Collingwood Surgery

Updated 3 January 2017

Collingwood Surgery provides care and treatment to around 17,000 patients in North Shields, North Tyneside. The practice is part of North Tyneside clinical commissioning group (CCG) and operates on a General Medical Services (GMS) contract agreement for general practice.

The practice provides services from the following addresses, which we visited during this inspection:

• Collingwood Surgery, Hawkeys Lane, North Shields, Tyne and Wear, NE29 0SF;
• Jubilee Park Surgery, Nelson Health Centre, Cecil Street, North Shields, Tyne and Wear, NE29 0DZ;
• New York Surgery, Brookland Terrace, New York, North Shields, Tyne and Wear, NE29 8EA.

The practice had one patient list; patients could access services at any of the three sites.

The Collingwood Surgery is located in a purpose built two storey building. The majority of patient facilities are on the ground floor. There is no lift to the first floor but arrangements have been made for patients to have their appointments on the ground floor where necessary. There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access.

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

The New York Surgery is located in a purpose built single storey building. There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access.

Opening hours at each branch are as follows:

• Collingwood Surgery; between 8.30am and 8pm Mondays and Thursdays, between 8.30am and 6pm every Tuesday, Wednesday and Friday and between 8.30am and 12.30pm on the last Saturday of the month.
• Jubilee Park Surgery; between 8.30am and 6pm Monday to Friday.
• New York Surgery; between 8.30am and 6pm on Mondays, Tuesdays, Thursdays and Fridays and between 8.30am and 1pm every Wednesday.

Patients can book appointments in person, on-line or by telephone.

Appointments with GPs are available at the following times:

• Monday - 8.30am to 10.45am; then from 2.30pm to 7.45pm
• Tuesday – 8.30am to 10.45am; then from 2.30pm to 5.30pm
• Wednesday – 9.20am to 10.45am; then from 2.30pm to 5.30pm
• Thursday – 8.30am to 10.45am; then from 2.30pm to 7.45pm
• Friday – 8.30am to 10.45am; then from 2.30pm to 5.30pm
• Saturday (once per month) – 8.30am to 12.15pm

A duty doctor is available each Tuesday, Wednesday and Friday afternoon until 6.30pm.

The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Vocare, which is also known locally as Northern Doctors Urgent Care.

The practice has:

• nine GP partners (four female and five male),
• five salaried GPs (four female and one male),
• two nurse practitioners and five practice nurses (all female),
• a healthcare assistant,
• a practice manager, and
• 22 staff who carry out reception and administrative duties.

The practice is a training practice and four of the GPs are accredited GP trainers. At the time of the inspection there were three trainee GPs working at the practice.

The age profile of the practice population is in line with the CCG averages, but is made up of a slightly higher than average proportion of patients over the age 65 (18.8% compared to the national average of 17.1%). Information taken from Public Health England placed the area in which the practice is located in the fourth more deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

Updated 3 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Collingwood Surgery on 17 November 2016. Overall the practice is rated as outstanding.

Our key findings were as follows:

• Patients’ needs were assessed and care was planned and delivered in line with current legislation.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• 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 were able to get an appointment with a GP when they needed one, with urgent appointments available the same day. Results from the National GP Patient Survey, published in July 2016, showed that patients’ satisfaction with how they could access care and treatment was much higher than local and national averages
• The practice had a long track record of training new GPs. Feedback from trainees was very positive. The practice scored highly in the General Medical Council (GMC)’s national training scheme survey for 2015.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about services and how to complain was available and easy to understand.
• There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.
• There was strong collaboration and support across all staff groups.

We saw several areas of outstanding practice including:

• The practice had developed end of life care arrangements over many years and promoted the use of the palliative care register with clinicians. The practice was one of four nationally to take part in a MacMillan project to link patients on the palliative care register with a MacMillan social worker. This project had subsequently been rolled out to all practices within the CCG.
• The practice had responded to the needs of its patients experiencing poor mental health and there were effective arrangements to provide care and support for those patients. The practice funded 50% of a mental health worker who worked full time within the surgeries; this ensured that 95% of patients with mental health problems were seen within the practice, rather than in secondary care.
• The practice team was forward thinking and part of local and national pilot schemes to improve outcomes for patients. For example, the practice took part in the first phase of the national Health Foundation’s MAGIC programme ( ‘making good decisions in collaboration’), which looked at how to embed best practice in shared decision making.

The area where the provider should make improvements is:

• Take steps to monitor and record the minimum and maximum temperatures for the refrigerators at the New York surgery.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 January 2017

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.
• The practice scored well in the Quality and Outcomes Framework (QOF). This rewards practices for managing some of the most common long term conditions. For example, performance for asthma related indicators was better than the national average (100% compared to 97.4% nationally) and performance for heart failure related indicators was better than the national average (100% compared to 98.1% nationally). QOF exception rates were also well below average (the QOF scheme includes the concept of ‘exception reporting’ to ensure that practices are not penalised where, for example, patients do not attend for review, or where a medication cannot be prescribed due to a contraindication or side-effect).
• 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 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.

Updated 3 January 2017

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 80.5%, which was slightly below the CCG average of 82.9% and the national average of 81.5%.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 3 January 2017

The practice is rated as outstanding 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.
• Collingwood Surgery was the lead practice for two large nursing homes, GPs carried out a weekly ward round to review patients and had close to 100% co-ordinated care plans in place for patients.
• The practice had developed end of life care arrangements over many years and promoted the use of the palliative care register with clinicians. The practice was one of four nationally to take part in a MacMillan project to link patients on the palliative care register with a MacMillan social worker. The pilot showed an increased rate of death in the patients’ usual place of residence in those who were on the register and had interacted with the service; and showed increased quality of care and was subsequently rolled out to all practices within the CCG.
• Since January 2016, 172 deaths were recorded; of those 80 were on the practice’s palliative care register (47%, compared to the CCG average of 24%) and 71 died in their usual place of residence.

Updated 3 January 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 and flexible. Extended hours surgeries were offered on Monday and Thursday evenings between 6pm and 8pm and one Saturday morning each month for working patients who could not attend during normal opening hours.
• 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 3 January 2017

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

• Performance for mental health related indicators was above the national average (100% compared to 92.8% nationally). For example, 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 94.3%, compared to the national average of 88.8%.
• 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.
• The practice funded 50% of a mental health worker who worked full time within the surgeries. The funding ensured that 95% of patients with mental health problems were seen within the practice, rather than in secondary care. Staff told us that patients valued the flexibility of appointments and continuity of care.

Updated 3 January 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, including those with a learning disability.
• The practice engaged with a national learning disability project, “Getting it Right”, where volunteers with a learning disability delivered workshops to staff. The practice had developed a number of ‘easy read’ leaflets and health check invitation letters for patients. Following a review of attendance rates at annual health checks for patients with learning disabilities, improvements to the recall system were implemented. The practice’s prevalence rate was 0.88%, which was above the local CCG average of 0.67% and the national average of 0.46%.
• One of the nurses was the first point of contact for patients on the learning disability register and acted as their advocate where appropriate. The nurse liaised with secondary care health staff on behalf of patients to facilitate hospital appointments.
• 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; 617 patients (3.6% of the practice list) had been identified as carers.