Archived: Middle Chare Medical Group

Updated 15 March 2017

Gardiner Crescent Surgery, 21 Gardiner Crescent, Pelton Fell, Chester-Le-Street, Co Durham, DH2 2NJ is part of Middle Chare Medical Group. The Medical Group consists of four separate practices. Gardiner Crescent and the Lavender Centre practices predominantly share the same staff and patients and Middle Chare and Woodlands practices do the same.

This is due to the proximity of each practice for patients to access. Gardiner Crescent Surgery is a GP premises in Pelton Fell, Chester-Le-Street, County Durham. The practice is in an area of relative deprivation as it is in the fourth most deprived decile (one being most deprived and ten least deprived). The practice is in a former house and is currently going through a period of redecoration and rewiring to bring it up to date. As a consequence of the inherited building there are only two consulting rooms and the upstairs area is used as a kitchen, meeting room and staff toilet facilities. They have a Personal Medical Services (PMS) contract and also offer enhanced services for example; minor surgery. The practice covers the area of Pelton Fell, Chester-Le-Street and is situated approximately one and a half miles from the town centre. Car parking facilities are limited. Transport links are satisfactory. There are 2047 patients on the practice list (this is the combined figure in conjunction with the Lavender Centre) and the majority of patients are of white British background. Patient survey and QOF (Quality Outcomes Framework) results are reported in a combined figure between the two locations and therefore it is not possible to report data on specific locations. The practice is a partnership with five partners, three male and two female. There are two salaried GPs, both female, four practice nurses, a nurse practitioner and three health care assistants (all female). There is a practice manager and a team of reception and administration staff. The practice is a teaching and training practice and regularly has GP Registrars (qualified Doctors in training to become GPs) and undergraduates. The practice is open between 8.30am and 3.30pm on Mondays and Wednesdays and between 8am and 6pm on Tuesdays, Thursdays and Fridays. Extended hours are offered at the Middle Chare location on Mondays and Tuesdays until 8pm. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hours service (111) commissioned by North Durham CCG.

Updated 15 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gardiner Crescent Surgery on 26 April 2016. Gardiner Crescent Surgery was part of one large provider (Middle Chare Medical Group) who had four locations. The overall rating for the practice was good but the safe domain was rated as requires improvement. The full comprehensive report on the 26 April 2016 inspection can be found by selecting the ‘all reports’ link for Middle Chare Medical Group on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 24 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 26 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

• Governance systems and process had been developed further to monitor and assess the whole service in relation to risk and improvement. This included quality assurance of internal processes including checking of emergency medicines and the safe storage of vaccines.

• Effective arrangements were in place to ensure that vaccines and other medicines stored in the refrigerators were stored at the correct temperatures and appropriate records were maintained.

• Procedures were in place to track prescription forms after they had been received into the practice.

• Staff were working under the accepted definition of a Patient Group Direction or Patient Specific Direction and these were in date and relevant staff had their own authorised copy.

• All staff were able to access policies and procedures.

• The practice had ceased to provide a dispensing service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less was 81% which was comparable to the national average of 79%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Patients with long term condition who were at risk of unplanned admission to hospital were able to access a GP at weekends from a rota provided by six local practices. This was from 8am until 6pm on Saturday and Sunday and included telephone consultations and home visits. Any patients identified as possibly needing the service during the week were given a mobile contact number to talk direct to a GP. This service had also been extended to care homes in the area.

Updated 23 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, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 78% which was comparable to the national average of 74%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had achieved the Investors in Young People award to ensure that the services they provided were appropriate to this age group.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 23 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• A named GP did weekly visits at nursing homes assigned to the practice, providing continuity of care and information sharing.

• As part of the ‘Improving outcomes scheme’ in conjunction with the CCG, the practice held a register of patients who were at risk of unplanned emergency admission to hospital. These patients were assessed by the practice nurse and care provided accordingly.

• Frail elderly patients were able to access a GP at weekends from a rota provided by six local practices. This was from 8am until 6pm on Saturday and Sunday and included telephone consultations and home visits. Any patients identified as possibly needing the service during the week were given a mobile contact number to talk direct to a GP. This service had also been extended to care homes in the area.

Updated 23 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 as well as a full range of health promotion and screening that reflects the needs for this age group.
• Dermoscopy and ENT appointments were offered by the practice to allow patients to be seen closer to home. This had reduced referrals to secondary care and improved patient care by reducing the need for biopsy due to the investment in a dermoscope.

Updated 23 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 patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 June 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed 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. 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.