Archived: Grange Road Medical Practice

Updated 27 October 2017

Grange Road Medical Practice provides care and treatment to approximately 3,757 patients from the NE40 postcode area of Gateshead, Newcastle Upon Tyne. The practice is part of the NHS Newcastle Gateshead 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:

Grange Road Medical Practice

Grange Road

Ryton

Gateshead

Tyne and Wear

NE40 3LT

The surgery is located in a purpose built building which was erected in 1961 and has since been extended. All reception and consultation rooms are fully accessible for patients with mobility issues. An on-site car park is available with dedicated disabled parking spaces and electric car charging points. On-street parking is also available nearby.

The surgery is open from 8am to 6pm on a Monday to Friday with appointments generally running from 8am to 5.40pm.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and the Gateshead Doctors on Call service known locally as GatDoc.

Grange Road Medical Practice offers a range of services and clinic appointments including long term condition reviews, contraceptive services, childhood health surveillance and immunisation services, maternity services and travel immunisations and advice.

The practice consists of:

• Four salaried GPs (two male and two female)
• One nurse practitioner (female)
• One practice nurses (female)
• One healthcare assistant (female)
• Eight non-clinical members of staff including an operations manager, senior medical administrator, medical secretary and receptionists.

The contract for Grange Road Medical Practice has been held by Gateshead Community Based Care (CBC) Ltd since March 2015. CBC Ltd is a not for profit healthcare support organisation who represent and support 31 GP practices across the Gateshead area and hold the contract for Grange Road Medical Practice and another local GP practice as well as running GatDoc.

The average life expectancy for the male practice population is 80 (CCG average 77 and national average 79) and for the female population 82 (CCG average 81 and national average 83).

At 53.6%, the percentage of the practice population reported as having a long standing health condition was higher than the CCG average of 56.9% 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 60.9% the percentage of the practice population recorded as being in paid work or full time education was comparable with the CCG average of 60.5% and national average of 61.5%. The practice area is in the seventh most deprived decile. Deprivation levels affecting children were lower than local and national averages. Deprivation levels affecting adults were lower than the CCG average but higher than the national average.

Updated 27 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Grange Road Medical Practice on 22 August 2017. Overall the practice is rated as good.

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. However, we did not see any evidence of trends, themes and lessons learned from significant events or complaints being shared with the entire staff group.
• Risks to staff and patients were assessed and well managed. Staff had received a full range of appropriate training and there was no evidence of health and safety and fire risk assessments.
• The practice carried out clinical audit activity. However, none of the audits we saw demonstrated improvements to patient care as a result of the audit.
• The practice had a comprehensive recruitment policy and staff files we viewed confirmed that appropriate pre-employment checks had been completed.
• Feedback from patients about their care was positive compared to local and national averages. Patients reported that they were treated with compassion, dignity and respect.
• Patients were able to access same day appointments, including telephone consultations. Pre-bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were easily accessible to staff.
• The practice sought feedback from patients and implemented suggestions for improvement and made changes to the way they delivered services in response to feedback.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness but had achieved an overall result which was lower than local and national averages. However, practice staff were able to provide an explanation for this and were committed to improvement.
• Information about services and how to complain was available and easy to understand.

However, there were areas where the provider should make improvements. Importantly, the provider should:

• Ensure that the practice’s clinical audit activity is used to drive improvements in patient care, outcomes and service quality.
• Educate staff on the existence of the practice business continuity plan and their responsibilities in relation to this.
• Ensure all staff are up to date with routine immunisations and that a record is kept of this.
• Provide carers with an annual health checks
• Ensure that the finding’s of the practice’s reviews of significant events and complaints are shared learning with the entire staff group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 October 2017

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

Longer appointments and home visits were available when needed. The practice used a centralised chronic disease recall system to flag when patients were due for review. Patients with multiple long term conditions were offered one fully comprehensive review whenever possible and a system was in place to contact patients who failed to respond to review invitation letters.

The QOF data for 2015/16 provided by the practice showed that they had achieved mixed 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 and above local and national averages for providing recommended care and treatment for patients with asthma, chronic kidney disease and epilepsy. However, at 75.7% they had obtained below local and national averages in respect of diabetes (CCG average 93.5% and national average 99.8%). Practice staff told us this was because of the loss of numerous members of the clinical staffing team, including the practice nurse with experience of treating and caring for patients with diabetes, during this period of time. The practice now had a more stable workforce and the current practice nurse was undertaking diabetes masterclass training. As a result the practice was able to supply evidence that they had achieved a score of 91.1% for 2016/17 although this information was yet to be published.

Patients with asthma and chronic obstructive pulmonary disease were encouraged to participate in the production of a care and self-management plan during their annual health care reviews.

Updated 27 October 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. The needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

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 achieved the target of 90% for three of the four separate childhood immunisation indicators. The exception was the indicator in respect of the percentage of children aged 2 who had received their booster immunisation for pneumococcal infection for which they had attained 86.7%. The practice was able to provide evidence during the inspection that this was an error due to miscoding which they subsequently rectified. Their actual attainment rate for this indicator was 95%.

The practice participated in the ‘Little Orange Book’ scheme which was a CCG initiative to provide parents and carers with information to help them recognise and respond appropriately to a range of diseases, illnesses and conditions which may affect young children.

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 82.4% and national average of 81.4%.

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

Updated 27 October 2017

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

Nationally reported Quality and Outcomes Framework (QOF) data for 2015/16 (the most recently published results) showed the practice had achieved good outcomes for most of the 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 atrial fibrillation, heart failure and osteoporosis and for those requiring palliative care. However, they had only obtained 18.7% of the points available to them in relation to dementia (78.9% below the local CG and 77.9% below national averages). Although not yet published the practice were able to provide evidence to confirm that they had scored 100% in respect of dementia for 2016/17.

The practice was able to demonstrate effective collaborative working with multi-disciplinary professionals including district nurses to reduce admissions to hospital for high risk patients. They also worked with local health care navigator to ensure older people received coordinated care and treatment to enable them to stay in their own home or care home and avoid non-elective admission to hospital. Regularly reviewed emergency healthcare plans were in place for patients at risk of unplanned admission to hospital.

Updated 27 October 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 to Friday with appointments generally running from 8am to 5.40pm. Patients registered with the practice were also able to access appointments with a GP at one of three local extended access care facilities from 8am to 8pm on a Monday to Friday and from 9am to 2pm on a Saturday and Sunday.

The practice offered contraception services, travel advice, childhood health surveillance and immunisation service, maternity services and long term condition reviews. They also offered new patient and NHS health checks (for patients aged 40-74). At 82.5% the percentage of women screened for breast cancer within six months of invitation was higher than the CCG average of 74.6% and national average of 72.2%.

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.

Updated 27 October 2017

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

QOF data for 2015/16 provided by the practice showed that they had achieved below local and national averages for caring for patients with dementia, depression and mental health conditions. The practice attributed this to the loss of a number of clinical staff members during this period and reliance on locum cover. However, they felt that the situation had now improved due to a more stable workforce and centralised review recall system and were able to supply evidence that QOF attainment for 2016/17 had improved although this information was yet to be published.

Patients registered with the practice were able to access on site counselling via their GP or by self-referral.

Updated 27 October 2017

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 15 patients who had a learning disability. Patients with a learning disability were offered an annual health check and flu immunisation. The practice was registered with the safe place scheme. This scheme provides vulnerable people with a place to go for help and support in dealing with any incident that should occur whilst they are out in the community regardless of whether they are registered with the practice.

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 had received safeguarding training at a level appropriate to their role and 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 a flu vaccination. However, they were not offered an annual health check.