Parkgate Medical Practice Also known as IntraHealth Limited

Updated 2 January 2018

Parkgate Medical Practice, Park Place, Darlington, Co Durham provides Primary Medical Services to a population of approximately 4,900 patients. The practice is part of the Intrahealth Limited group and operates under a Primary Medical Services contract, the website address is www.intrahealth.co.uk. Issues regarding finance, recruitment and some other governance areas are dealt with by the head office team of Intrahealth Limited. The practice is in central Darlington and operates from a purpose built healthcare facility which is shared with other community based health services. The building is leased from NHS property services.

There is one female salaried GP ( 0.45 WTE) , two locum GPs who work under a service level agreement with Intrahealth and are both male, a nurse practitioner who is female ( 1WTE), 2 female practice nurses ( 1 WTE and 0.53 WTE) and a female healthcare assistant ( 0.6 WTE). There is also a female clinical pharmacist (0.72 WTE). They are supported by a team of management, reception and administrative staff. Out of Hours services are provided via the NHS 111 service.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures, and treatment of disease, disorder and injury. The practice is in an area classed as level two in the Indices of Multiple Deprivation. The lower the Indices of Multiple Deprivation (IMD) decile, the more deprived an area is. People living in more deprived areas tend to have greater need for health services. The practice has a higher proportion of males in the age range of 25 – 50 than the local or national average. It also provides support to a nearby mental health unit, where patients have a higher proportion of drug and alcohol related problems.

The practice has had problems with staff recruitment and sickness over the past year however this has now resolved and there are a number of new staff, including a practice manager, non-clinical and clinical staff. The practice manager is currently in the process of registering with the Care Quality Commission as the Registered Manager of the practice.

Updated 2 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection March 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Parkgate Medical Practice on 5 December 2017. This was as part of our inspection programme.

At this inspection we found:

• The practice was on a trajectory of improvement and had successfully recruited new staff within the last year. Some of the data in the report related to the previous governance and the practice were aware of this and had an action plan to monitor any issues of concern.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Some patients found the appointment system difficult to use. Some patients stated that it was difficult to get through to the practice by telephone. Most reported that they were able to access urgent care when they needed it, but had to wait too long for an appointment.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

Ensure that GPs are provided with clinical supervision.

Have a system in place that ensures facilities are regularly maintained by the landlord.

Continue to monitor the action plan with regard to improving access to appointments.

Risk assess the emergency equipment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 June 2015

The practice is rated as good for the care of people with long term conditions. People with long term conditions were monitored and discussed at multi-disciplinary clinical meetings so the practice was able to respond to their changing needs. Clinical staff had obtained qualifications in specific disease areas and the clinical team met regularly to discuss NICE guidelines and clinical cases. This ensured that patients received the most appropriate treatment. Information was made available to out of hours providers for those on end of life care to ensure appropriate care and support was offered. People with conditions such as diabetes and asthma attended regular nurse clinics to ensure their conditions were appropriately monitored and were involved in making decisions about their care. The practice routinely followed up non-attenders to ensure they had the required routine health checks.

Updated 25 June 2015

The practice is rated as good for the care of families, children and young people. Systems were in place to identify children who may be at risk, those on a child protection plan or looked after children. The practice monitored levels of children’s vaccinations and immunisation rates were mostly above the national average for childhood immunisations. The practice had recognised the difficulties young people can experience in accessing health services and worked with a group of young patients to make services more friendly and accessible and had gained the ‘Investing in Children’s’ award. There were protected daily appointment slots to ensure that children who were ill could be seen in a timely manner.

Updated 25 June 2015

The practice is rated as good for the care of older people. The practice held multi-disciplinary meetings to ensure the needs of those with chronic conditions or end of life care were met. Care plans were tailored to meet to individual needs and circumstances. Patients and their carer’s were involved in this process. The practice also undertook opportunistic screening for the early signs of dementia and offered health checks to carers. The over 75’s had a named GP. Information was shared with other services, such as out of hours services. Nationally reported data showed the practice had good outcomes for conditions commonly found in older people.

Updated 25 June 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working population had been identified and services met these needs. Routine appointments could be booked in advance, or made online. Repeat prescriptions could be ordered online. Longer appointments and extended hours opening were available. Working people had access to additional GP appointments, provided in the Darlington area, on Saturday and Sunday.

Updated 25 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Nationally returned data showed the practice performed well in carrying out additional health checks and monitoring for those experiencing a mental health problem. For instance, 95% of patients diagnosed with dementia had their care reviewed in last 12 months, which was above the national average. The practice identified and referred patients in need of mental health support to the Primary Care Mental Health service. It also supported patients undergoing a mental health crisis with onward referral to the crisis team. The practice also supported patients with severe mental health issues who lived at a nearby residential home, by offering reviews of their physical health. These reviews were also offered to all patients on the practices mental health register.

Updated 25 June 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice had a register of those who may be vulnerable, including those who were homeless. They were offered annual health checks and opportunistic screening when they visited the practice. Patients or their carers were able to request longer appointments if needed. The practice had a register for looked after or otherwise vulnerable children and worked with school nurses to follow up if any routine appointments were missed. The practice supported patients engaged with substances reduction services by ensuring the monitoring tests were taken and reported to the initiating service. Potential misuse of drugs was minimised by dose reduction and monitoring within the practice.

The computerised patient plans were used to flag up issues where a patient may be vulnerable or require extra support, for instance if they were a carer. Staff were aware of their responsibilities in reporting and documenting safeguarding concerns.