Archived: Woodlands Road Surgery

Updated 1 March 2017

Woodlands Road Surgery, 6 Woodlands Road, Middlesbrough TS1 3BE is located close to the town centre in Middlesbrough. There is pay and display car parking available on the road in front of the practice. The practice is located in an adapted property with disabled access and consulting and treatment rooms available on the ground floor. There is one branch site, Acklam Road Surgery, 283 Acklam Road, Middlesbrough TS5 7BP which is located in a residential area three miles from the Woodlands Road Surgery. There is disabled access and all consulting and treatment rooms are on the ground floor. This site was not visited during the inspection. The practice is moving to a new purpose built surgery in May 2017 and all services will be delivered from one site.

The practice provides services under a General Medical Services (GMS) contract with the NHS Durham, Darlington And Tees Area Team to the practice population of 9300, covering patients of all ages.

The proportion of the practice population in the 65 years and over age group is slightly higher than the local CCG and the England average and in the under 18 age group is slightly below the local CCG and the England average. The practice scored two 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 practice has three GP partners, all full time. There are two male GPs and one female GP. There is a full time practice manager who is also a management partner. There are two nurse practitioners both full time and both female. There are three practice nurses, one trainee health care assistant and a phlebotomist, all part time and all female. There is a deputy practice manager and a team of administrators, secretaries and receptionists.

The Woodlands Road Surgery is open between 8am and 6pm on Monday, Tuesday Thursday and Friday and 8am to 7.30pm on Wednesday. The practice operates a same day appointment system. Each clinician manages their workflow from their telephone triage screen and appointments are booked throughout the day from 8am to 6pm.

The Acklam Road Surgery is open between 8am and 5pm Monday, Tuesday and Friday, 7am to 5pm on Wednesday and 7am to 7.30pm on Thursday. The same day appointment system also operates at Acklam Road therefore appointments are booked throughout the day when the practice is open.

Information about the opening times is available on the website and in the patient information leaflet.

The practice, along with all other practices in the South Tees CCG area have a contractual agreement for the Out of Hours provider to provide OOHs services from 6.00pm. This has been agreed with the NHS England area team.

The practice has opted out of providing out of hours services (OOHs) for their patients. When the practice is closed patients use the NHS 111 service to contact the OOHs provider. Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.

The practice is a training practice for student nurses.

Updated 1 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Woodlands Road Surgery on 15 November 2016. We visited the main surgery on Woodlands Road, we did not visit the Acklam Road branch surgery during the inspection. The practice is rated as good.

Our key findings across all the areas we inspected were as follows;

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they were able to get same day appointments and pre bookable appointments were available.
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice had an active virtual Patient Reference Group which worked with the practice to make improvements.

We saw an area of outstanding practice;

• The practice operated a same day ‘Dr First’ appointment system. Each clinician managed their workflow from their telephone triage screen and appointments were booked throughout the day from 8am to 6pm. Since the introduction of the Dr First system the practice performance for unplanned admissions and attendance at A/E had improved. Before the system was introduced in January 2013 the practice was ranked seventh out of 22 for overall spend with 22 being the lowest spend practice, this included costs for unplanned admissions and attendance at A/E. At the end of October 2016 the practice was ranked 20 out of the 22 practices for overall spend; this included a reduction in the number of unplanned admissions and A/E attendances.

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

Importantly the provider should:

• Implement a planned clinical audit programme to ensure audit cycles are completed.

• Monitor the process for seeking consent for minor surgery procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 March 2017

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

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

• Nationally reported data for 2015/2016 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 85%. This was comparable to the local CCG average of 83% and the England average of 80%.

• Longer appointments and home visits were available when needed.

• 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.

• Patients presenting with suspected blood clots were assessed in the surgery in a timely manner using the d-dimer blood testing strips, this ensured any treatment needed was administered quickly.

Updated 1 March 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 or who failed to attend hospital appointments.

• Immunisation rates were high for all standard childhood immunisations. Data from 2015/2016 showed immunisation rates were comparable to the local CCG average and above the England national average. For example, rates for immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 89% to 100% compared to 86% to 98% for the local CCG and 73% to 95% for the England national average.

• Children and young people were treated in an age-appropriate way and were recognised as individuals.

• Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 80%. This was comparable to the local CCG average of 83% and the England average of 81%.

• The practice had worked with the Middlesbrough Public Health team to increase take up of cervical smears for eligible patients. Working groups were set up and leaflets, large banners and posters were displayed in reception to encourage ladies to come for a smear test. This targeted particular groups, for example ladies from ethnic minority groups and younger patients.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• Combined appointments with the GP and practice nurse were arranged at eight weeks post-delivery. This enabled the mother’s post-natal check and baby’s first immunisations to be carried out in one appointment and avoided having to visit twice.

• We saw good examples of joint working with midwives, health visitors and school nurses. The practice monitored any non-attendance of babies and children at vaccination clinics. The practice nurses contacted the parents of children who did not attend for vaccinations and worked with the health visiting service to follow up any concerns.

Updated 1 March 2017

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. Patients over the age of 75 had a named GP.

• The practice had assessed the older patients most at risk of unplanned admissions and had developed care plans which were regularly reviewed.

• They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice worked collaboratively with other Middlesbrough practices to immunise patients requiring flu vaccines in nursing homes. The nursing homes in their geographical area were distributed evenly amongst the practices that took part, thus eliminating the need for the practice staff to visit every home. This ensured patients received the vaccine early on in the campaign.

• The practice was involved in the ‘Ageing Better in Middlesbrough Scheme’. This was tackling loneliness and providing activities that people could get involved with, for example, reading groups, community walks and café meetings. One staff member had attended workshops at the local university to learn about the scheme so they could promote it with their patients. Information was displayed in the practice and had been shared with the Patient Reference Group lead.

• 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%; compared to the local CCG average of 94% and the England average of 98%.

Updated 1 March 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.

• Telephone consultations were available every day with a call back appointment arranged at a time to suit the patient, for example during their lunch break.

• Extended hours appointments were available with GPs, nurse practitioners, practice nurses and the trainee HCA outside of working hours. Two early morning clinics and two evening clinics were available and additional clinics were planned for January 2017.

• 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 offered a range of sexual health services where patients could get advice and treatment, for example contraception.

• 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.

• The practice had worked with the local university and co-ordinated the attendance of Middlesbrough GP practices at fresher’s events and at international student enrolment events. Practice staff gave presentations in the lecture hall at the university to international students. They informed students about NHS services available, health promotion about sexual health and the availability of the meningitis vaccine.

Updated 1 March 2017

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

• Nationally reported data from 2015/2016 showed 100% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was above the local CCG average of 85% and England average of 84%.

• The practice carried out advanced care planning for patients with dementia.

• Nationally reported data from 2015/2016 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 95%. This was comparable to the local CCG average of 93% and above the England average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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.

• There was a nurse practitioner lead for patients experiencing mental health issues. They ensured where necessary patients had annual reviews, were monitored regularly and care plans were in place.

• The practice hosted counselling sessions for patients who needed support with mental health issues.

Updated 1 March 2017

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

• The practice held registers of patients living in vulnerable circumstances which included those with a learning disability.

• The practice offered longer appointments for people with a learning disability.
• There was a nurse practitioner lead for patients with a learning disability. They ensured where necessary patients had annual reviews, were monitored regularly and care plans were in place where required.

• Nursing staff used easy read leaflets to assist patients with learning disabilities to understand their treatment.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice told 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.

• Telephone interpretation services were available and information leaflets in different languages were provided in the waiting room.