Dr. Joseph, Dr. Herbert & Dr. Devlin Also known as Villette Surgery

Updated 27 September 2016

Dr Brigham and Dr Joseph provide care and treatment to approximately 5714 patients predominantly from the Hendon, Grangetown and Tunstall Hill areas of Sunderland, Tyne and Wear. The practice is part of the NHS Sunderland Clinical Commissioning Group (CCG) and operates on a Personal Medical Services (PMS) contract.

The practice provides services from the following address, which we visited during this inspection:

Villette Surgery

Suffolk Street

Hendon

Sunderland

SR2 8AX

The surgery is located in purpose-built accommodation which opened in 1985 and was extended in 2011. All reception and consultation rooms are on the ground floor and fully accessible for patients with mobility issues. An on-site car park is available which includes dedicated disabled car parking spaces.

The surgery is open from 8am to 6pm on a Monday, Tuesday, Wednesday and Friday (appointments from 8am to 12 midday then 2.30pm to 5.30pm) and from 8am to 5pm on a Thursday (appointments from 8am to 12 midday and 2.30pm to 5pm). Patients registered with the practice are also able to access GP appointments at the local extended hours facility in a nearby health centre from 6pm to 8am weekdays and from 9am to 2pm on a Saturday and Sunday.

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

Villette Surgery offers a range of services and clinic appointments including contraception advice, travel clinic, anti-coagulation clinic, childhood immunisation service and long term condition reviews.

The practice consists of:

• Three GP partners (two male and one female)
• One salaried GP (female)
• One career start GP (male)
• One practice nurses (female)
• One health care assistant (female)
• One pharmacist
• Nine non-clinical members of staff including a practice manager, assistant practice manager, a computer co-ordinator and a team of receptionists

The area in which the practice is located is in the third (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The average life expectancy for the male practice population is 76 (CCG average 77 and national average 79) and for the female population 81 (CCG average 81 and national average 83).

53.4% of the practice population were reported as having a long standing health condition (CCG average 59.7% and national average 54%). Generally a higher percentage can lead to an increased demand for GP services. 45.5% of the practice population were recorded as being in paid work or full time education (CCG average 55.5% and national average 61.5%). Deprivation levels affecting children and older people were much lower than the local CCG and national averages.

Updated 27 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Brigham and Dr Joseph on 18 August 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 to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• Feedback from patients about their care was consistently positive. Patients reported that they were treated with compassion, dignity and respect. Patient feedback in relation to access was comparable with local clinical commissioning group and national averages.
• Patients were able to access same day appointments. Pre-bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice had proactively sought feedback from patients and had an active patient participation group. The practice implemented suggestions for improvement and made changes to the way they delivered services in response to feedback.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved an overall result which was higher than local and national averages.
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 September 2016

The practice is rated as good for the care of people with long term conditions.

Longer appointments and home visits were available when needed. The practice’s computer 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 with multiple long term conditions were offered an annual comorbidity (multiple condition) review when possible.

The QOF data (2014/15) showed the practice had achieved some good outcomes in relation to most of the conditions commonly associated with this population group. For example:

• The practice had obtained 100% of the points available to them for providing 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 had obtained 100% of the points available to them in respect of hypertension (0.5% above the local CCG average and 2.2% above the national average).

However, the practice had scored below local and national averages for other conditions, including, for example:

• 91.7% for chronic kidney disease (4.1% below CCG and 3% below national averages)
• 92.0% for peripheral arterial disease (6% below CCG and 4.7% below national averages)
• 94.0% for rheumatoid arthritis (3.7% below CCG and 1.4% below national averages)

Patients with certain long term conditions such as asthma, chronic obstructive pulmonary disease and diabetes were supported in the self-management of their condition with the provision of comprehensive, individualised care plans.

Updated 27 September 2016

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

The practice had identified the needs of families, children and young people, and put plans in place to meet them. 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. This included children who had failed to attend hospital appointments.

Appointments were available outside of school hours and the premises were suitable for children and babies. A system was in place to ensure childhood emergencies were seen the same day. Patients registered with the practice were able to access GP appointments at a local extended hours facility as part of a GP alliance initiative. This operated from 6pm to 8am on weekdays and from 9am to 2pm on weekends.

Data available for 2014/15 showed that the practice childhood immunisation rates for the vaccinations given to two year olds ranged from 96.7% to 100% (compared with the CCG range of 96.2% to 98.9%). For five year olds this was a consistent 100% (compared to CCG range of 31.6% to 98.9%)

At 83%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was slightly higher than the CCG and national averages of 82%.

Pregnant women were able to access a full range of antenatal and post-natal services at the practice. The practice GPs carried out post-natal mother and baby checks.

Updated 27 September 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data for 2014/15 showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 95.6% of the points available to them for providing recommended care and treatment for patients with heart failure. This was comparable with the local clinical commissioning group (CCG) average of 95.7% and the England average of 94.7%.

The practice was participating in an enhanced service to reduce unplanned admissions to hospital and all clinical staff had received training in developing fully comprehensive emergency health care plans.

The practice was also participating in a local GP alliance initiative to ensure their patients had access to GP care at a local health centre when the surgery was closed. This operated from 6pm to 8am on weekdays and from 9am to 2pm on weekends

The practice had identified that 23% of their patient list was over the age of 65. Older people were offered vaccinations against influenza, pneumonia and shingles and were opportunistically screened for dementia and referred to a memory clinic if appropriate.

The practice was participating in a care home alignment project. The intention was that they would be allocated a main or link care home for whom they would provide care and support. This would be achieved by delivering a ward round approach and visiting the home on a regular basis.

Updated 27 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 met. The surgery was open from 8am to 6pm on a Monday, Tuesday, Wednesday and Friday (appointments from 8am to 12 midday and 2.30pm to 5.30pm) and from 8am to 5pm on a Thursday (appointments from 8am to 12 midday and 2.30pm to 5pm). Patients registered with the practice are also able to access GP appointments at the local extended hour’s facility at a nearby health centre from 6pm to 8am weekdays and from 9am to 2pm on a Saturday and Sunday.

The practice offered contraception services, travel advice, an anti-coagulation clinic, childhood immunisation service, sexual health advice and long term condition reviews. They also offered new patient and NHS health checks (for patients aged 40-74).

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. A text messaging service was available which was used to remind patients of their appointments. Pre-bookable telephone consultations were available.

Updated 27 September 2016

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

Nationally reported QOF data for 2014/15 showed the practice had achieved below local CCG and national averages for caring for patients with dementia, depression and mental health conditions:

• The practice had obtained 91.2% for dementia (CCG average 95.5% and national average 94.5%)
• The practice had obtained 92.6% for depression (CCG average 95.7% and national average 92.9%)
• Then practice had obtained 79.9% for mental heath indicators (CCG average 91.8% and national average 92.8%)

Practice management explained that they felt this had been due to only having one practice nurse who had been on sick leave for a period of time so they had been unable to carry out annual reviews of patients with these conditions. They had therefore appointed an additional practice nurse/nurse practitioner who was due to commence employment with the practice in September 2016 to prevent recurrence of this problem.

Patients experiencing poor mental health were signposted to various support groups and third sector organisations, such as local wellbeing and psychological support services. The practice patient participation group had arranged and hosted a dementia open day which had been attended by the local carers association and dementia support agencies.

Patients were opportunistically screened for dementia and referred to the local memory service when appropriate

The practice was participating in a local CCG initiative to ensure patients who were intentionally self-harming were allocated a designated GP to ensure they were well supported and closely monitored.

Updated 27 September 2016

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

The practice held a register of patients living in vulnerable circumstances, including 52 patients who had a learning disability. Longer appointments were available for patients with a learning disability, who were also offered an annual health check and flu immunisation which were undertaken during a home visit if necessary.

The practice had established 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.

The practice identified carers and ensured they were offered appropriate advice and support and an annual health check and flu vaccination.

Patients known to have experienced bereavement were sent a condolence card and sign posted to appropriate support services.