Forest Hall Medical Group

Updated 21 January 2016

Forest Hall Medical Group is registered with the Care Quality Commission to provide primary care services. It is located to the east of Newcastle upon Tyne.

The practice provides services to around 11,000 patients from one location: Station Road, Forest Hall, Newcastle upon Tyne, NE12 9BQ. We visited this address as part of the inspection. The practice has three GP partners (two male and one female), four salaried GPs (two female and two male), a nurse practitioner (female), one practice nurse (female), two healthcare assistants, a practice manager, and 11 staff who carry out reception and administrative duties.

The practice is part of North Tyneside clinical commissioning group (CCG). The practice population is made up of a slightly higher than average proportion of patients over the age 65 (19.7% compared to the national average of 16.7%). Information taken from Public Health England placed the area in which the practice was located in the fourth less 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 single storey building. There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access.

Opening hours are between 8.00am and 7.30pm on Mondays; between 7.30am and 6.30pm on Tuesdays; between 7.30am and 6.30pm on Wednesdays and Thursdays and between 8.00am and 6.30pm on Fridays. Patients can book appointments in person, on-line or by telephone. Appointments were available with a GP from 8.30am to 12pm; then from 3pm to 5.20pm Tuesday to Thursday and until 7.30pm on Mondays.

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

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

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forest Hall Medical Group on 1 December 2015. Overall the practice is rated as good.

Our key findings were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Information about services and how to complain was available and easy to understand.
• Patients said they were able to get an appointment with a GP when they needed one, with 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 in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.

• Staff throughout the practice worked well together as a team.

• Staff had received training appropriate to their roles.

We saw several areas of outstanding practice including:

• An analysis tool, Reporting Analysis and Intelligence Delivering Results (RAIDR) was used, which enabled the practice to look at trends and compare performance with other practices. The latest report showed the practice was one of only two across the whole clinical commissioning group (CCG) area to achieve all of the ‘higher level indicators’ (for example, in relation to hospital admission rates and accident and emergency attendances).

• Staff were proactive in carrying out clinical audits to help improve patient outcomes. A significant number of audits had been carried out in the past year (14) and one of the GP partners had a dedicated weekly clinical session set aside specifically for audit work. All of the clinical audits we looked at were relevant, well designed, detailed and showed learning points and evidence of changes to practice. We saw these were clearly linked to areas where staff had reviewed the practice’s performance and judged that improvements could be made.

• A review of the uptake of the pneumonia vaccine showed that numbers had decreased over the past few years. A proactive campaign to contact patients was undertaken. This resulted in an increase from around 50 patients receiving the vaccine in 2013 to over 600 in 2014.

• The practice had written to high risk patients to encourage them to attend for health checks. Data showed the practice was the best performer across the CCG in relation to health checks, with over 20% of eligible patients receiving a check, compared to an average of around 9%.

• Patient privacy was given a high priority within the practice. There was a ‘patient station’ screened off from the main waiting room, this allowed patients to complete forms and collect specimen packs in a private area. Staff had designed forms for patients to complete to give to the receptionist if they did not wish to discuss their condition or requirement.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 21 January 2016

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

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. For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Nationally reported 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 all of the points available to them for providing recommended care and treatment for patients with asthma. This was 2.4 percentage points above the local CCG average and 2.6 points above the national average.

Updated 21 January 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 in line with the national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 97.1% to 100% and five year olds from 89.5% to 96%. The practice’s uptake for the cervical screening programme was 91.0%, which was well above the CCG average of 83.1% 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 21 January 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 slightly above local clinical commissioning group (CCG) average (99.6%) and 2.1 points above the England average.

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 and patients at high risk of hospital admission and those in vulnerable circumstances had care plans.

The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people. A review of the uptake of the pneumonia vaccine showed that numbers had decreased over the past few years. A proactive campaign to contact patients was undertaken. This resulted in an increase from around 50 patients receiving the vaccine in 2013 to over 600 in 2014

Updated 21 January 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. Extended hours surgeries were offered on Monday evenings between 6.30pm and 7.30pm and from 7.30am on Tuesday, Wednesday and Thursday mornings 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 45s and travel vaccinations. The practice was the highest performer in the area in relation to the number of health checks carried out.

Updated 21 January 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. 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.

Nationally reported QOF data (2014/15) showed the practice had achieved good outcomes in relation to patients experiencing poor mental health. For example, the practice had obtained 100% of the QOF points available to them for providing recommended care and treatment for patients with poor mental health. This was 4.8 percentage points above the local CCG average and 7.2 points above the England average. Performance for dementia related indicators was also above local and national averages (100% compared to 96.8% locally and 94.5% nationally).

Updated 21 January 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. The practice offered longer appointments for people with a learning disability, if required.

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.