Tennant Street Medical Practice

Updated 18 November 2016

Tennant Street Medical Practice, Farrer Street, Stockton On Tees, Cleveland and is located near the centre of Stockton. The practice is housed in a purpose built medical centre and has recently been extended and totally refurbished. There is limited parking with a nearby public car park available. Many of the patients live within walking distance of the practice and there is access to public transport. There are 13642 patients on the practice list. The practice scored three on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

There are eight GP partners four female and four male. There are four practice nurses, a long term conditions nurse and a nurse practitioner. There are also two heath care assistants HCAs on of who is undertaking her nurse training. There is a practice manager, departmental leads and administrative staff.

The practice is open from 8am to 6pm, Monday to Friday. The practice provides extended hours on a Tuesday from 6.30pm to 8pm. Appointments can be booked by walking into the practice, by the telephone and on line. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Northern Doctors via the NHS 111 service. The practice holds a General Medical Service (GMS) contract.

Updated 18 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tennant Street Medical Practice on 11 October 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. All opportunities for learning from internal and external incidents were maximised.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice promoted a no blame culture and encouraged staff to raise concerns and possible risks.

• 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. Improvements were made to the quality of care as a result of complaints and concerns. When a complaint related to any aspect of clinical work it was discussed at the multi-disciplinary significant event meeting.

• 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 and pre bookable appointments available in two to three days. The GP partners held a personal patient list, which meant whenever possible the GPs saw their own patients. The exception would be when a GP was on annual leave. When the named GP was not available another GP provided buddy cover. These meant as far as possible the patients were seen by their named GPs or the buddy even when requesting an emergency appointment.

• Feedback from patients about their care was consistently positive.

• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had been extended and refurbished in 2015.

• 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. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).

We saw one area of outstanding practice:

The practice had recently liaised with Public Health to organise a promotional event in all local community areas to promote the Lung Health check. The practice had identified a high incidence lung disease in their practice population and reluctance of patients to change their life styles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 November 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. A chronic disease nurse lead was employed by the practice. There was a joint approach in managing these patients with community matrons and district nurses.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 86%. This was 3% above the local CCG average and 6% above the England average.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicine needs were being met.

• The practice promoted self-management for some long term conditions.

• The practice was involved in the healthy lung and healthy heart checks. The practice had recently liaised with Public Health to organise a promotional event in all local community areas to promote the Lung Health check. The practice had identified a high incidence lung disease in their practice population and reluctance of patients to change their life styles.

• The practice provided facilities for in-house external agency workers, for example the Stockton Navigation service and a Pathways Advisory Service. These services provide patients with services to improve their health and wellbeing by supporting them to access activities, services, return to work and further studies.

• GPs within the practice actively promoted referral to the Diabetes walking groups and Cycling for Health and had a pre-diabetes management process in place.

Updated 18 November 2016

The practice is rated as good for the care of families, children and young people.

• 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.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 84% compared to the local CCG average of 83% and national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. There was a dedicated room for breastfeeding and baby changing facilities.

• We saw positive examples of joint working with multidisciplinary teams, health visitors and school nurses.

• Young people were able to access contraception and screening for sexually transmitted diseases (STDs). There was a walk in family planning service on Mondays.

• The practice offered ten day and six week post-delivery checks for mothers and babies. Mothers were also screened for depression and this was regularly monitored and reviewed using audit.

Updated 18 November 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.

• Patients who had not been seen by the practice in the previous twelve months were contacted to check on their wellbeing.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had identified and reviewed the care of those patients at highest risk of admission to hospital. Those patients who had an unplanned admission or presented at Accident and Emergency (A&E) had their care plan reviewed and patients were contacted within three days of hospital discharge. All discharges were reviewed to identify areas for improvement. The practice worked closely with the community matrons to prevent unnecessary admissions.

• The practice offered extended appointments for older people.

The practice were part of a local initiative supported by the local federation to host Care Co-ordinators within the practice. The Care Co-ordinator followed up on the patients who already had care plans and visited them in their homes. They provided non-clinical support, advice on local support groups, did shopping, provided some company and any other support they could offer to provide the patients with a more holistic and personalised service.

Updated 18 November 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 had late appointments available on a Tuesday evening and telephone consultations were available.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 18 November 2016

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

• Nationally reported data from 2014/2015 showed 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the previous 12 months, which was 4% above the CCG average and 6% above the national average.

• Nationally reported data showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 96%, which was 3% above the CCG average and 8% above the national average.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advanced 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.

• Patients on medicines requiring regular monitoring and where the practice shared their care with mental health services were monitored regularly.

• The practice hosted counselling and Cognitive Behavioural Therapies (CBT) which was a talking therapy that could help manage problems by changing the way people thought and behaved.

Updated 18 November 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 and provided a supportive and non-judgemental approach. Examples of these patient groups were people with drug and alcohol problems and those living with a learning disability. There were same day appointments available for those in crisis. Where required the practice signposted patients to citizen’s advice and ‘lifeline’ for drug and alcohol support. A bi-monthly in-house service with a drug and alcohol specialist was available in the practice. The service was both drop-in and appointment based.

• The practice offered longer appointments for patients with a learning disability. Annual reviews for this group were monitored by the practice.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. 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.

• The practice held Gold Standards Framework (GSF) palliative care meetings every four weeks to discuss and agree care plans. This was a way of working that had been adopted locally. It involved the practice working together as a team and with other professionals in hospitals, hospices and specialist teams to provide the highest standard of care possible for patients and their families.