Westbourne Medical Group

Updated 17 October 2016

Westbourne Medical Group are registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 6,500 patients from two locations:

• Westbourne Medical Group, Kelso Grove, Houghton-le-spring, Sunderland, DH4 4RW
• Branch: Houghton Surgery, Church Street, Houghton Le Spring, DH4 4DN

We visited the main surgery as part of this inspection. The branch surgery is subject to a consultation process to close and at the time of the inspection no clinical services were provided from the branch.

Westbourne Medical Group is a medium 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 fourth most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The average male life expectancy is 78 years, which is one year lower than the England average and the average female life expectancy is 81 years, which is two years lower than the England average.

The percentage of patients reporting with a long-standing health condition is much higher than the national average (practice population is 70% compared to a national average of 54%).

The age demographics of patients in the practice area are similar to the England average.

The practice has one GP partner (female) and a partner practice manager. There are also two salaried GPs (female), a career start GP (female) and a long term locum GPs (female). The practice has two nurse prescribers (female), a practice nurse (female), a healthcare assistant (female), a phlebotomist, six administrative support staff, a modern apprentice, an apprentice healthcare assistant, two work placement students and a domestic staff member.

The practice is open between 7am to 6pm on a Monday and 8am to 6pm Tuesday to Friday. Extended hours surgeries are offered on a Monday between 7am and 8am, and for the young person clinic fortnightly on a Wednesday until 7:30pm.

Appointments are available on a Monday between 7am to 11:30am and 2.30pm and 5pm. From Tuesday to Friday appointments are available between 8.30am to 11.30am and 2.30pm to 5pm. Reception services are available from 7am to 6pm on a Monday and 8.30am - 6.00pm on other working days. The local CCG has commissioned the out of hours provider to provide services to the practice patient list between 6pm to 6:30pm.

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

Updated 17 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westbourne Medical Group on 16 August 2016. Overall, the practice is rated as outstanding.

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.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. They had also increased access to health advice for young people, including sexual health, by delivering a confidential clinic for young people outside normal school and work hours.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example they worked with local support organisations for veterans and people with learning disabilities to help improve patient outcomes. The practice had high levels of commitment and invested time and resource to helping to improve the health of the local community.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice; in particular, we found there was a strong focus within the practice on identifying and improving outcomes for patients who may otherwise be at risk of poor access to primary care or poor health outcomes. For example:

People with learning disabilities

• The practice had identified poorer outcomes were achieved for patients with learning disabilities across the Sunderland area and put an action plan in place to address this. As a result of action taken both the number of identified patients with learning disabilities and the number attending for an annual health check had shown a year on year improvement. The practice put a high value on enabling people with learning disabilities to gain life skills. The practice manager had volunteered their time and delivered cardiopulmonary resuscitation (CPR) and emergency first aid training to two groups of people with learning disabilities, through a local support organisation. The practice had supported young people with learning disabilities or autism to access short and long term work opportunities within the practice. The practice had been designated a safe place for vulnerable people, including people with learning disabilities.

Families, children and young people

• The practice had recently initiated, along with other practices in the locality, an ‘Eat well and let’s be fit’ scheme to tackle childhood obesity. The practice had produced packs which included helpful information, healthy eating sticker charts, lunch bag and water bottle. This initiative was at an early stage, but the practice planned to evaluate it in the future. The practice, along with a neighbouring practice, had worked with local schools and involved children and young people in the development of the pack. To help prevent unplanned pregnancy and to reduce the risk of sexually transmitted disease the practice held a confidential young person’s clinic every week in conjunction with another local practice.

Veterans of the armed forces 

• The practice had taken action to increase the identification of veterans locally, to ensure they had access to appropriate health and support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 October 2016

The practice is rated as outstanding for the care of patients with long-term conditions. There were aspects of the practice which were outstanding and this related to all population groups.

• Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
• 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.
• Patients had regular reviews to check health and medicines needs were being met.
• For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice nurses visited housebound patients with long term conditions to review their health and administer vaccination, such as during the influenza season.

Updated 17 October 2016

The practice is rated as outstanding for the care of families, children and young people. There were aspects of the practice which were outstanding and this related to all population groups.

• The practice had identified the needs of families, children and young people, and put plans in place to meet them.
• 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.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice’s uptake for the cervical screening programme was 83.9%, which was higher than the national average of 81.8% and the CCG average of 81.7%.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
• Data showed high rates of conception to women aged under 18 in the Sunderland area. To prevent unplanned pregnancy and to reduce the risk of sexually transmitted disease t
• The practice had achieved ‘You’re Welcome’ accreditation. Participation in the scheme demonstrates that practices have actively listened and developed a service based around the needs of young people.
• The practice had recently, along with other practices in the locality, initiated an ‘Eat well and let’s be fit’ scheme to tackle childhood obesity. The practice had produced packs which included helpful information, healthy eating sticker charts, lunch bag and water bottle. This initiative was at an early stage, but the practice planned to evaluate it in the future. The practice, along with a neighbouring practice, had worked with local schools and involved children and young people in the development of the pack.

Updated 17 October 2016

The practice is rated as outstanding for the care of older people. There were aspects of the practice which were outstanding and this related to all population groups.

• 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. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.
• The practice was part of the local vanguard scheme to support vulnerable and frail older people to keep well and healthy, by care planning and regular visits by GPs and nurses into the community. As part of this project the lead GP from the practice had spent time in local care homes, and had used the opportunity to train and upskill care staff.

Updated 17 October 2016

The practice is rated as outstanding for the care of working age people (including those recently retired and students). There were aspects of the practice which were outstanding and this related to all population groups.

• 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 a Monday between 7am and 8am, and for the young person clinic fortnightly on a Wednesday until 7.30pm for working patients who could not attend during normal opening hours.
• 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. The practice was a designated Yellow Fever Vaccination Centres and offered this vaccine to anyone who wishes to access this service, including patients from other practices.
• The practice provided medical services to a people working on a local film production.

Updated 17 October 2016

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). There were aspects of the practice which were outstanding and this related to all population groups.

• 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.
• 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.
• 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.
• 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.

Updated 17 October 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. There were aspects of the practice which were outstanding and this related to all population groups.

• The practice held a register of patients living in vulnerable circumstances, including those with a learning disability.
• The practice was a designated safe haven for vulnerable people, including people with learning disabilities.
• The practice had taken action to increase the identification of veterans locally, to ensure they had access to appropriate health and support.
• The practice put a high value on enabling people with learning disabilities to gain life skills. The practice manager had volunteered her time and delivered cardiopulmonary resuscitation (CPR) and emergency first aid training to two groups of people with learning disabilities, through a local support organisation. The practice had supported young people with learning disabilities or autism to access short and long term work opportunities within the practice.
• 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.
• Improved 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.