Pallion Family Practice

Updated 21 December 2017

Pallion Family Practice is registered with the Care Quality Commission (CQC) to provide primary care services. It is located in the Pallion area of Sunderland.

The practice provides services to around 10,100 patients from one location: Pallion Health Centre, Hylton Road, Sunderland, Tyne and Wear, SR4 7XF. We visited this address as part of the inspection. The practice has two GP partners (both male), three salaried GPs (all female), three nurse practitioners (two female and one male) and three practice nurses (all female), one career start practice nurse (female), two healthcare assistants, a practice manager, deputy manager, IT manager, office manager and nine staff who carry out reception and administrative duties.

Due to the retirement of one of the former partners, the partnership arrangements in the practice were different to those registered with CQC. The practice is in the process of registering the new partnership.

The practice is part of Sunderland clinical commissioning group (CCG). The age profile of the practice population is broadly in line with local CCG and national averages. Information taken from Public Health England placed the area in which the practice is located in the third more deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The practice is located in a purpose built two-storey building. All patient facilities are on the first floor. There is on-site parking, disabled parking, a lift, a disabled WC, wheelchair and step-free access.

Opening hours are between 8am and 6pm Monday to Friday. Patients can book appointments in person, on-line or by telephone. There is an open access clinic every morning between 8am and 10am. Pre-bookable appointments are available from 1pm to 3.45pm, then from 4pm to 5.30pm.

A duty doctor is available each afternoon until 6pm. The service for patients requiring urgent medical attention out of hours (after 6pm) is provided by the NHS 111 service and Vocare, which is also known locally as Northern Doctors Urgent Care Limited.

The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

Updated 21 December 2017

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pallion Family Practice on 20 September 2016. The overall rating for the practice was good, although the practice was rated as requires improvement for providing well-led services. We issued a requirement notice with respect to Regulation 17 on Good Governance because we found that processes were not in place to assess, monitor and improve the quality of service provided in carrying out the regulated activities for which the practice is registered. The full comprehensive report for the September 2016 inspection can be found by selecting the ‘all reports’ link for Pallion Family Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 November 2017 to review in detail the actions taken by the practice to improve the quality of care. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

The practice is now rated as good for providing well-led services, and overall the practice is rated as good.

Our key findings at this inspection were as follows:

• The practice had implemented an action plan to address most of the issues identified during the previous inspection.
• Appropriate arrangements were now in place to record and investigate significant events.
• Appropriate arrangements were now in place to ensure all relevant staff were aware of patient safety alerts.
• The practice had improved their approach to clinical audit; however, further improvements should still be made.
• Appropriate arrangements were now in place to record and monitor staff training.

At our previous inspection on 20 September 2016, we also told the provider that they should make improvements in other areas that included recruitment checks, complaints and appointment management. We saw at this inspection that improvements had been made:

• The practice had a process in place to ensure relevant recruitment checks were carried out and recorded. Records we checked confirmed that improvements had been made.
• Appropriate arrangements were now in place to record verbal complaints. When the practice responded to complaints with a letter this now included advice on what to do if the complainant was unhappy with the practice’s response.
• The practice had reviewed their appointment system to ensure its structure met the needs of the patient population. The patient participation group had supported the changes made and we saw that since changes had been made there had been a 14% reduction in the number of appointments where patients did not attend.

At this inspection, we found that there were some areas of practice where the provider still needed to make improvements. We also found that the practice’s registration with CQC was not up to date.

Therefore the provider should:

• Complete the process for the registration of the partnership with the Care Quality Commission.
• Continue to improve the arrangements for clinical audit. Clinical audit should be clearly linked to patient outcomes, monitored for effectiveness and comprise of two cycles to monitor improvements to patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 November 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
• Longer appointments and home visits were available when needed. The practice’s electronic 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 had regular reviews to check with health and medicines needs were being met.
• For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice was keen to promote self-help to patients; the practice website had a comprehensive set of guides and links to support organisations.
• Performance for diabetes related indicators was lower than the national average (86.5% compared to 89.2% nationally). However, performance in some sub-categories was above average. For example, the percentage of patients with diabetes, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 88.8%, compared to the national average of 80.5%.
• Overall performance for asthma related indicators was better than the national average (99.3% compared to 97.4% nationally). However, performance in some sub-categories was below average. For example, the percentage of patients with asthma who had had an asthma review in the preceding 12 months that included an assessment of asthma control using the 3 RCP questions was 69.6%, compared to the national average of 75.3%.

Updated 10 November 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 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.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice’s uptake for the cervical screening programme was 78.9%, which was slightly below the CCG average of 81.6% and the national average of 81.8%.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 10 November 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. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.
• A palliative care audit had been undertaken to determine the proportion of patients on the palliative care register (the practice benchmarked themselves against the national target of 1%); the initial audit in 2015 showed that 0.5% of the practice population were on the palliative care register. A review was undertaken and changes implemented, including nominating a member of staff to lead on co-ordinating the register. A further audit carried out in 2016 showed that the list size remained the same at 0.5% of the population.

Updated 10 November 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 and flexible. Although the practice did not have any extended opening hours; patients were able to access a GP at a local health centre between 6pm and 8pm Monday to Friday, and on Saturday mornings.

• The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.

• Additional services were provided such as health checks for the over 40s and travel vaccinations.

Updated 10 November 2016

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

• The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
• Staff had been trained as dementia friends to help support patients and their carers and families.
• Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
• The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.

Updated 10 November 2016

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, including those with a learning disability.
• Patients with learning disabilities were invited to attend the practice for annual health checks and were offered longer appointments, if required.
• The practice engaged with a group of patients with learning disabilities to carry out a ‘health quality check’ of the practice. A team of health quality checkers visited the practice, looked at the premises and spoke with staff. They provided a report on their findings. The report was positive but also made some suggestions, including changing the layout of the chairs in the waiting room. All actions were immediately undertaken.
• The practice had 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.
• Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check and referred for a carer’s assessment.