Happy House Surgery

Updated 8 August 2016

Happy House Surgery is registered with the Care Quality Commission to provide primary care services.

The practice provides services to around 5,500 patients from one location:

• Happy House Surgery, Durham Road Sunderland, Tyne and Wear, SR3 4BY.

We visited this this address as part of the inspection.

Happy House Surgery is based in converted premises in Sunderland. All reception and consultation rooms are fully accessible; a lift is available to allow access to services provided on the first floor of the practice. There is on-site parking and disabled parking. Disabled WCs are available.

The practice has two GP partners and one salaried GP (two male, one female). The practice employs a practice manager, a senior receptionist, a nurse practitioner, two practice nurses and two healthcare assistants, as well as five staff who undertake reception and administrative duties. The practice provides services based on a General Medical Services (GMS) contract agreement for general practice.

Happy House Surgery is open at the following times:

• Monday and Friday 7am to 5:45pm.
• Tuesday, Wednesday and Thursday 8:30am to 5:45pm.

The telephones are answered by the practice during their opening times. When the practice is closed patients are directed to the NHS 111 service. This information is also available on the practices’ website and in the practice leaflet.

Appointments are available at Happy House Surgery at the following times:

• Monday 7am to 12:10pm and 1pm to 5:20pm
• Tuesday 9:10am to 12:10pm and 2:40pm to 5:20pm
• Wednesday 8:30am to 11:30pm and 2:40pm to 5:20pm
• Thursday 9:10am to 12:10pm and 2:40pm to 5:20pm
• Friday 7am to 12:10pm and 1pm to 5:20pm

Extended hours appointments are available from 7am to 8:30am on a Monday and Friday.

The practice is part of NHS Sunderland clinical commission group (CCG). Information from Public Health England placed the area in which the practice is located in the second most deprived decile. The income deprivation score for the practice was 35 compared to the CCG average of 29.7 and the national average of 21.8. In general, people living in more deprived areas tend to have greater need for health services

Average male life expectancy at the practice is 76 years compared to the national average of 79 years. Average female life expectancy at the practice is 81 years compared to the national average of 83 years.

The proportion of patients with a long-standing health condition is above average (66.3% compared to the national average of 54%). The proportion of patients who are in paid work or full-time employment or education is below average (48% compared to the national average of 61.5%). The proportion of patients who are unemployed above average (13.6% compared to the national average of 5.4%).

The service for patients requiring urgent medical care out of hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited.

Updated 8 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Happy House Surgery on 29 June 2016. 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 report incidents and near misses. Lessons were learned when incidents and near misses occurred.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Extended hours appointments were available on a Monday and Friday between 7am and 8:30am.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on. An influential and active patient participation group (PPG) had been established for over 20 years. The PPG were actively consulted on possible changes at the practice and they responded to issues raised by the group quickly.
• The provider was aware of and complied with the requirements of the duty of candour regulation.
• The practice won local awards from in 2015 and 2016 following nominations from patients.
• Data from the National GP Patient Survey, published in January 2016, showed that patients rated the practice highly for access to care and treatment. For example, of those that responded 99% found it easy to get through to the practice by phone (CCG average 78%, national average 73%) and 91% describe their experience of making an appointment as good (CCG average 76%, national average 73%). Of those who responded 84% feel that they don’t normally wait too long to be seen (CCG average 64%, national average 58%).

We saw two areas of outstanding practice:

• Audio leaflets were available on the practice website so that patients who had difficulty seeing or reading were able to access practice information. Audio leaflets were available with information about the practice, opening hours, making an appointment, ordering repeat prescriptions, home visits and emergencies and making a complaint. The practice could also provide this information directly to patients as a file that could be saved on a patient’s phone or computer.
• Non-clinical staff who acted as chaperones wore a blue ‘chaperone’ badge that ensured patients were aware of the availability of chaperones at the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 8 August 2016

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

• GP and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Patients at risk of hospital admission were identified as a priority for care and support by the practice, comprehensive care plans were in place and regularly reviewed.
• Nationally reported data showed that outcomes for patients with conditions commonly found in this population group were generally in line with local and national averages. For example, the practice had achieved 97.3% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 3.8% above the local CCG average and 8.1% above the national average. The practice had achieved 91.9% of the QOF points available for providing the recommended care and treatment for patients with chronic obstructive pulmonary disease (COPD). This was 4.2% below the local CCG average and 4.1% below the national average.
• Longer appointments and home visits were available when needed.
• All patients with a long-term condition 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 held weekly meeting were the management of long-term conditions was discussed.
• The practice held regular clinics for long terms conditions, for example for patients with diabetes.

Updated 8 August 2016

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

• 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. For example, 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.
• There were arrangements for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 95.7% to 100% (CCG average 96.2% to 98.9%) and for five year olds ranged from 92.3% to 100% (CCG average 31.6% to 98.9%).
• Urgent appointments for children were available on the same day.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
• Nationally reported data showed that outcomes for patients with asthma were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 2.9% above the local CCG average and 2.6% above the national average.
• The practice provided contraceptive and sexual health advice and services.

Updated 8 August 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in their population. Patients aged 75 and over were allocated a named GP to help ensure their needs were met. The practice worked to reduce the unplanned hospital admissions for patients over the age of 75.
• The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients with conditions commonly found in older people were generally in line with local and national averages. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 1.3% above the local clinical commissioning group (CCG) average and 2.1% above the national average.
• The practice maintained a palliative care register and offered immunisations for shingles and pneumonia to older people.

Updated 8 August 2016

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 identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Patients could order repeat prescriptions and routine healthcare appointments online.
• Telephone appointments were available.
• A text message reminder service was available.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group.
• The practice’s uptake for cervical screening was 75%, compared to the CCG average of 81.7% and the national average of 81.8%.
• Additional services such as new patient health checks, travel vaccinations and minor surgery were provided.
• The practice website provided a good range of health promotion advice and information.

Updated 8 August 2016

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

• The practice had identified 2% of their population with enduring mental health conditions on a patient register to enable them to plan and deliver relevant services. 53% of those has an annual review, 24% had an influenza vaccination (2015/2016 data, which is yet to be verified or published).
• Nationally reported data showed that outcomes for patients with mental health conditions were below average. The practice had achieved 85.5% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 6.3% below the local CCG average and 7.3 % below the national average.
• Nationally reported data showed that outcomes for patients with dementia were below average. The practice had achieved 91.2% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 4.3% below the local CCG average and 3.3% below the national average. 95.5% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which was above as the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• Staff had undertaken dementia friends training and the signs in the practice were ‘dementia friendly’ to support accessibility for people with dementia.

Updated 8 August 2016

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.
• The practice held a register of patients with a learning disability; patients with learning disabilities had been invited to the practice for an annual health check. 78 patients were on this register, 54% had an annual review and 38% had an influenza vaccination (2015/2016 data, which had not yet been verified or published).
• Nationally reported data showed that outcomes for patients with a learning disability were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with a learning disability. This was the same as the local CCG average and 0.2% above the national average.
• The practice offered longer appointments for patients with a learning disability if required.
• The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people.
• 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.
• Good arrangements were in place to support patients who were carers.