Roseworth Surgery

Updated 18 July 2016

Roseworth Surgery is located in the Gosforth area of Newcastle Upon Tyne and provides care and treatment to approximately 5,131 patients from the Gosforth, Kenton, Fawdon, Wideopen, Seaton Burn, Jesmond, Benton, Longbenton, Killingworth and Kingston Park areas. It is part of the NHS Newcastle Gateshead 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:

Roseworth Surgery, 27-29 Roseworth Avenue, Gosforth, Newcastle Upon Tyne, NE3 1NB.

The practice is located in a converted ex residential detached property. All reception and consultation rooms are fully accessible for patients with mobility issues. The practice does not have a car park but on street parking is available nearby.

The practice is open from 8.30am to 6pm on a Monday, Tuesday, Thursday and Friday (appointments from 8.30am to 5.45pm) and from 7am to 7.45pm on a Wednesday (appointments from 7am to 7.30pm).

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

Roseworth Surgery offers a range of services and clinic appointments including chronic disease management clinics, cervical screening, antenatal care, childhood health surveillance and immunisations. The practice is a teaching and training practice and provides training for medical students and GP trainees (fully qualified doctors with experience of hospital medicine who are training to become a GP).

The practice consists of:

• Three GP partners (two male and one female)
• Two salaried GPs (one male and one female)
• Two practice nurses (both female)
• A health care assistants (female)
• Nine non-clinical members of staff including a practice manager, assistant practice manager/secretary, administration and reception staff

The area in which the practice is located is in the eighth (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 79 (CCG average 77 and national average 79) and for the female population 83 (CCG average 81 and national average 83).

51.2% of the practice population were reported as having a long standing health condition (CCG average 56.9% and national average 54%). Generally a higher percentage can lead to an increased demand for GP services. 59.4% of the practice population were recorded as being in paid work or full time education (CCG average 60.5% and national average 61.5%). Deprivation levels affecting both children and adults were lower than CCG and national averages.

Updated 18 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Roseworth Surgery on 14 April 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 positive. Patients reported that they were treated with compassion, dignity and respect.
• The practice had obtained good National GP Patient Survey results in relation to appointment availability and experience and ease of making an appointment. 93% of patients described their experience of making an appointment as good compared to the CCG average of 75% and the national average of 73%.
• Urgent appointments were usually available on the day they were requested. 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 in response to feedback. For example, comments received via the practice suggestion box had led to a review of the practice search and recall system to ensure patients with comorbidities were invited to one annual review
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved 98.6% of the point’s available (local clinical commissioning group average 96.7% and national average 94.7%)
• 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 with staff and stakeholders.
• Practice staff were aware of, and complied with Duty of Candour requirements.

We saw an area of outstanding practice:

• Patients who lived outside of the practice catchment area but who worked in the area were able to register with the practice.

However there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Ensure that a risk assessment is in place detailing why it has not been felt necessary for all staff to undertake a Disclosure and Barring Service (DBS) check.
• Consider replacing the carpeting in one of the nurse’s consultation rooms with easy to clean flooring.
• Consider ways of more proactively identifying and supporting carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 July 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 which was either six monthly or annually dependent on their condition. 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 review. The practice had identified 22% of their patient population as being over 65 with a comorbidity. A system was in place to follow up on patients who failed to attend review appointments.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to 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 3.4% above the local CCG average and 2.6% above the national average.
• The practice had obtained 100% of the point available to them in respect of chronic obstructive pulmonary disease. This was 3% above the local CCG average and 4% above the national average
• The practice had obtained 100% of the points available to them in respect of hypertension (2.2% above the local CCG average and 2.2% above the national average).
• The practice had obtained 99.7% of the points available to them in respect of diabetes (7.7% above the local CCG average and 10.5% above the national average).

The practice was part of a cluster arrangement with three other local practices. Together they had been successful in obtaining funding for a pilot scheme. This had enabled them to employ a nurse to visit patients with long term conditions at home with a view to helping them avoid unplanned admission to hospital.

Updated 18 July 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.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 96.7% to 98.4% (compared with the CCG range of 94.8% to 97.2%). For five year olds this ranged from 92.2% to 98% (compared to CCG range of 91.4% to 100%).

At 89.1%, 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 higher than the national average of 81.8%.

The practice had developed a young people policy and sent all younger patients a letter on their 16th birthday explaining their services and issues relating to consent.

Pregnant women were able to access antenatal clinics provided by healthcare staff attached to the practice. The practice GPs carried out post-natal mother and baby checks.

The practice offered ‘between practice’ contraceptive services which meant that patients from other practices could access contraceptive services at Roseworth Surgery and vice versa.

Updated 18 July 2016

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

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 97.9% and the England average of 97.9%.

Patients over the age of 75 were offered an annual health review and the practice operated an in house search and recall system to ensure older people were followed up proactively and appropriately.

The practice had a palliative care register and held monthly multi-disciplinary meetings to discuss and plan end of life care.

The practice had identified that they had 87 patients at high risk of admission to hospital and had taken steps to ensure that they had a GP consultation during which comprehensive care plans were drawn up which were then reviewed every six months.

Due to the relatively high number of older patients the practice, together with other practices in their local area, had been successful in obtaining funding from their local clinical commissioning group to provide additional support to their older patients. This resulted in older patients now being able to benefit from social prescribing support from Age UK and another charitable organisations able to offer support with social isolation and poor management of long term conditions and enable older people to live independently in the local community.

The practice had taken steps to ensure that their older patients were offered in-house training on the use of online services such as booking appointments and requesting repeat prescriptions.

Updated 18 July 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 practice is open from 8.30am to 6pm on a Monday, Tuesday, Thursday and Friday (appointments from 8.30am to 5.45pm) and from 7am to 7.45pm on a Wednesday (appointments from 7am to 7.30pm).

The practice offered minor surgery, cervical screening, antenatal care, childhood health surveillance and immunisations and travel immunisation advice. Patients who lived outside of the practices catchment area but who worked in the area were able to register with the practice.

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 appointment confirmation and reminder service was available.

Updated 18 July 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 the maximum point available to them for caring for patients with dementia, depression and mental health conditions. At 83.6% the percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 2.4% below the local CCG and 0.4% below the national averages.

Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as local wellbeing and psychological support services.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

Updated 18 July 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 those with a learning disability. Patients with learning disabilities were able to request longer appointments and were invited to attend the practice for an annual review.

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 had developed a protocol for carers and ensured that any carer they identified was given a carers pack with details of relevant support services.