Zetland Medical Practice

Updated 16 February 2017

Zetland Medical Practice, Windy Hill Lane, Marske-by-the-Sea, Redcar, Cleveland, TS11 7BL. There is a large free public car park available opposite the practice. The practice is in a purpose built building with disabled access and consulting and treatments rooms available on the ground floor. There is one branch practice, 2 Windsor Road, Saltburn-by-Sea, TS12 1BH4RA. This site was not visited during the inspection. Both of the premises were on long-term leases.

The practice has a Primary Medical Services contract with NHS England, South Tees Clinical Commissioning Group (CCG). The total practice patient population is 5,058 covering patients of all ages. They also provide some Directed Enhanced Services, for example they offer minor surgery, acupuncture and the childhood vaccination and immunisation scheme. The practice is a training practice and teaches third and fifth year medical students.

The practice has held contracts to deliver GP services at two local prisons, a specialist Asylum Seeker and Refugee Practice and Specialist Drug and Alcohol services. They currently hold a contract to deliver GP services to patients in a Secure Mental Health Unit at the local NHS Mental Health Trust.

The proportion of the practice population in the 65 years and over age group is higher than the England average. The practice scored seven 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 staff team comprises six GP partners (three female and three male). The is also a salaried GP and as the practice is a teaching practice there was also two GP registrars. There are two practice nurses and two healthcare assistants. The practice is managed and supported by a two practice manager, administration, secretarial and reception staff. In total there are 16 staff, in addition to the GPs.

The practice reception is open Monday to Friday 8am until 6pm (excluding bank holidays), with appointment being available between 8.30am and 11.30am, 3.30pm and 5.30pm with extended hours on a Wednesday between 6.30pm and 8.40pm. The branch practice at Saltburn was open between 8.30am and 1.00pm Monday to Friday. Appointments were available between 9.00am and 11.30am.

The practice operates a telephone triage system for urgent appointments, through the use of a duty doctor. Face to face appointments are available daily for patients that ring the same day. The practice telephones switch to the out-of-hours provider at 6pm each evening and at weekends and bank holidays.

Updated 16 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Zetland Medical Practice on 20 October 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.

• 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.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients said they found it easy to make an appointment with a named GP and 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 acted upon feedback from staff and patients.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw areas of outstanding practice:

The practice provides an acupuncture service for pain management. The practice had one of the lowest referral rates within South Tees CCG to the pain clinic.

The continuous improvement work that specific GP’s were involved in, which benefitted both their patients and the wider community. For example, the use of Skype with a computer link up to local care home, where advice and consultations could take place.

The practice operated a duty GP system. An important aspect of this role was to conduct home visits to patients earlier in the day. This then allowed for earlier health intervention which prevented overnight stays in hospital.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 February 2017

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

• GP partners were GPSI’s in diabetes and heart disease. This benefitted the patients due to their expert knowledge in these conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All these patients had a usual 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.

• Nationally reported data for 2015/2016 showed that outcomes for patients with long term conditions were good. For example, 100% of diabetic patients had received the flu vaccination compared to the local CCG average of 96% and England average of 94%.

• Patients with LTCs had a named GP and a structured annual review to check that their health and medicines needs were being met. For those patients with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Practice nurses visited patients at home to do long term conditions reviews and administer flu vaccinations during the flu season.

Updated 16 February 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. Uptake rates were high for all standard childhood immunisations.

• The practice had a system of follow up when it had been informed that a child had not attended an appointment with an external agency or alternative care provider.

• 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.

• Immunisation rates were comparable to the local CCG and England.

• Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 100%. This was comparable to the local CCG average of 99% and the England average of 97%.

• The practice offered a range of sexual health services where patients could get advice and treatment, for example contraception. Information and testing kits for sexually transmitted diseases were available in the practice.

• The practice had close, regular links with midwives, health visitors and school nurses.

Updated 16 February 2017

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

• The practice demographic indicated a higher than average percentage of older people within its registered list.

• As part of the unplanned admission scheme the practice offered same day telephone appointments with a GP and refer patients who were elderly or vulnerable to community matrons for support.

• The practice offered proactive, personalised care to meet the needs of the older people in its population, including home visits.

• Nationally reported data for 2015/2016 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicators was 100%; this was 6% above the local CCG average and 1% above the England average.

Updated 16 February 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 reflected the needs for this age group.

• Working with the local STAR (South Tees Access and Response) service, the practice were able to offer extended hours appointments through dedicated hubs.

• Family planning clinics, minor surgery and joint injections were provided at the practice so patients did not have to attend hospital to access these services.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 16 February 2017

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

• Performance for mental health related indicators was better than the national average.

  The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months was 100% which was 10% higher than the CCG average and 1%higher than the England average.

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 96% which was higher than the CCG average by 11% and the England average by 12%.

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

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

• 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.

• The practice regularly worked 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 normal working hours and out of hours.

• The practice had a GP who had a special interest in mental health.

Updated 16 February 2017

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

• The practice had a good in depth knowledge of its vulnerable patients.

• Same day medication delivery was available to housebound patients.

• 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.

• The practice had good links with the alcohol liaison team.

• The practice worked with asylum seeker agencies to provide care and support.

• The practice worked with Eva an organisation to support patients who suffered domestic abuse. 

• The practice provided healthcare in local prison services and in a practice for asylum seekers and refugees and for those suffering from drug and alcohol problems in the vulnerable population group in the report.