Chadwick Practice

Updated 8 March 2017

Chadwick Practice, One Life Hartlepool, Park Road, Hartlepool, TS24 7PW. The practice is based in The One Life Centre close to Hartlepool Town centre. It is based in a purpose built centre providing other general practices and health care services. The practice is based on the ground floor of the premise. There is parking available near the practice. Many of the patients live within walking distance of the practice and there is good access to public transport.

The practice hold a General Medical Service (GMS) contract providing services to the practice population of 11,435. The practice scored two 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.

The proportion of the practice population in the 65 years and over age group is above the England average. The practice population in the under 18 age group is comparable to the England average.

There are five GPs, four of whom are partners and one is a salaried GP, three male and two female. There is one nurse practitioner who is the nurse manager and three practice nurses, two of who are nurse prescribers. There is also one health care assistant (HCA). There are two practice managers who are supported by a team of administration and reception staff. The practice also employs a pharmacist.

The practice is open from 7.30am to 6pm, Monday to Friday. The practice provides some extended hours on a Saturday morning between 8am and 10.30am. 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 hours service provided by Northern Doctors via the NHS 111 service.

Updated 8 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chadwick Practice on 29 September 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.

• 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.
• 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. The practice promoted a no blame culture and encouraged staff to raise concerns and possible risks.
• 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.

• 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.
• 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.

We saw areas of outstanding practice

The practice had developed a range of in-house information and education leaflets, a number of which were easy read and pictorial. For example they had developed an A4 brochure giving patient information about the blood taking procedure. It was an easy read brochure which also contained photographs of the procedure and gave patient clear explanations of what to expect though each part of the procedure.

The practice provided a ‘drop in’ clinic for patients who needed blood tests. This allowed for flexibility and good access for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 March 2017

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.

• 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 88%. This was 5% above the local CCG average and 8% 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. 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 promoted self-management for some long term conditions.

• The practice loans out TENS machines to help patients with their pain management.

• The practice had robust systems for monitoring patients on anticoagulation medicine, NOACs and disease-modifying anti-rheumatic drugs (DMARDs). DMARDS are used in the treatment of rheumatoid arthritis and require regular monitoring and review of the patients.

The practice has dedicated clinics for patients with long-term conditions lead by the nurse practitioner.  There is an annual review system that ties in with the patient’s medicines reviews.

Updated 8 March 2017

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.

• The practice held clinical meetings attended by the practice leads and clinicians where they reviewed child safeguarding and discussed those children who did not attend pre-booked hospital appointments, GP or immunisation appointments.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 94%. This was above the local CCG average which was 83% and the England average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

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

• One of the registered nurses was a trained paediatric nurse practitioner.

• Young people were able to access contraception and screening for sexually transmitted diseases (STD).

• The practice provided easy access for temporary residents, such as university students.

Updated 8 March 2017

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 over the age of 75 had a named GP and nurse led annual reviews.

• The practice offered 20 minute appointments.

• Regular patient summaries were supplied to the nursing homes to aid the GP visits and urgent care as part of the avoiding unplanned admissions.

• 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 registered patients in twelve nursing homes that were visited on a two weekly basis. The practice had completed care plans for those patients who needed them.

• The practice had identified and reviewed the care of those patients at highest risk of admission to hospital. These 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 had a number of initiatives in place for care to their older patients. An example included the provision of a frailty register for patients 75 years of age and over.

• The practice had employed a part-time pharmacist to help clinicians with poly-pharmacy. Polypharmacy is the use of four or more medications by a patient, generally in patients over 65 years.

Updated 8 March 2017

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 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.

• The practice provided Saturday morning appointments.

• There was a minor ailments clinic which was a daily clinic held until 6pm.

Updated 8 March 2017

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 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 90%. This was slightly below the local CCG average of 93% and slightly above the England 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.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• One mental health organisation visited the practice twice per week and was available to any patients who needed support or advice.

• 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 who shared care with mental health services were monitored regularly in the practice. Those patients with complex problems were reviewed regularly at multi-disciplinary meetings held in the practice.

• Staff had a good understanding of how to support patients with mental health needs and dementia and the practice had ‘Dementia Friendly’ status.

Updated 8 March 2017

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 drug and alcohol and learning disability were there were same day appointments available for those in crisis.

• The practice offered longer appointments for patients with a learning disability. Annual reviews for this group were monitored by the practice. Following low numbers previously the practice had now appointed two named GPs to lead in this area.

• 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 kept a register of patients who had been coded as having suffered from or at risk of female genital mutilation (FGM).  All GPs have completed training regarding females at risk of FGM and patient’s records were reviewed each month.

• The practice also provided the practice address for patients who were homeless.