Trinity Medical Centre

Updated 19 August 2016

Trinity Medical Centre is registered with the Care Quality Commission to provide primary care services. It is located in the South Shields area of Tyne and Wear.

The practice provides services to around 6,200 patients from one location: New George Street, South Shields, Tyne and Wear, NE33 5DU. We visited this address as part of the inspection. The practice has three GP partners (two female and one male), two salaried GPs (both female), a nurse practitioner and two practice nurses (all female), a healthcare assistant, a business manager, a practice manager, and 10 staff who carry out reception, administrative and cleaning duties.

The practice is part of South Tyneside clinical commissioning group (CCG). The age profile of the practice population is broadly in line with CCG and national averages. Information taken from Public Health England placed the area in which the practice is located in the second most deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The practice is a training practice; one of the GPs is an accredited GP trainer.

The practice is located in a purpose built two storey building. All patient facilities are on the ground floor. There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access.

Opening hours are between 7.30am and 6pm Monday and Thursday; between 8.15am and 6pm on Tuesdays and between 8.30am and 6pm on Wednesday and Friday. Patients can book appointments in person, on-line or by telephone. Appointments were available at the following times:

• Monday – 7.30am to 11.20am; then from 2pm to 5.20pm
• Tuesday – 8.30am to 11.10am; then from 2.30pm to 5.10pm
• Wednesday – 8.30am to 11.20am; then from 2.30pm to 5.20pm
• Thursday – 7.30am to 11.20am; then from 1.50pm to 4.20pm
• Friday – 8.30am to 11.20am; then from 2.30pm to 5.10pm.

A duty doctor is available each afternoon until 6pm.

The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Vocare, which is also known locally as Northern Doctors Urgent Care.

Updated 19 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trinity Medical Centre on 14 July 2016. Overall the practice is rated as good.

Our key findings were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• 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 were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.

• Staff throughout the practice worked well together as a team.

• The practice proactively sought feedback from patients. Patients were involved in the review of complaints; anonymised details of complaints were shared with the patient participation group (PPG).

We saw several areas of outstanding practice including:

• The practice had developed an ‘older population clinic’. Clinics had been held monthly since December 2015. The clinics were aimed at all patients over the age of 65, including housebound patients. Patients were invited in for a two and a half hour appointment; which included a full health check with a nurse, then a medication review with a GP, this time was also used for the patient to have time to talk about any concerns they may have had. The practice worked with a charity to arrange for a minibus to collect housebound patients and take them home again after their appointment.

• One of the receptionists was the ‘young person champion’; they were a point of contact for any young patients who needed advice on which service to access. The practice wrote to all registered patients when they reached 14 years of age. A newsletter specifically designed for young people was included; this gave information about how to use the surgery, what their rights were, an explanation about confidentiality and had links to various health related ‘apps’ for mobile devices. The practice website had a dedicated section for young people.

• The practice used new technologies to engage with patients. This included the use of ‘facetime’ to carry out consultations; when the nurses carried out visits to housebound patients they used a tablet device to allow the patient to communicate with the GP back at the surgery. This allowed for medication reviews to be carried out at the same time as health checks, and enabled staff carrying out the home visit to access patients’ full medical records. At the time of the inspection the practice was actively reviewing a web cam based system which would link directly into the clinical records system.

The areas where the provider should make improvements are:

• Take steps to ensure all recommendations in the recent legionella risk assessment are actioned.

• Take steps to ensure staff are aware of any necessary action to be taken following receipt of national patient safety alerts.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 19 August 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
• Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.
• Patients had regular reviews to check with health and medicines needs were being met.
• For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 19 August 2016

The practice is rated as outstanding 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 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.
• 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.
• The practice’s uptake for the cervical screening programme was 81.2%, which was in line with the clinical commissioning group (CCG) average of 81.9% and the national average of 81.8%.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
• One of the receptionists was the ‘young person champion’; they were a point of contact for any young patients who needed advice on which service to access. The practice wrote to all registered patients when they reached 14 years of age. A newsletter specifically designed for young people was included; this gave information about how to use the surgery and had links to various health related ‘apps’ for mobile devices. The practice website had a dedicated section for young people.
• In order to reach more of the local young people, the nurse practitioner attended the local primary school to present health awareness sessions. The nurse practitioner was also part of a team of GPs and nurses which held a ‘talk to us’ session at a local secondary school.

Updated 19 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 its population. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.
• In response to the needs of the older patients the practice had developed an ‘older population clinic’. Clinics had been held monthly since December 2015. The clinics were aimed at all patients over the age of 65, including housebound patients. Patients were invited in for a two and a half hour appointment; which included a full health check with a nurse, then a medication review with a GP, this time was also used for the patient to have time to talk about any concerns they may have had.

Updated 19 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 and flexible. Extended hours surgeries were offered on Monday and Thursday mornings from 7.30am for working patients who could not attend during normal opening hours.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
• Additional services were provided such as health checks for the over 40s and travel vaccinations.

Updated 19 August 2016

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

• The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
• Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
• The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.

Updated 19 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, including those with a learning disability.
• Patients with learning disabilities were invited to attend the practice for annual health checks and were offered longer appointments, if required.
• A review of how the practice met the needs of patients with learning disabilities had been carried out. Improvements were made, including appointing a dedicated administrative lead and pictures were put on doors including the nurses and doctors rooms and toilet facilities. Leaflets were available in easy read format and invitations to attend reviews were updated to include more suitable wording and pictures.
• The practice had 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. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out of hours.
• Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check and referred for a carer’s assessment.