Marlborough Surgery

Updated 8 April 2016

Marlborough Surgery provides general medical services (GMS) to approximately 10,200 patients in the catchment area of Seaham and surrounding villages. The practice is located within a purpose built primary care centre. This is the Durham Dales, Easington and Sedgefield Clinical Commissioning Group (CCG) area. The practice team consists of five partner GPs, two salaried GPs, two nurse practitioners, two practice nurses, and two healthcare assistants. These are supported by a practice manager, and a team of reception, and administrative staff. The practice is a training practice and provides placements to one GP registrar. These are fully trained hospital Doctors who spend an additional three years training to become primary care GP’s.

The practice core hours are between 8am and 6pm on Mondays to Fridays. Additional extended hours are available between 8am and 12pm on Saturdays, and from 6pm until 8:30pm on Mondays. All patients living in the area can access the Saturday morning appointments on a walk-in basis through agreement with the CCG. Recently in response to patient demand the practice offered additional appointments with health care assistants and GPs from 7:30am on Thursday.

The practice has higher levels of deprivation compared to the England average. There are higher levels of people with daily health problems, and claiming disability living allowance. The practice has opted out of providing Out of Hours services, which patients access via the 111 service. The practice is part of the South Durham Health CIC federation.

Updated 8 April 2016

Letter from the Chief Inspector of General Practice

We carried out this comprehensive inspection on 16 February 2016.

Overall, we rated this practice as good.

Our key findings were as follows:

• The practice provided a good standard of care, led by current best practice guidelines. A programme of clinical audit was used to identify where patient outcomes could be improved.
• Staff understood and fulfilled their responsibilities to raise concerns. Information about safety was monitored, appropriately reviewed and addressed.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• The practice had comprehensive policies and procedures to govern activity, which were reviewed regularly.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice was proactive in the promotion of good health and management of long term conditions. Staff communicated within multi-disciplinary teams to manage complex conditions.
• There was a clear leadership structure and staff felt supported by management. Staff felt confident in their roles and responsibilities.
• The practice worked with the Patient Participation Group (PPG) to listen to feedback and instigate change.

We saw one area of outstanding practice:

• The practice had invested in a blood pressure machine and scales in reception for patients to use, with instructions, or support from staff. This could either opportunistically identify areas for concern, or patients attending for long term condition reviews could collect these results before their appointment, leaving more time to discuss their condition once they were with a member of clinical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 April 2016

The practice is rated as good for the care of people with long term conditions. Staff implemented clinics to minimise patient need for attendance, for instance patients with multiple conditions. Staff ensured through joint working that housebound patients had the same access to reviews through home visits.

Staff skill mix had been reviewed and was mapped to patient need. Lead clinicians had been identified for all the major chronic disease areas, such as asthma and diabetes. Practice nurses and GPs worked collaboratively to implement annual chronic disease reviews. Patients with long term conditions were monitored and discussed at multi-disciplinary clinical meetings so the practice was able to respond to their changing needs. Non- attendance at clinics was followed up, and reminders issued. Outcomes were monitored through clinical audits. Data showed the practice was proactive in managing long term conditions. Diabetes indicators were all above national averages. For instance QOF data from 2014-15 showed the percentage of diabetic patients having a record of a foot check in the previous 12 months was 90.94%, above the national average of 88.3%.

Updated 8 April 2016

The practice is rated as good for the care of families, children and young people. Systems were in place to identify children who may be at risk. The practice monitored levels of children’s vaccinations and attendances at A&E. Regular multidisciplinary meetings were held to review children on the safeguarding register. Immunisation rates were around average for all standard childhood immunisations. Weekly Baby Clinics were run at the surgery by the local health visitor, along with the GP lead. These were combined with nurse-led Childhood Immunisation clinics, to minimise the need to attend multiple appointments at the practice. The under-five’s had protected appointment slots with same day access to a GP. Young people could access family planning and sexual health advice. In the school holidays the practice provided an additional asthma annual review clinic so that school age children could attend without missing school.

Updated 8 April 2016

The practice is rated as good for the care of older people. The practice held palliative care and multi-disciplinary meetings regularly to discuss those with chronic conditions or approaching end of life care. Information was shared with other services, such as out of hours services and district nurses. Nationally returned data from the Quality and Outcomes Framework (QOF) showed the practice had good outcomes for conditions commonly found in older people.

The practice participated in the local Admission Avoidance service, where vulnerable patients living in care homes, housebound or at high risk of admission were cared for by a GP in conjunction with Advanced Nurse Practitioners. These patients were monitored and visited, ensuring assessments and care plans were in place when required. All care home patients were reviewed annually by their named GP, which included dementia and mental health reviews, and medication reviews. Housebound patients received care reviews at home from the practice nurses.

Updated 8 April 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 population had been identified, and services adjusted and reviewed accordingly, for instance extended hours appointments were available later in one evening and earlier one morning. Patients could also access a Saturday morning surgery. Patients could access a variety of services during these times, such as NHS health checks and contraceptive services. Routine appointments could be booked in advance, or made online. Repeat prescriptions could be ordered online. Electronic prescribing meant prescriptions could be sent electronically to a pharmacy of choice, which could be out of the area, for example close to where the patient worked, which made it more convenient to collect medication.

Telephone appointments were available. An on-call duty doctor system meant urgent calls could be triaged, and the patient either given telephone advice, or allocated a same day appointment. The practice carried out NHS health checks for people of working age, and actively promoted screening programmes such as for cervical cancer. 

Updated 8 April 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice made referrals to and worked with other local mental health services as required.

Patients with mental health issues or dementia were coded on their records so they could be offered extra support to access services and health checks. These patients were offered an annual review. The GP mental health lead followed up patients who did not respond to their appointment invites. The practice was proactive in dementia screening and review for at risk patients.

The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the previous 12 months was above the national average of 88.47%, at 100%.

Updated 8 April 2016

The practice is rated as good for the care of people living in vulnerable circumstances. The practice had a register of those who may be vulnerable, including those with learning disabilities, who were offered annual health checks. New patients who may be vulnerable were identified through health checks and screening questionnaires. The practice offered permanent or temporary registration for patients from women’s refuge and sheltered housing services.

Patients or their carers were able to request longer appointments if needed. The practice had a register for looked after or otherwise vulnerable children and also discussed regularly any cases where there was potential risk or where people may become vulnerable. The computerised patient plans were used to flag up issues where a patient may be vulnerable or require extra support, for instance if they were a carer. Carers could then be signposted to support organisations. Staff were aware of their responsibilities in reporting and documenting safeguarding concerns. Vulnerable patients were discussed at quarterly safeguarding meetings or fortnightly clinical meetings according to need.