Archived: Rickleton Medical Centre

Updated 8 August 2016

Rickleton Medical Centre are registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately just under 2,100 patients from one location, Rickleton Medical Centre, Office Row, Washington, Sunderland, NE38 9EH, which we visited as part of this inspection.

Rickleton Medical Centre is a small sized practice providing care and treatment to patients of all ages, based on a General Medical Services (GMS) contract agreement for general practice. The practice is part of the NHS Sunderland clinical commissioning group (CCG).

Information taken from Public Health England placed the area in which the practice was located in the fifth least deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The average male life expectancy is 79 years, which is the same as the England average and the average female life expectancy is 82 years, which is one year lower than the England average.

The percentage of patients reporting with a long-standing health condition is slightly higher than the national average (practice population is 59.1% % compared to a national average of 54.0%).

The practice has one lead GP (male) who owns the practice and a partner practice manager. There is also a practice nurse (female), a healthcare assistant / phlebotomist, three administrative support staff and a domestic staff member.

Surgery opening times are Monday, Tuesday, Thursday, Friday 8:30am to 6pm, and Wednesday 8:30am to 7:30pm. The phone lines are also open between these times. Appointments are available between the following times:

Monday 9:00am – 11am and 3pm - 5pm

Tuesday 9:00am – 11am and 3pm - 5pm

Wednesday 9:00am – 11am, 3pm - 5pm and 6:30pm to 7:30pm

Thursday 9:00am – 11am and 3pm - 5pm

Friday 9:00am – 11am and 3pm - 5pm

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 8 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rickleton Medical Centre on 17 May 2016. Overall, the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Most risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• There was a programme of clinical audit, but it was not clear how the practice used this to demonstrate quality improvement.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice encouraged patient feedback, including complaints. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• 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 sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice led on a locality initiative to improve the information available to parents to help them access the right support for their ill child. This won the national General Practice Award for clinical team of the year for paediatrics in 2015. The initiative included holding a fun day, educational sessions for parents and producing a children’s leaflet. Analysis of parental knowledge about what conditions could be treated at home, prior to and following education sessions, demonstrated a 29% increase in understanding (from 67% to 96%).

The areas where the provider should make improvements are:

• Consider how they review incidents and significant events over a period of time to increase learning related to any trends and themes.
• Improve the approach to audit to ensure standards are clearly defined, and there is a clear link between audits and improvement in the quality of the service.

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.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Effective systems were in place, which helped ensure patients with long-term conditions received an appropriate service, which met their needs. These patients all had a named GP and received an annual review to check that their needs were being met. For those people with the most complex needs, the named GP worked with other relevant health and care professionals to deliver a multidisciplinary package of care.
• Longer appointments and home visits were available when needed.
• Nationally reported data showed the practice had performed well in providing recommended care and treatment for some of the clinical conditions commonly associated with this population group. For example, performance for asthma related indicators was higher than the CCG and national averages. The practice achieved 100% of the points available. This compared to an average performance of 97.1% across the CCG and 97.4% national average. For example, the percentage of patients on the asthma register who had an asthma review within the preceding 12 months that included an assessment of asthma control was 78.4%, this compared to a CCG average of 73.7% and a national average of 75.4%.
• Staff had completed the training they needed to provide patients with safe care.

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. 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. The needs of all at-risk children were reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors. However, the arrangements for multi-disciplinary information sharing about safeguarding issues were informal and ad hoc.
• Immunisation rates were relatively high for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given were comparable to CCG averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 96.2% to 100% and five year olds from 96.7% to 100%. The average percentage across the CCG for vaccinations given to under two year olds ranged from 96.2% to 98.9% and five year olds from 31.6% to 98.9%.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Nationally reported data showed the practice had performed in line with average for providing recommended care and treatment for this group of patients. For example, the Quality and Outcomes Framework (QOF) data for 2014/15 showed the practice’s uptake for the cervical screening programme was 90.4%, which was higher than the national average of 81.8% and the CCG average of 81.7%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives, health visitors and school nurses.
• The practice led on a locality initiative to improve the information available to parents to help them access the right support for their ill child. This won a General Practice Award for clinical team of the year for paediatrics in 2015.

Updated 8 August 2016

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

• Staff provided proactive, personalised care, which met the needs of older patients. Patients aged 75 and over were allocated a named GP to help ensure their needs were met.
• Good arrangements had been made to meet the needs of ‘end of life’ patients. Staff held regular palliative care meetings with other healthcare professionals to review the needs of these patients and ensure they were met.
• The practice offered home visits and longer appointment times where these were needed by older patients.
• The practice was part of a local pilot scheme to improve outcomes for patients in the area, to deliver support to patients in care homes through local integrated teams.

• Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. For example, performance for heart failure related indicators was better than the CCG and national averages. The practice achieved 100% of the points available. This compared to an average performance of 98.7% across the CCG and 97.9% national average.

• The practice maintained a palliative care register and offered immunisations for pneumonia and shingles 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.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Nationally reported data showed the practice provided recommended care and treatment that was in line with or above national averages for this group of patients. For example, the percentage of patients with hypertension having regular blood pressure tests was above the national average. 86.5% of patients had a reading measured within the last nine months, compared to a CCG average of 83.7% and 83.7% nationally.

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 0.5% of their population with enduring mental health conditions on a patient register to enable them to plan and deliver relevant services.
• The summary performance for mental health related indicators was lower than the CCG and national average. The practice achieved 88.5% of the points available. This compared to an average performance of 91.8% across the CCG and 92.8% national average. For the practice, 100% of patients with schizophrenia, bipolar affective disorder and other psychosis had a comprehensive agreed care plan documented within the preceding 12 months. This compared to a CCG average of 86.9% and a national average of 88.5%.Performance on QOF mental health was low because two indicators relating to lithium were at zero percent.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review within the preceding 12 months was better than the national average at 100% (compared to a CCG average of 80.8% and a 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• They 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 people with mental health needs and dementia. The practice carried out advance care planning for patients with dementia. The practice had made reasonable adjustments to the building to make it accessible to patients 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 including patients with learning disabilities.
• Staff carried out annual health checks for patients who had a learning disability. The practice offered longer appointments for patients with a learning disability. The practice had made improvements following a visit by a local support agency for people with learning disabilities in October 2015.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.