Cestria Health Centre

Updated 23 February 2017

Cestria Health Centre provides care and treatment to approximately 11,717 patients from the Chester le Street area of County Durham. The practice is part of the NHS North Durham Clinical Commissioning Group (CCG) and operates on a Personal Medical Services (PMS) contract.

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

Whitehill Way

Chester le Street

County Durham

DH2 3DJ

The surgery is located in an extended purpose built health centre. All reception and consultation rooms are fully accessible for patients with mobility issues and there is an elevator for patients needing to access the upper floor of the building. An on-site car park is available which includes dedicated disabled car parking spaces. A pharmacy is attached to the building.

The surgery is open from 8am to 6pm on a Monday, Tuesday, Wednesday and Friday (appointments from 8am to 11.30am and 2pm to 6pm) and from 8am to 8pm on a Thursday (appointments from 8am to 11.30 am and 2pm to 8pm). It is also open on occasional Saturdays from 9am to 1pm depending on need.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service.

Cestria Health Centre offers a range of services and clinic appointments including ante-natal, family planning, long-term condition and travel advice clinics. As some of the practice GPs also had special interests and expertise in areas including diabetes, cardiology, minor surgery, sexual health, contraception and ear nose and throat the practice also delivered specialist clinics for the area.

The practice consists of:

• Three GP partners (all male)
• Eight salaried GPs (two male and six female)
• Two nurse practitioners (one male and one female)
• One nurse prescriber (female)
• One practice nurse (female)
• Three health care assistants (female)
• 17 non-clinical members of staff including a practice manager, personal assistant, team leaders, receptionists, secretaries and administration assistants.

The practice is a teaching and training practice and involved in the training of qualified doctors wishing to pursue a career in general practice as well as the teaching of undergraduate medical students learning about GP practice.

The practice is also a member of Chester-le-Street GP Federation which is a group of practices working collaboratively to co-commission services and to share responsibility for developing and delivering high quality, patient focused services for the local community.

The average life expectancy for the male practice population is 78 (CCG average 78 and national average 79) and for the female population 82 (CCG average 82 and national average 83).

At 48.8%, the percentage of the practice population reported as having a long standing health condition was lower than the CCG average of 58.9% and national average of 54%. Generally a higher percentage of patients with a long standing health condition can lead to an increased demand for GP services. At 62.8% the percentage of the practice population recorded as being in paid work or full time education was higher than the CCG average of 57.8% and national average of 61.5%). The practice area is in the seventh most deprived decile. Deprivation levels affecting children were lower than both CCG and national averages. Deprivation levels affecting adults were lower than the CCG average but slightly higher than the national average.

Updated 23 February 2017

We carried out an announced comprehensive inspection of Cestria Health Centre on 10 November 2016. Overall the practice is rated as outstanding.

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. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care and prescribing as a result of this.
• Feedback from patients about the care they received was better than local and national averages. Patients reported that they were treated with compassion, dignity and respect. Patient feedback in relation to access was higher than local clinical commissioning group and national averages.
• Patients were able to access same day appointments. Pre-bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice had proactively sought feedback from patients and implemented suggestions for improvement and made changes to the way they delivered services in response to feedback. Patient participation group members had been invited to attend a practice away day to decide on a new model of appointment system.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved an overall result which was comparable with the local average and higher than the national average.
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed.

We saw area’s of outstanding practice, including:

• The practice held a monthly multi-disciplinary meeting at their linked care home which was attended by a mental health practitioner. This enabled early identification and treatment of mental health related issues in the elderly and ensured residents were supported appropriately by care home staff. This, together with a ward round approach to visiting residents in the home and effective emergency health care planning had led to a reduction in the number of unplanned admissions to hospital and A&E attendances for older patients.
• The practice had a dedicated nurse practitioner who carried out regular home visits to review patients’ care plans and contacted patients on discharge from hospital to ensure they were receiving appropriate support and their needs were being met. This had also contributed to a reduction in the number of unplanned admissions to hospital and A&E attendances. A further nurse practitioner had been appointed to extend this area of work.

• The practice had been instrumental in developing and providing staff and facilities to provide a weekend service for frail, elderly and vulnerable patients. This had resulted in fewer admissions to hospital over weekends and generally for this patient group.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 23 February 2017

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

The practice offered longer appointments of 12 minutes as standard. Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review. Patients with multiple long-term conditions were offered a fully comprehensive review in their birthday month whenever possible.

The QOF data for 2015/16 provided by the practice showed that they had achieved good outcomes in relation to 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, chronic kidney disease, epilepsy and rheumatoid arthritis.

The practice had several GPs who had a special interest in a range of conditions including dermatology, diabetes, ophthalmology, cardiology and ear, nose and throat. This enabled the practice to offer an enhanced level and standard of care to patients, including patients from other practices.

The practice had developed a system to ensure patients at risk of developing diabetes were identified and appropriately monitored. The practice offered a insulin inititation and monitoring service for diabetic patients. Patients with long term conditions known to be at risk of rapid deterioration were automatically offered an immediate GP appointment.

The practice offered an in-house electro cardiogram (ECG) service, 24 hour blood pressure monitoring and spirometry which helped provide patients with access to care and treatment closer to home.

Updated 23 February 2017

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

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, such as those who did not attend for childhood vaccinations or had visited A&E. The needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as the community midwife.

Appointments were available outside of school hours and the premises were suitable for children and babies.

Data available for 2015/16 showed that the practice had performed well in terms of childhood immunisation rates. For example, uptake the vaccinations given to two year olds ranged from 98.4% to 99.2% (compared with the CCG range of 97.7% to 99% and national range of 73.3% to 95.1%). For five year olds this ranged from 99.2% to 100% (compared to CCG range of 97.2% to 98.5% and national range of 81.4% to 95.1%).

At 84.4%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was higher than the CCG average of 83.2% and national average of 81.8%.

Pregnant women were able to access a full range of antenatal and post-natal services at the practice.

The practice had developed a relationship with the local secondary school to promote preventative and pastoral care of young people in their area. They had also developed an action plan to help them deliver a young people friendly health service at the practice.

Updated 23 February 2017

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

Nationally reported Quality and Outcomes Framework (QOF) data for 2015/16 showed the practice had achieved 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 experiencing heart failure and osteoporosis and for those requiring palliative care. However, although the clinical exception rate was lower than local and national averages for osteoporosis it was higher than average for heat failure.

One of the GPs acted as the frail elderly lead for the local Clinical Commissioning Group (CCG) which helped clinicians keep up to date and conform with best practice management for this group of patients. The practice had employed nurse practitioners to carry out home visit assessments of their most frail patients to review care plans and ensure appropriate support services were in place. A system was in place to ensure that frail elderly patients and those on the practices high risk register who had recently been discharged from hospital were contacted by a nurse practitioner within three days of discharge to reassess their needs. The practice operated a ward round approach to caring for their linked care home patients and had ensured all had an emergency health care plan in place and that their medication was reviewed on at least a six monthly basis by the practice pharmacist. Staff had implemented a monthly multi-disciplinary team meeting in the care home, including a mental health practitioner which enabled early identification and treatment of mental health related issues in the elderly. Together this approach had led to a reduction in unplanned admissions to hospital and A&E attendance for this group of patients.

Updated 23 February 2017

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 surgery was open from 8am to 6pm on a Monday, Tuesday, Wednesday and Friday (appointments from 8am to 11.30am and 2pm to 6pm) and from 8am to 8pm on a Thursday (appointments from 8am to 11.30 am and 2pm to 8pm). It was also open on occasional Saturdays from 9am to 1pm depending on need.

The practice offered sexual health and contraception services, travel advice, childhood immunisation service, antenatal services and long-term condition reviews. They also offered new patient 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. A digital health information board was available in the practice waiting room which patients could use to access support services, health and practice information.

Updated 23 February 2017

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

QOF data for 2015/16 provided by the practice showed that they had achieved the maximum score available for caring for patients with dementia and depression. The practice had attained 87

.7% in respect of caring for patients with a mental health condition, which was below the CCG average of 96.7% and national average of 92.8%.

The practice held an on-site multi-disciplinary team meeting during their weekly ward round visit to their linked care home which was attended by a representative from the liaison psychiatry service. This enabled a timely discussion about patients with new or deteriorating mental health issues and speedier intervention.

Updated 23 February 2017

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 38 patients who had a learning disability. Patients with a learning disability were offered a 45 minute annual health check and influenza immunisation.

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. Staffs 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 identified carers and ensured they were offered appropriate advice and support and an annual health check and influenza vaccination.

The practice was pro-active in their identification and support of veterans and in ensuring their health care needs were being met in line with the Armed Forces Covenant (which dictates that injured armed force personnel are given priority for medical treatment in the years after their service).