Northgate Village Surgery

Updated 9 June 2017

Northgate Village Surgery is responsible for providing primary care services to approximately 6,590 patients. The practice is situated in Chester city centre, Cheshire. The practice is based in an area with average levels of economic deprivation when compared to other practices nationally. The number of patients with a long standing health condition is about average when compared to other practices nationally

The staff team includes three partner GPs, three salaried GPs, one advanced nurse practitioner, one lead nurse, three practice nurses, two health care assistants, practice manager, two management support staff, office manager, IT manager and administration and reception staff. There are both male and female GPs. The nursing team and health care assistants are female. The practice is a training practice for GP Registrars and medical students and practice nurses.

Northgate Village Surgery is open from 8am to 6.30pm Monday to Friday. Extended hours are being trialled at the practice on Tuesday, Wednesday and Thursday from 7am to 7.45am. An extended hour’s service for routine appointments and an out of hour’s service are commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. Patient facilities are located on the ground floor. The practice has a car park for on-site parking. The practice shares a building with other GP practices and a number of community services such as community nursing, podiatry and sexual health services.

The practice has a General Medical Service (GMS) contract. The practice offers a range of enhanced services including avoiding unplanned hospital admissions, minor surgery, timely diagnosis of dementia, flu and shingles vaccinations and learning disability health checks.

Updated 9 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northgate Village Surgery Centre on 11 April 2017.

Overall the practice is rated as good.

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

• There were systems in place to reduce risks to patient safety, for example, equipment checks were carried out, there were systems to protect patients from the risks associated with insufficient staffing levels and to prevent the spread of infection.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt supported. They had access to training and development opportunities and had received training appropriate to their roles.

• Patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.

• Services were planned and delivered to take into account the needs of different patient groups.

• Access to the service was monitored to ensure it met the needs of patients.

• There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

The areas where the provider should make improvements are:

• Introduce a written protocol detailing the process for changes to be made to medication by the medicines management team and safeguards to ensure changes made are correct. This protocol should also identify the remit of the medicines managers. An audit should be undertaken to ensure this system is operating effectively.

• Make a record of the in-house checks of cleaning standards.
• Ensure staff recruitment records contain evidence of qualifications having been verified and evidence of information having been gathered about any physical or mental conditions which were relevant (after reasonable adjustments) to the role the person was being employed to undertake.

• The health and safety risk assessment specific to the practice should contain more detail about possible risks and how they are to be mitigated.

• A record should be made of which staff participated in fire drills and any action to be taken to improve the process.

• The salaried GPs should have an in-house appraisal in addition to the external appraisal process.
• Provide a more comprehensive record of the induction provided to staff.
• Include in records of clinical meetings discussion concerning National Institute for Health and Care Excellence (NICE) updates and alerts received from the Medicines and Healthcare Products Regulatory Agency.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 June 2017

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. The practice had introduced the ‘Year of care’ for diabetes management and as a consequence had streamlined its management of this long term condition, minimising the number of appointments patients had to attend. The clinical team took the lead for different long term conditions. A GP with a special interest in epilepsy held clinics for patients within the Chester city area. A further GP with a special interest in diabetes was able to initiate insulin for patients with a new diagnosis of diabetes. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access to specialist help when needed.

Updated 9 June 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Priority was given to young children who needed to see the GP and appointments were available outside of school hours. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. Child health promotion information was available on the practice website and in leaflets displayed in the waiting area. Family planning and sexual health services were provided. Gynaecological clinics were led by female GPs and longer appointments were available.

Updated 9 June 2017

The practice is rated as good for the care of older people. The practice kept registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. GPs visited two local nursing homes weekly and made daily visits to a local care home. V isits were carried out by the same clinicians where possible to provide continuity. A practice nurse visited patients at risk of hospital admissions. During these visits patients’ needs were assessed, care plans were developed and a review of long term conditions took place. These assessments also considered social care needs and vulnerability of the patient and as a result of the assessment referrals were made to appropriate health and social care services. The practice worked with other agencies and health providers to provide support and access specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients.

Updated 9 June 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice appointment system and opening times provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday. In addition the practice was currently trialling an extended hours’ service three mornings a week (Tuesday, Wednesday and Thursday) from 7am to 7:45am to improve accessibility for patients who were not able to attend the surgery during normal working hours. Patients could book routine appointments in person, via the telephone and on-line. Repeat prescriptions could be ordered on-line or by attending the practice. Telephone consultations were also offered. Mobile phone texts were made to remind patients about appointments and reduce missed appointments and for some test results. The practice website provided information around self-care and local services available for patients. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, contraceptive services, smoking cessation advice and family planning services. Reception staff sign-posted patients who did not necessarily need to see a GP. The Patient Participation Group held a workshop for patients to provide information on and encourage the use of on-line access.

Updated 9 June 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). GPs worked with specialist services to review care and to ensure patients received the support they needed. The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review. GPs made weekly visits to two local nursing homes to support patients with dementia . V isits were carried out by the same clinicians where possible to provide continuity. Housebound patients with dementia were visited by a designated nurse who assessed their needs and fed back any concerns to their GP.

The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services.

Updated 9 June 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice identified vulnerable patients through multi-disciplinary meetings. A register was kept of patients with a learning disability and there was a system to ensure these patients received an annual health check. Alerts were placed on the records of vulnerable patients and longer appointments were offered. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and children and all staff had safeguarding training relevant to their role. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff acted as a carer’s link and they were working to identify carers and promote the support available to them through organisations such as the Carers Trust. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the wellbeing coordinator. The practice with the support of the PPG had produced a list of services and charities booklet which was free to all patients.