Alma Medical Centre

Updated 19 September 2016

Alma Medical Practice is located in Stockton-on-Tees, Cleveland. The practice is located within easy reach of the town centre and occupies a modern purpose built building. There are 10,612 patients registered with the practice. Parking is available on–site and on roads surrounding the practice. Disabled facilities are provided.

The practice is part of NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group and provides services under a General Medical Services contract with NHS England.

There are six GPs working at the practice, three male and three female. Five are partners and the other is a salaried GP. There are two permanent practice nurses and one providing temporary cover, and one health care assistant. The practice nurses are part-time and the health care assistant is full-time. There is a full-time practice manager and a team of administrative staff, including a part-time pharmacist. The practice also offers services to students based at the Queens campus of the University of Durham. This includes three lunchtime clinics per week, outside of lectures during term time, as well as access to all services within the practice.

The practice opening times are Monday to Friday 8.30 to 6pm. The practice appointment times are:

Monday to Friday 8.30am to 10.30am open access and 2pm to 5.20pm for general appointments.

Saturday morning surgeries have been suspended due to GP shortages, but will be reintroduced once a new GP partner has been recruited.

Patients requiring a GP outside of normal working hours are advised to call 111 and thereby access the out of hours service provided by Vocare.

Updated 19 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Alma Medical Practice on 13 July 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, chaperone training for the nurses and health care assistant was yet to be arranged.
• 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.
• 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.
• 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.

The areas where the provider should make improvement are:

• Provide appropriate staff with chaperone training.
• Review how patients who are also carers are identified to ensure they receive appropriate support.
• Review the implementation of a patient participation group to improve feedback from patients on how services are delivered.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 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.
• Performance for diabetes related indicators was better than the national 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 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.
• There was an emphasis on educating and informing patients about how to look after themselves in order to maintain good health.
• Regular palliative care meetings were held to discuss patients with cancer and long term chronic conditions.

Updated 19 September 2016

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

• Immunisation rates were comparable to CCG and national averages for all standard childhood immunisations.

• 84% of patients with asthma, on the practice register, had had an asthma review in the preceding 12 months that included an assessment of asthma control using the 3 routine clinical practice (RCP) questions. This compared to a national average of 75%.
• 76% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compared to a national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There was a dedicated child and adult safeguarding lead. Safeguarding training had been provided for practice staff.
• Childhood immunisations were undertaken and strongly encouraged by GPs when carrying out six-week checks on babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 19 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 its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Care plans and health checks were in place, with regular medicine reviews carried out.
• The building was accessible for patients who may have mobility problems.
• Patients with complex needs were discussed at multi-disciplinary team meetings, to ensure their needs were met.
• Referrals to other services were regularly made, for example, district nursing or the community matron service.
• The practice identified carers and offered services such as health checks and annual flu vaccinations.
• The practice introduced a named GP service for five nursing homes where it was felt regular GP input would be most beneficial. This had resulted in excellent relationships being developed with the respective care teams, promoting continuity of care and a single point of contact for all prescribing and management decisions. The practice showed that this had resulted in an increase of patients to their list from within these homes and as such, gave them an increased proportion of patients in care beyond the CCG average.

Updated 19 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. The practice provided healthcare for the University of Durham Queens campus, meaning they took an active role in the health of the local student population.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Practice nurse and health care assistant appointments were available from 9am, with a limited number of emergency appointments available on a daily basis.
• Routine GP appointments were available to pre-book from 8.30am.
• NHS health checks were routinely encouraged.
• The practice was open from 8.30am to 6pm, with telephone lines opening at 8pm. This meant patients could collect prescriptions or book appointments during their lunch hour.

Updated 19 September 2016

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

• 92% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is higher than the CCG averge of 87% and the national average of 84%.
• 96% of patients with schizophrenia, bipolar effective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This is comparable to the CCG average of 94% and higher than the national average of 88%. 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 advance care planning for patients with dementia. This included a dedicated practice nurse who was actively engaged in providing services such as an annual review of these patients and liaison with the lead GP to review medication and discuss other health concerns.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice provided a room once a week for a community psychiatric nurse. This meant that having this service on-site provided additional communication routes to discuss referrals with team members in advance, for the benefit of GPs and the patient.
• 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.

Updated 19 September 2016

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

• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.