happen. The nursing team also carried out these reviews in patients’ own homes, to help alleviate any anxiety. Most staff had completed training to become dementia friends, and clinical staff carried out opportunistic screening, to help ensure patients received appropriate care and treatment. Housebound patients without a diagnosed long-term condition also had access to an annual review. Good arrangements had been made to meet the needs of patients who were also carers. The practice maintained a carers’ register and used this to provide these patients with access to care, treatment and support. Systems were in place to protect vulnerable children from harm. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns.