Denmark Street Surgery

Updated 17 October 2016

Denmark Street Surgery is a purpose built GP premises in Darlington, County Durham. They have a General Medical Services (GMS) contract and also offer enhanced services for example: minor surgery. The practice covers the whole of Darlington and some surrounding villages. Car parking facilities are adequate. Transport links are good. There are 14292 patients on the practice list and the majority of patients are of white British background, however the practice does have some patients from the Travelling Community and some who are seeking asylum. We were told that the practice has a growing population and the list is constantly growing. The practice catchment area is classed as 4 out of 10 in the Indices of Multiple Deprivation (The lower the Indices of Multiple Deprivation (IMD) decile the more deprived an area is). The practice operates from two buildings with the nursing team in an annexe building nearby. There are two chemists in the immediate vicinity of the practice.

The practice consists of nine GP partners, five female and four male. The practice is a teaching and training practice which means that patients can be seen by medical students and GP trainees. They have more GP trainers than the national average which means that there are more opportunities for patients to be seen as they sometimes have up to six GP trainees at a time.

The practice is supported by a practice manager along with reception and administration staff. There is a nurse practitioner who is a non-medical prescriber, five practice nurses, and two health care assistant all of which are female. The practice supports student nurses and the mentoring of non-medical prescribers. There are also three administration apprentices training at the practice. The practice is supported by a pharmacist employed by the Clinical Commissioning Group (CCG).

The practice is open between 7.30am and 6pm Monday to Friday. Extended hours appointments are offered every day between 7.30am and 8am. Appointments are offered at varying times throughout the morning starting from 7.30am sometimes up to 1.30pm and also at varying times throughout the afternoon.

Patients requiring a GP outside of normal working hours are advised to contact NHS 111 who will refer them to the GP out of hours service commissioned by Darlington CCG. The practice has an agreement with the CCG that the out of hours service will cover between the hours of 6pm to 6.30pm.

Updated 17 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Denmark Street Surgery on 21 September 2016. Overall 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 been trained to provide them with 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.
• Some patients said they found it difficult to make an appointment, and with a named GP. Urgent appointments were 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. Some staff commented that communication in the practice could be improved. 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 areas where the provider should make improvement are:

To monitor that regular fire drills are carried out.

To monitor and evaluate the changes made to the telephone system for improved access for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 October 2016

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

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

• The percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) was 83% which was in line with local figures of 81% and national figures of 78%.

• Longer appointments and home visits were available when needed.

• All these patients had a named 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.

Updated 17 October 2016

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. 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.

• The practice had completed the ‘You’re Welcome’ training which had led to a youth page on their website.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 81% which was in line with local figures of 83% and national figures of 82%.

• 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.

Updated 17 October 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.

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

Updated 17 October 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, 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.

Updated 17 October 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 94% which was comparable to the local average of 92% and higher than the national average of 88%.

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

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

• The practice had told patients experiencing poor mental health 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 17 October 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, refugees, asylum seekers and those from the travelling community. They had participated in a multi-agency approach (which included the local authority and interpreting services) to ensure the needs of refugees were met.

• 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 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.