Middle Chare Medical Group

Updated 23 June 2016

Middle Chare surgery is part of Middle Chare Medical Group. The Medical Group consists of four separate practices. Middle Chare and Woodlands practices predominantly share the same staff and patients and Gardiner Crescent and the Lavender Centre practices do the same. This is due to the proximity of each practice for patients to access.

Middle Chare Surgery is a purpose built GP premises in Chester-Le-Street, County Durham. The practice are awaiting permission to build new premises as they are limited in providing better services due to space. This was approved in 2004 but is still awaiting funds provision. They have a General Medical Services (GMS) contract and also offer enhanced services for example; extended hours. The practice covers the town of Chester-Le-Street and is situated close to the town centre. Car parking facilities are limited but there are public car parking facilities nearby. Transport links are good.

There are 9984 patients on the practice list (this is the combined figure in conjunction with Woodlands practice) and the majority of patients are of white British background. Patient survey and QOF (Quality Outcomes Framework) results are reported in a combined figure between the two locations and therefore it is not possible to report data on specific locations.

The practice is a partnership with five partners, three male and two female. There are two salaried GPs, both female, four practice nurses, a nurse practitioner and three health care assistants (all female). There is a practice manager and a team of reception and administration staff. The practice is a teaching and training practice and regularly has GP Registrars (qualified Doctors in training to become GPs) and undergraduates.

The practice is open between 8am and 8pm Mondays and Tuesdays and between 8am and 6pm on Wednesdays, Thursdays and Fridays.

Extended hours are offered on Mondays and Tuesdays until 8pm.

Patients requiring a GP outside of normal working hours are advised to contact the GP out of hours service (111) commissioned by North Durham CCG.

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Middle Chare Surgery on 26 April 2016. Middle Chare Surgery is part of one large provider (Middle Chare Medical Group) who have four locations. All patients can be seen at any of the locations; however, most attend one of two for continuity of their care. Patients attending Middle Chare Surgery also attend Woodlands Surgery. 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.
• Patients said they found it easy to make an appointment, although not always with a named GP and there was continuity of care, 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 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. They encouraged a culture of openness and honesty.

We saw areas of outstanding practice:

The practice worked in collaboration with the Ear Nose and Throat department from the local hospital and provided a room for consultations. This collaborative way of working had led to improved knowledge in this area and had reduced practice referrals to secondary care, providing care closer to home.

The practice provided a dermoscopy service to its patients and this had led to a reduction in referrals to secondary care.

The areas where the provider should make improvement are:

To monitor that all staff are able to access policies and procedures.

To monitor clinical audit as a continuous process to demonstrate quality improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 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 was 79% which was comparable to the national average 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.

• Patients with long term condition who were at risk of unplanned admission to hospital were able to access a GP at weekends from a rota provided by six local practices. This was from 8am until 6pm on Saturday and Sunday and included telephone consultations and home visits. Any patients identified as possibly needing the service during the week were given a mobile contact number to talk directly to a GP. This service had also been extended to care homes in the area.

Updated 23 June 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 percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 82% which was higher than the national average of 74%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had achieved the Investors in Young People award to ensure that the services they provided were appropriate to this age group.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 23 June 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.

• A named GP did weekly visits at nursing homes assigned to the practice, providing continuity of care and information sharing.

• As part of the ‘Improving outcomes scheme’ in conjunction with the CCG, the practice held a register of patients who were at risk of unplanned emergency admission to hospital. These patients were assessed by the practice nurse and care provided accordingly.

• Frail elderly patients were able to access a GP at weekends from a rota provided by six local practices. This was from 8am until 6pm on Saturday and Sunday and included telephone consultations and home visits. Any patients identified as possibly needing the service during the week were given a mobile contact number to talk direct to a GP. This service had also been extended to care homes in the area.

Updated 23 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 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 reflects the needs for this age group.

• Dermoscopy and ENT appointments were offered by the practice to allow patients to be seen closer to home. This had reduced referrals to secondary care and improved patient care by reducing the need for biopsy due to the investment in a dermoscope.

Updated 23 June 2016

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

• 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 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.

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

Updated 23 June 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.

• 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 about how to access various support groups and voluntary organisations, including referrals to local food banks.

• 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.