East Durham Medical Group

Updated 15 March 2017

Shinwell Medical Centre, Fourth Street, Peterlee, County Durham, SR8 4LD is a GP practice in Co Durham. There is a branch practice at Peterlee; this was not visited during the inspection. The practice covers the area of Horden. The area of Horden is measured as having one of the highest levels of deprivation in the country, with high levels of unemployment and high levels of patients with long term conditions. The practice has a Personal Medical Services (PMS) contract and also offers a range of enhanced services.

There are three partners, two clinical (both male GPs, one whole time equivalent (WTE) and one 0.75 WTE) and the other a business partner who is the Practice Manager (0.5 WTE). There is one salaried GP (female 0.75 WTE), an assistant practice manager, a business manager, one Nurse Practitioner, (female 0.4 WTE), three practice nurses, one 0.67 WTE, one 0.8 WTE and one 0.48 WTE (all female), two health care assistants both WTE, (both female), two Pharmacists (one employed directly by the practice) and a range of receptionists, administrative staff and secretaries. The practice has a patient list size of approximately 6279 patients. The practice is not a teaching or training practice for GPs, but student nurses are supported with mentorship from the nursing team. The Practice Manager is also Director of Primary Care for Durham for two local Clinical Commissioning Groups.

The significant changes the practice has faced included the senior partner retiring in July 2015, supporting a nearby practice and consequently taking on 800 patients in September 2015 and completing a new building in September 2016. The new building was developed in consultation with patients and staff and also incorporates another unrelated GP practice.

The practice is open between 8am and 6pm Monday to Friday with extended appointments offered on Saturday mornings each week from 8.15am to 12pm. They offer a mixture of pre-bookable and drop-in clinics.

Pre-bookable appointments are available daily (up to three weeks in advance), with urgent appointments available on the day.

Patients requiring a GP outside of normal working hours are advised to contact NHS 111 who will refer them to the GP out of hours service commissioned by North Durham CCG. The practice has an agreement with the CCG that the out of hours service will cover between the hours of 6pm to 6.30pm.

Updated 15 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shinwell Medical Centre on 18 January 2017. 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 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. For example they had set up a charitable trust to save a local community centre in response to local authority plans to close it.

• Feedback from patients about their care was consistently 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. Examples included; Tendering and supporting ten local Practices to develop services closer to home for patients in 2013, leading the proposed re-development of the new Peterlee Health Centre as part of the NHS Estates and Technology Transformation Fund and operating Peterlee Health Centre premises that housed six local practices since 2000, developing a Saturday opening pilot in Peterlee for 45,000 patients, and developing a new extended hours hub with seven day working in Peterlee from 1 April 2017 in collaboration with neighbouring practices.

• They had a culture of working to sustain primary care. For example they had successfully sustained a contract for a local practice that was closing in order to provide care to local patients. This had led to the practice taking on the care of an extra 800 patients.

• 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 the new building had been developed in consultation with patients. GPs were to be individually audited by patients in order to improve their consultation skills following recommendation by the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints, including verbal complaints, and how they were managed and responded to, and made improvements as a result.
• 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• Public health prevention and promotion as part of the NHS agenda was a priority for the practice, measures included the setting up of a local charity in order to save a local community centre (Roseby Road Wellbeing Centre) which was due for closure. This was then utilised to combat social isolation and provide health promotion for the local community. The practice also participated in the Peterlee Annual Carnival in practice staff’s own time and collaborated with the Pony Club to provide free health checks to patients. The practice also visited local primary schools to familiarise the children with medical equipment and talk about health promotion.

• The leadership in the practice drove continuous improvement and staff were accountable for delivering change. Safe innovation was celebrated. There was a clear proactive approach to seeking out and embedding new ways of providing care and treatment.

In addition the provider should:

• Increase the identification and support to carers on the practice list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 March 2017

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

• The number of patients with a with a long-standing health condition was 68% which was significantly higher than the national average of 54%

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

• Longer appointments and home visits were available when needed.

• 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 Coronary Heart Disease and Heart Failure were seen by the Coronary Heart Disease community Nurse in a monthly clinic, in addition to the clinic she offered domiciliary visits.

• Patients with Respiratory Disease were able to access a support group at Roseby Road Wellbeing Centre. This was facilitated by a Respiratory Disease Specialist Nurse.

Updated 15 March 2017

The practice is rated as outstanding 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 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 practice had participated in and been accredited with the “You’re Welcome” young person’s scheme to raise staff awareness of young people friendly health services.

• 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.

• The practice operated a sexual health and family planning clinic provided by female GP with extended qualifications. This was a regular clinic for implants and coils and an audit of patient satisfaction was regularly conducted.

• The practice told families about Roseby Road Health Wellbeing Centre, which also provided focus on children and young people. Some of the activities include Cinema clubs and playgroups. There were regular events at the centre involving the whole community. Health trainers attended and healthy eating educational sessions were undertaken and there was a fruit and vegetable Co-Op providing affordable healthy food.

• A creative club was available at the Roseby Road Wellbeing Centre for young people with autism to provide a support service to this group of patients.

Updated 15 March 2017

The practice is rated as outstanding 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.

• The practice participated in the ‘Vawas’ scheme. This vulnerable adults wrap around service supported patients admitted or discharged from hospital to prevent re-admission.

• The practice supported those at risk of an unplanned admission using a risk stratification tool. Care plans were in place for all patients on the vulnerable adults register.

• Roseby Road Wellbeing Centre had been set up by the practice and offered activities to help combat social isolation such as bingo, lunch and friendship clubs.

Updated 15 March 2017

The practice is rated as outstanding 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 percentage of patients who were unemployed was significantly higher at 22% than the national average of 5%.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice offered a dermatology service with provision for in house dermatoscopy from a GP who had undertaken extra training.

• The practice offered an orthotics clinic, this was a monthly in house clinic provided by a visiting service and offered care closer to home.

• The practice offered a cryotherapy clinic which provided this care closer to home. This was provided by a Practice Nurse fortnightly.

Updated 15 March 2017

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (01/04/2015 to 31/03/2016) was 100% compared to the national average of 89%

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 93% compared to the national average of 89%

• 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.

• There was a practice based Counsellor every Monday with clinic sessions available all day. The counsellor also saw cases that would be referred to a primary care psychologist.

• Face to face sessions were available in the practice on a Thursday from Talking Changes (a counselling service). Referrals were offered by clinicians and the practice also promoted self-referral without needing to see clinician.

• There was a Mental Health Worker (CPN) attached to the practice every Wednesday. This service provided an expert mental health service for patients and meant that they did not have to attend hospital for their care.

Updated 15 March 2017

The practice is rated as outstanding for the care of people who 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.

• The practice participated in an urgent care response service, whereby advanced nurse practitioners were employed by the Federation. Working with the practice they supported Multi-Disciplinary Team meetings and the 2% most vulnerable population. They saw patients on discharge to prevent re-admission.