Millfield Medical Group

Updated 10 March 2016

Millfield Medical Group is registered with the Care Quality Commission to provide primary care services. It is located close to the city centre in Sunderland.

The practice provides services to around 12,800 patients from one location: 63-83 Hylton Road, Sunderland, Tyne and Wear, SR4 7AF. We visited this address as part of the inspection. The practice has eight GP partners (five male and three female), one salaried GP (female), a trainee GP, a career start GP, a nurse practitioner, a healthcare assistant, a practice manager, and 20 staff who carry out reception and administrative duties.

The practice is part of Sunderland clinical commissioning group (CCG). Information taken from Public Health England placed the area in which the practice was located in the third more deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice’s age distribution profile is in line with national averages but is made up of a higher than average proportion of patients with health-related problems in daily life (65.4% compared to 48.8% nationally).

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 8am and 6pm Monday to Friday and between 8am and 11am on Saturday mornings. Patients can book appointments in person, on-line or by telephone. Appointments were available at the following times:

• Monday - 8.30am to 12pm; then from 2pm to 5.30pm
• Tuesday – 8.30am to 11.30am; then from 2pm to 5.30pm
• Wednesday – 8.30am to 11.30am; then from 2pm to 5.30pm
• Thursday – 8.45am to 12pm; then from 2pm to 5.30pm
• Friday – 8.30am to 12pm; then from 2pm to 5.30pm
• Saturday – 8am to 11am

A duty doctor is available each afternoon until 6pm. Patients are also able to access services at a local health centre between 6pm and 8pm on weekdays and between 9am and 2pm on Satursdays and Sundays.

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

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

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Millfield Medical Group on 26 January 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.
• Extended hours surgeries were offered between 8am and 11am every Saturday morning. Patients
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had comprehensive policies and procedures governing their activities and there were very good systems in place to monitor and improve quality.
• 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.

We saw several areas of outstanding practice including:

• People could access appointments and services in a way and at a time that suited them. Patients had very good access to the service. Extended hours surgeries were offered between 8am and 11am every Saturday morning. The practice scored very highly in relation to nearly all questions about access in the National GP Patient Survey. The most recent results (July 2015) showed 100% of patients said the last appointment they got was convenient to them, compared to local average of 93% and the national average of 92%.

• Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care. The practice was the preferred practice for a number of students at a local school for children and young people on the autistic spectrum (c60 patients). Services were tailored to meet those patients’ individual needs. We were told about several examples of how staff from the practice positively engaged with the patients. For example, some patients were familiar with a particular consultation room so always had their appointments in that room.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 10 March 2016

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

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. For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Nationally reported QOF data (2014/15) showed the practice had achieved good outcomes in relation to some of the conditions commonly associated with this population group. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with hypertension. This was 0.5 percentage points above the local CCG average and 2.2 points above the national average. However, performance in relation to diabetes was below average; the practice achieved 79.1% of the points available compared to 93.5% locally and 89.2% nationally. The practice had only achieved 84.4% of the points available for asthma; this was 12.7% below the local average and 13% below the national average. Managers were aware of the areas where performance was below average, and had plans in place to address the issues. There was a GP lead for each of the clinical areas and QOF was a standing item on the clinical governance meetings.

Updated 10 March 2016

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. 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. Arrangements had been made for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 94.5% to 100% and five year olds from 92.2% to 98.7%.

The uptake for the cervical screening programme was 72.5%, which was below the CCG average of 81.6% and the national average of 81.8%. Managers were aware of the lower uptake; they had planned to carry out an audit to determine if there was a reason for non-attendance.

Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 10 March 2016

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

Nationally reported data showed the practice had good outcomes for 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 with cancer. This was slightly above local clinical commissioning group (CCG) average (99.3%) and the England average of 97.9%.

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 and patients at high risk of hospital admission and those in vulnerable circumstances had care plans. GPs held weekly multi-disciplinary team meetings to discuss patients who had emergency health care plans.

The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Updated 10 March 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 Saturday mornings between 8am and 11am for working patients who could not attend during normal opening hours. Patients were also able to access GP services at a local health centre between 6pm and 8pm each weekday.

Lunchtime appointments were available for minor surgical procedures.

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 10 March 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. All staff had been trained as ‘dementia friends’. 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.

Nationally reported QOF data (2014/15) showed the practice had not always achieved good outcomes in relation to patients experiencing poor mental health. Performance for mental health indicators was worse than the national average (65.4% compared to 92.8% nationally). However, at the time of the inspection the practice was progressing well against the 2015/16 QOF targets, with two months left until the deadline to complete the remaining checks.

Updated 10 March 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

The practice aimed to reduce barriers to access. Staff took the time to get to know vulnerable patients and how they preferred to communicate. 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. The practice offered longer appointments for people with a learning disability, if required.

Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care. The practice was the preferred practice for a number of students at a local school for children and young people on the autistic spectrum (c60 patients). Services were tailored to meet those patients’ individual needs. We were told about several examples of how staff from the practice positively engaged with the patients. For example, some patients were familiar with a particular consultation room so always had their appointments in that room.

Translation services were available and some of the doctors were fluent in other languages, including Punjabi, Hindi, Hakka and Cantonese. Nearly 10% of the local population were from non-British ethnic minorities.

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. The practice had recently signed up to a local ‘Safe Place’ scheme, which gave vulnerable people a short term ‘safe place’ to go if they were feeling threatened when out and about in the local community.

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. A carers champion had recently been appointed within the practice to proactively identify further patients who were carers so they could receive appropriate support.