Bridge View Medical Group

Updated 25 July 2016

Drs Cloak, Choi and Milligan is registered with the Care Quality Commission to provide primary care services.

The practice provides services to around 9,900 patients from one location:

• Southwick Health Centre, The Green, Southwick, Sunderland, Tyne and Wear, SR5 2LT.

We visited this this address as part of the inspection.

Drs Cloak, Choi and Milligan is based in purpose built premises in Sunderland. The premises are shared with two other GP practices and external services. All reception and consultation rooms are fully accessible. There is on-site parking and disabled parking. Disabled WCs are available.

The practice has four GP partners and three salaried GPs (five male, two female, the nurse practitioner is a partner at the practice.) The practice employs a practice manager, an assistant practice manager, two practice nurses, a healthcare assistant and a smoking advisor who also undertakes reception duties. The practice employs 15 staff who undertakes reception or administrative duties, including two apprentices. In addition to this, one member of staff is available for ad hoc administrative work when required. The practice provides services based on a Personal Medical Services (PMS) contract agreement for general practice.

The practice is:

• An approved training practice; where qualified doctors gain experience in general practice.
• Active in clinical research and patients are encouraged to participate in appropriate clinical trials.

Drs Cloak, Choi and Milligan is open at the following times:

• Monday to Friday 8am to 6pm.

The telephones are answered by the practice from 8am to until 6pm. When the practice is closed patients are directed to the NHS 111 service. This information is available on the practices’ telephone message, website and in the practice leaflet.

Appointments are available at Drs Cloak, Choi and Milligan at the following times:

• Monday to Friday 8am to 5:30pm.
• Extended hours appointments are available from 5:30pm until 7:30pm on a Monday and Wednesday.

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 39.9 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 (66.6% compared to the national average of 54%). The proportion of patients who are in paid work or full-time employment or education is in line with the average (58.5% compared to the national average of 61.5%). The proportion of patients who are unemployed below average (7.7% 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 25 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Cloak, Choi and Milligan on 21 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 from 5:30pm until 7:30pm on a Monday and Wednesday.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour regulation.

We saw two areas of outstanding practice:

• The practice recognised the need for the control and delivery of evidence based medicine. A practice formulary had been developed and implemented, this included appropriate references where required. A system was in place to ensure the formulary was regularly updated. A quick reference guide had also been developed for use during consultations with patients. The work required to complete this formulary, and to ensure it is kept up to date is considerable.
• Data from the National GP Patient Survey, published in January 2016, showed that patients rated the practice highly for their experience of care at the practice. For example, of those that responded 100% patients had trust and confidence in the last GP they saw (CCG average 95%, national average 95%). 95% of those that responded said that the last GP they saw or spoke to was good at treating them with care and concern (CCG average 87%, national average 85%).

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 July 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. The practice has weekly meetings to discuss the management of long term conditions.
• 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 below average. For example, the practice had achieved 84.2% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 9.3% below the local CCG average and 5% 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 had recently introduced regular weekly clinical meetings to discuss the management of long-term conditions. This was attended by the lead GP, the nursing staff and the healthcare assistant.
• The practice provided an insulin initiation service for patients newly diagnosed with type two diabetes.
• The practice held regular clinics for some long terms conditions, for example for patients with diabetes.

Updated 25 July 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 95.5% to 99.1% (CCG average 96.2% to 98.9%) and for five year olds ranged from 91.8% 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 below average. The practice had achieved 50.1% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 47% below the local CCG average and 47.3% above the national average.
• The practice provided contraceptive and sexual health advice.

Updated 25 July 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. Patients over the age of 75 were offered an annual health check. The practice worked to reduce the unplanned hospital admissions for patients over the age of 75.
• The practice had implemented the Priorities for Care of the Dying Person document that aimed to improve patients’ experience of the last few days of life.
• 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 below average. For example; the practice had achieved 83.5% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 15.4% below the local clinical commissioning group (CCG) average and 14.6% below the national average. The practice had achieved 97.5% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with hypertension. This was 2% below the local clinical commissioning group (CCG) average and 0.3% below the national average.
• The practice maintained a palliative care register and offered immunisations for pneumonia to older people.

Updated 25 July 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.
• 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 78%, 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 and joint injections were provided.
• The practice website provided a good range of health promotion advice and information.

Updated 25 July 2016

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

• The practice held a register for patients experiencing poor mental health. There were 81 patients on this registered and, 81% of those eligible for a care plan, had one completed (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 73% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 18.8% below the local CCG average and 19.8% below the national average.The practice were aware of this and attributed it to their patient population.
• Nationally reported data showed that outcomes for patients with dementia were good. The practice had achieved 96.7% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 1.2% above the local CCG average and 2.2% above the national average. 75.3% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which was below 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.
• The nurse practitioner visited the patients diagnosed with dementia who lived in care homes each year.

Updated 25 July 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. Fifty patients were on this register and, 26% had a health check in the last 12 months.
• 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.