Bedlingtonshire Medical Group

Updated 29 April 2016

Bedlingtonshire Medical Group is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 11,000 patients from one location at Glebe Road, Bedlington, Northumberland, NE22 6JX. This is the location we visited on the day of our inspection.

The practice is based in a purpose-built surgery shared with other local healthcare services, such as health visitors and district nurses. The building is owned and managed by NHS Property Services Limited and has level-entry access and a car park for patients to use. All the services provided to patients by Bedlingtonshire Medical Group are on the ground floor.

The practice has 30 members of staff, comprising two GP partners (both male), four salaried GPs (one male, three female), one GP registrar (female), one foundation doctor (male), one nurse practitioner (female) three practice nurses (all female), two healthcare assistants (one male, one female), a pharmacist, a four-person practice management team (including the practice manager and a patient services manager) and reception/administrative staff.

The practice is part of Northumberland clinical commissioning group (CCG). Information taken from Public Health England placed the area in which the practice was located in the fifth least deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The surgery is open from 8am until 6pm, Monday to Friday. Additionally, the practice operates earlier opening hours on Tuesdays from 7am, and later appointments on Wednesdays until 8.15pm. The telephone lines operate at all times during these opening hours. Outside of these times, a message on the surgery phone line directs patients to out of hours care, NHS 111 or 999 emergency services as appropriate. Appointments with a GP are available as follows:

• Monday: 8am-11am and 1.30pm-6pm
• Tuesday: 7am-11am and 1.30pm-6pm
• Wednesday: 8am-11am, 1.30pm-6pm and 6.30pm-8.15pm
• Thursday: 8am-11am and 1.30pm-6pm
• Friday: 8am-11am and 1.30pm-6pm

The practice provides services to patients of all ages based on a Personal Medical Services (PMS) contract agreement for general practice. The practice population roughly reflects national averages for age distribution, although there are slightly fewer patients than average between the ages of 20 and 39. The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited.

Updated 29 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bedlingtonshire Medical Group on 2 February 2016. Overall the practice is rated as outstanding.

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

• People were protected by a strong comprehensive safety system and a focus on openness, transparency and learning when things go wrong.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• Feedback from patients about their care was consistently and strongly positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, they had implemented a change to the telephone system which allowed patients who could not press buttons (such as those with arthritis) to speak to a receptionist quicker than they could previously.
• The practice was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw several areas of outstanding practice including:

• The practice had implemented a number of initiatives as part of their High Risk pathway, which was designed to manage patients at risk of unplanned hospital admissions. These included a review of prescribing which had reduced unnecessary repeat prescriptions by 16%, and the development of their own evidence-based care plans to allow patients with respiratory conditions to manage them at home. Since implementing these measures the practice had reduced unplanned hospital admissions for their patients from 239 in 2013/14 to 99 in 2015/16. Some of these iniatives had been adopted by the local clinical commissioning group (CCG) and extended to practices across the region.

• The practice manager had designed and implemented an evidence-based system for reporting and analysing significant events. This had created a culture which prioritised safety and learning in the practice, and resulted in an increase from 11 significant events reported in 2013 to 54 in 2015, driving a number of improvements at the practice. Where the practice did not achieve 100% of the Quality and Outcomes Framework points available for a particular domain a significant event analysis was performed to learn what could be improved. All staff, adminisitrative and clinical, were included in this process, and patients were invited to be involved to suggest ways to improve.
• A practice nurse with experience of minor illness care had been employed to implement a minor illness clinic at the practice. They created an evidence-based minor illness triage pathway developed for receptionists, and any patients who fit the criteria on the list could be given an appointment with the nurse instead of a GP. Minor illness appointments were blocked out for these patients, creating on average 25 additional GP appointments per day.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 April 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority and discussed weekly.
• The practice had implemented a number of initiatives that had reduced unplanned hospital admissions for their patients from 239 in 2013/14 to 99 in 2015/16.
• Performance for diabetes related indicators was better than the CCG and national average. For example 94.4% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) compared to a national average of 88.3%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and were offered 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.
• The practice had developed their own evidence-based care plans to allow patients with conditions such as asthma and chronic obstructive pulmonary disease to manage their conditions at home. Patients were regularly followed-up by a practice nurse with specialist experience of managing these conditions.
• The practice held a daily meeting to discuss referrals and complex patients, such as those with long-term conditions.
• An acupuncture service was provided by one of the partners, reducing referral to secondary care and prescribing of analgesics to patients who used this with a success rate of approximately 70%.

Updated 29 April 2016

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

• 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. For example, rates for under two year olds ranged from 98.5% to 100% and five year olds from 95.1% to 99.3% (CCG averages 97.6% to 97.9% and 94.9% to 98.5% respectively).
• The time and length of appointments at the baby immunisation clinic was changed to ensure more school and nursery age children could attend.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. 

Updated 29 April 2016

The practice is rated as outstanding for the care of older people, as the practice is rated as outstanding overall.

• 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 over 75 years old.
• The nurse practitioner performed a weekly “ward round” at the six care homes where the practice had patients.
• Staff from the practice provided training to staff in the care homes to improve outcomes for patients. For example, the nurse practitioner had helped a care home to develop a protocol for administering sub-cutaneous fluids to reduce patients’ risk of dehydration.
• The practice operated a dedicated telephone line for the care homes and hospitals so that they could access staff directly.
• A review of medications prescribed to patients at the six care homes where the practice had patients had reduced unnecessary prescriptions by 16%.
• The practice had helped a local carers organisation to develop a Do Not Attempt Resuscitation (DNAR) policy, to protect patients and carers.

Updated 29 April 2016

The practice is rated as outstanding for the care of working age people (including those recently retired and students), as the practice is rated as outstanding overall.

• 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 offered “overspill” clinics on days when there was high demand for appointments, and extended hours were offered from 7am on Tuesdays and until 8.15 pm on Wednesdays.
• 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. For example, they offered online access to book appointments, order repeat prescriptions, send special requests or email messages for doctors.
• The practice’s uptake for the cervical screening programme was 81.2%, which was comparable to the national average of 81.8%. The practice was part of the CCG initiative to offer a personalised “pink letter” for patients who did not attend.

Updated 29 April 2016

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

• 84.2% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• Performance for mental health related indicators was better than national average. For example, 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (April 2014 to March 2015) compared to the national average of 89.6%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice was able to offer early diagnosis of dementia and begin advance care planning for these patients.
• 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 undergone “Dementia Friends” training with a national charity, and had a good understanding of how to support patients with mental health needs and dementia.

Updated 29 April 2016

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

• 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 those who needed them.
• The practice worked with multi-disciplinary teams in the case management of vulnerable people, and held weekly meetings to monitor their care.
• 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.