Drs Mears, Iqbal and Dahl Also known as Swarland Avenue Surgery

Updated 8 June 2016

Swarland Avenue Surgery is located in the Benton area of Newcastle Upon Tyne and provides care and treatment to approximately 5,022 patients from the NE2, NE3, NE6, NE7 NE12 and NE28 postcodes. It is part of the NHS North Tyneside Clinical Commissioning Group (CCG) and operates on a General Medical Services (GMS) contract.

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

Drs Mears, Iqbal and Dahl, Swarland Avenue Surgery, Swarland Avenue, Benton, Newcastle Upon Tyne, NE7 7TD.

The practice is located in a converted ex residential property. All reception and consultation rooms are fully accessible for patients with mobility issues. The practice has a small four bay car park which does not include any dedicated disabled parking bays and is mainly used by staff. A residents parking scheme is in operation in roads adjacent to the practice. However, a limited number of short stay parking spaces were available and further parking was available at a nearby local shopping are or in the pay and display car park attached to the local metro station.

The practice is open from 8.30am to 6pm on a Monday, Wednesday, Thursday and Friday (appointments from 8.30am to 11.30am and 2pm to 5.40pm) and from 8.30am to 6pm and 6.30pm to 9pm on a Tuesday (appointments from 8.30am to 11.30am, 2pm to 5.40pm and 6.30pm to 8.45pm).

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited (NDUC). The practice is one of 29 practices in the North Tyneside area who are members of the North Tyneside GP Federation. This enables the practice to co-commission more cost effectively and deliver additional healthcare services.

Swarland Avenue Surgery offers a range of services and clinic appointments including chronic disease management clinics, antenatal care, childhood health surveillance and immunisations, minor surgery, smoking cessation and weight management. The practice is a teaching and training practice and provides training for nurses, medical students and GP trainees (fully qualified doctors with experience of hospital medicine who are training to become a GP).

The practice consists of:

• Three GP partners (one male and two female)
• A practice nurse (female)
• A health care assistants (female)
• Nine non-clinical members of staff including a practice manager, systems & contract administrator, senior medical receptionist and medical receptionists

The area in which the practice is located is in the eighth (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The average life expectancy for the male practice population is 79 (CCG average 78 and national average 79) and for the female population 83 (CCG average 82 and national average 83).

57.6% of the practice population were reported as having a long standing health condition (CCG average 55.4% and national average 54%). Generally a higher percentage can lead to an increased demand for GP services. 49% of the practice population were recorded as being in paid work or full time education (CCG average 58.7% and national average 61.5%). Deprivation levels affecting children were lower than CCG and national averages. Deprivation levels affecting adults were lower than the CCG averages but higher than the national average.

Updated 8 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Mears, Iqbal and Dahl, Swarland Avenue Surgery on 5 April 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 to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• Feedback from patients about their care was positive. Patients reported that they were treated with compassion, dignity and respect.
• The practice had obtained good National GP Patient Survey results in relation to appointment availability and experience and ease of making an appointment. 89% of patients described their experience of making an appointment as good compared to the CCG average of 89% and the national average of 85%.
• Urgent appointments were usually available on the day they were requested. Pre- bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice had proactively sought feedback from patients and had an active patient participation group. The practice implemented suggestions for improvement and made changes in response to feedback. For example, they had moved back office functions away from the reception desk and to the upper floor of the building to aid patient confidentiality in response to patient feedback.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved 98.6% of the point’s available (local clinical commissioning group average 96.7% and national average 94.7%)
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed with staff and stakeholders.

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

Importantly, the provider should:

• Consider developing a comprehensive locum induction pack
• Consider installing a hearing loop
• Ensure that sharps bins are disposed of regularly regardless of whether they are less than two thirds full or not.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 June 2016

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

Longer appointments and home visits were available when needed. The practice’s computer 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 with multiple long term conditions were offered an annual comorbidity review in their birthday month. This included home visit reviews from a GP for housebound patients. A system was in place to follow up on patients who failed to attend review appointments.

The practice had ensured comprehensive care plans were in place for patients with complex long term conditions. This included patients with diabetes and the practice had adopted the ‘Year of Care’ approach to caring for their diabetic patients. This helped to ensure that they were supported in self-managing their conditions by providing access to a weekly diabetes clinic and dietician and issuing personalised results letters following annual reviews. The practice had obtained 92.8% of the points available to them in respect of diabetes (0.1% below the local CCG average but 3.6% above the national average).

Nationally reported Quality and Outcomes Framework (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 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 2.4% above the local CCG average and 2.6% above the national average.
• The practice had obtained 100% of the point available to them in respect of chronic obstructive pulmonary disease. This was 2.3% above the local CCG average and 4% above the national average
• The practice had obtained 100% of the points available to them in respect of hypertension (1.9% above the local CCG average and 2.2% above the national average).

Updated 8 June 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 comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 93.1% to 98.3% (compared with the CCG range of 97.3% to 98.7%). For five year olds this ranged from 88.7% to 92.5% (compared to CCG range of 92.2% to 98.3%).

At 75.7%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was lower than the national average of 81.8%.

Pregnant women were able to access antenatal clinics provided by healthcare staff attached to the practice. The practice GPs carried out post-natal mother and baby checks.

The practice offered a sexual health service and a full range of contraceptive services, including implants and insertion of intra uterine devices.

Updated 8 June 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 above the local clinical commissioning group (CCG) average of 99.9% and the England average of 97.9%.

All patients had a named GP and the practice offered flu vaccinations to older people. As at the end of February 2016, 80.2% of the practices eligible patient population of 1200 patients, which mainly consisted of people aged over 75, had received a flu vaccination during the 2015/16 flu campaign period. The practice were the second highest achiever out of 20 local practices.

The practice had a palliative care register and held monthly multi-disciplinary meetings to discuss and plan end of life care. This involved the development of comprehensive care plans in conjunction with patients and their families and carers, which included recording and planning for the patients preferred place of death. 25 of the 26 patients on the practices palliative care register who had died during the period 1 April 2015 to 31 March 2016 had done so in their preferred place of death.

Comprehensive care plans were in place for patients at high risk of admission to hospital. The practice were proactive in their approach to admission to hospital avoidance and referred relevant patients to the Northumbria Healthcare Trust Admission Avoidance and Resource Team (AART). AART then carried out urgent assessments of unwell patients living in the North Tyneside area to help them remain in their own home and prevent an unnecessary hospital visit.

Updated 8 June 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 met. The practice is open from 8.30am to 6pm on a Monday, Wednesday, Thursday and Friday (appointments from 8.30am to 11.30am and 2pm to 5.40pm) and from 8.30am to 6pm and 6.30pm to 9pm on a Tuesday (appointments from 8.30am to 11.30am, 2pm to 5.40pm and 6.30pm to 8.45pm). The practice also offered urgent and pre bookable telephone consultations to aid patients who worked or were unable to physically attend the surgery. As the practice nurse did not work during the 6.30pm to 9pm session on a Tuesday evening the GPs offered 15 minute appointment slots. This enabled them sufficient time to carry out procedures such as blood tests and cervical smears. The practice had arranged a late collection of samples for laboratory testing to facilitate this.

The practice offered minor surgery, joint injections, contraceptive services, travel health clinics, smoking cessation, weight management advice and NHS health checks (for patients aged 40-74).

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. A test messaging appointment confirmation and reminder service was available.

Updated 8 June 2016

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

Nationally reported QOF data for 2014/15 showed the practice had achieved the maximum point available to them for caring for patients with dementia, depression and mental health conditions. At 86% the percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 5.3% above the local CCG and 2% above the national averages.

Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as local wellbeing and psychological support services. A counsellor attended the practice on a regular basis.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Comprehensive care plans were in place for patients with dementia. The practice had previously been recognised by the CCG as having a high dementia diagnosis rate and achieving a steady month by month improvement in respect of this.

Updated 8 June 2016

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

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. Staff ensured these patients were given same day access to a GP if necessary when requesting an appointment. Patients with learning disabilities were able to request longer appointments and were invited to attend the practice for an annual review, during which comprehensive care plans were developed. Staff had received training on meeting the specific needs of patients with learning disabilities and the practice had taken steps to ensure that visual health related literature was available.

The practice had established 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.

The practice was working towards pro-actively identifying carers and had received training from a local carers support service to help them achieve this. In the meantime they had ensured that the carers they had identified were offered an annual flu vaccination and signposted to appropriate support services. At the time of our inspection they had identified 81 of their patients as being a carer (approximately 1.6% of the practice patient population).