Springwell Medical Group

Updated 29 September 2016

Springwell Medical Group is registered with the Care Quality Commission to provide primary care services. The practice provides services to around 6,400 patients from one location: Alderman Jack Cohen Health Centre, Springwell Road, Sunderland, Tyne and Wear, SR3 4HG. We visited this address as part of the inspection.

Springwell Medical Group is based in converted premises. All reception and consultation rooms are fully accessible. An on-site car park is available which includes dedicated disabled parking bays. Disabled toilets are available. A wheelchair was available for patients to use if they have difficulty walking.

The practice has four GP partners, one salaried GP and one career start GP (four male, two female). The practice employs a practice manager, an assistant practice manager, two practice nurses, a health care assistant and eight staff who undertake reception and administrative duties. The practice provides services based on a General Medical Services (GMS) contract agreement for general practice.

The practice is:

• An approved training practice; where qualified doctors gain experience in general practice.
• Registered to participate in clinical research, however, the practice are not currently active in any clinical trials.

Springwell Medical Group is open at the following times:

• Monday 8am to 8:15pm.
• Tuesday and Thursday 8am to 6pm.
• Wednesday and Friday 8:30 am to 6pm.

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 Springwell Medical Group at the following times:

• Monday 8:30am to 12:30pm and 3pm to 8pm
• Tuesday 8:30am to 12:15pm and 1pm to 4:50pm
• Wednesday 8:30am to 12:15pm and 12:30pm to 5:30pm
• Thursday 8:30am to 12:15pm and 2pm to 5:30pm
• Friday 8:30am to 12:15pm and 1:30pm to 4:50pm

Extended hours appointments are available on a Monday between 6:30pm and 8:15pm with a GP or healthcare assistant.

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 third most deprived decile. 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 (60.7% 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 (62.8% compared to the national average of 61.5%). The proportion of patients who are unemployed above average (6.8% 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 Vocare, known locally as Northern Doctors Urgent Care Limited.

Updated 29 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Springwell Medical Group on 28 July 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 between 6:30pm and 8:15pm with a GP or healthcare assistant.
• 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 one area of outstanding practice:

• The practice recognised the specific needs of a wide range of vulnerable patients. For example, they had identified a wider cohort of patients who may be in need of additional monitoring and support but were not part of any formal safeguarding process. These patients were discussed at quarterly meetings attended by the attached staff such as the health visitor. The practice kept records of any actions required and put in place support for these patients when required. The practice had also completed a clinical audit of their learning disability register and completed work to improve the care offered to these patients. The first audit in 2013 showed that no patients on the learning disability register had been offered or attended a health check. New processes and procedures were implemented and at the re-audit in 2014, 81% of eligible patients had been offered a health check and 61% had attended. At a third audit in April 2016 the practice were able to show that 83% of eligible patients had attended for a health check, this was an increase of 83% in 3 years.

The areas where the provider should make improvements are:

• Review and formalise the arrangements for the management of significant events to reflect the processes already in place.
• The practice should review the use of consulting rooms with carpeted flooring for taking clinical samples in line with national guidance.
• The practice should review the monitoring arrangements in place for the use of blank prescription pads within the practice in line with the latest guidance.
• The practice should review and formalise their processes for confirming that NHS Property Services have completed the health and safety checks they are contracted to carry out.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 September 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.
• 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 above the local and national averages. For example, the practice had achieved 99.7% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 6.2% above the local CCG average and 10.5% above 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 regular clinics for long terms conditions, for example for patients with diabetes and asthma.

Updated 29 September 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 93.8% to 100% (CCG average 96.2% to 98.9%) and for five year olds ranged from 94.5% to 100% (CCG average 31.6% to 98.9%). The practice booked the new mum post-natal check for the same time as the baby’s first immunisation appointment to support new parents.
• 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 a contraceptive service.

Updated 29 September 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. All patients over the age of 75 had a named GP and 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 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 29 September 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.
• Ad hoc 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 80.3%, 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 29 September 2016

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

• The practice had identified 1% of their population with enduring mental health conditions on a patient register to enable them to plan and deliver relevant services. 97% of those has an annual review, 97% 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 above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 8.2% above the local CCG average and 7.2% above the national average.
• Nationally reported data showed that outcomes for patients with dementia were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 4.5% above the local CCG average and 5.5% above the national average. 78.6% 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.
• The practice had an in-house counselling service for patients; as part of a local initiative they used the services of trainee counsellors to reduce the waiting time for appointments.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• Staff had undertaken ‘dementia friends’ training and as part of a local initiative the signs in the practice were ‘dementia friendly’ to support accessibility for people with dementia.

Updated 29 September 2016

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

• The practice held a register of patients living in vulnerable circumstances including a register of patients with a learning disability. Patients with learning disabilities had been invited to the practice for an annual health check. 34 patients were on this register, 83% had an annual review (2015/16 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.
• Staff ensured that patients who found it stressful to attend when the practice was busy were seen when the practice was quiet or were offered a separate waiting area.
• The practice were part of the Sunderland Safe Place scheme; this is a scheme for all vulnerable people and not limited to patients at the practice. Vulnerable people can ask for support and advice at any location that is part of the scheme.
• The practice recognised the needs of patients who had been prescribed addictive medication such as benzodiazepines and provided an effective support process that enabled new and existing patients to reduce or stop the use of the these drugs. Over the last five years, eight new patients had signed up for this programme, 63% of these patients completed the programme and ceased taking this medicine. The practice had undertaken work for reduce the number of its patients on these medicines since 2005.
• The practice recognised the specific needs of a wide range of vulnerable patients. They had identified a wider cohort of patients who may be in need of additional monitoring and support but were not part of any formal safeguarding process. These patients were discussed at quarterly meetings attended by the attached staff such as the health visitor. The practice kept records of any actions required and put in place support for these patients when required.
• The practice had also completed a clinical audit of their learning disability register and completed work to improve the care offered to these patients. The first audit in 2013 showed that no patients on the learning disability register had been offered or attended a health check. New processes and procedures were implemented and at the re-audit in 2014, 81% of eligible patients had been offered a health check and 61% had attended. At a third audit in April 2016 the practice were able to show that 83% of eligible patients had attended for a health check, this was an increase of 83% in 3 years.
• 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.