Bridge End Surgery

Updated 21 April 2016

Bridge End Surgery is a purpose built GP premises in Chester-Le-Street, County Durham. 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. There are 8733 patients on the practice list and the majority of patients are of white British background. The practice has a small population of homeless patients as there is a shelter and a YMCA nearby.

The practice is a partnership with five partners, two male and three female. There are two salaried GPs, one male and one female, three Practice Nurses, a Nurse Practitioner and two Health Care Assistants (all female). There is a Practice Manager and a team of 15 reception and administration staff. The practice is a teaching and training practice and regularly has GP Registrars.

The practice is open between 8am and 8pm Mondays, Wednesdays and Thursdays and between 8am and 6.30pm on Tuesdays and Fridays. Extended hours are offered on Mondays, Wednesdays and Thursdays until 8pm and every other Saturday between 8am and 1pm.

Patients requiring a GP outside of normal working hours (after 6.30pm) are advised to contact the GP out of hour’s service (111) provided by North Durham CCG.  

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridge End Surgery on 22 March 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 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.

• Some patients said they found it difficult to make an appointment. There were urgent appointments available the same day for GPs and Nurses. Routine appointments were available to book but this was in sixteen days.

• 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. This means they must be open and transparent with patients about their care and treatment, including when it goes wrong.
• The practice engaged well with the voluntary sector and the local authority to provide services for patients.

We saw areas of outstanding practice:

The practice had developed the role of a ‘veteran co-ordinator’ who was a point of contact for veterans registered at the practice who may be in need of extra support.

The practice held a register of patients who were at risk of unplanned emergency admission to hospital and these patients were offered an additional weekend service. By being identified as potentially needing extra weekend support, patients were given a dedicated mobile number for telephone consultation or a pre-booked appointment in a nearby surgery.

The practice had a register of patients who were homeless and communicated monthly with the local hostels to keep up to date with this transient patient group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 April 2016

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

• Nursing staff and the GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients with long term conditions were seen in their birth month for an annual review.
• 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.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example;

• 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 to31/03/2015) was 85% compared to a national figure of 78%.

Updated 21 April 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.
• The percentage of patients with asthma, on the register, who had had an asthma review in the preceding 12 months that included an assessment of asthma control was 79% compared to a national average of 75%.
• 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 Nurse had undertaken extended training in sexual health and contraception in order to provide care closer to home. This included the provision of intra uterine devices and contraceptive implants. The practice had developed a protocol for cervical cytology to ensure that staff were clear on the correct guidelines.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 81% compared to a national average 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.
• The practice had recently completed the ‘investors in children’ award to help ensure that they were child and young person friendly.

Updated 21 April 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.

• 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.

• Staff had received extra training in dementia and were ‘dementia friends’.

Updated 21 April 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.
• In conjunction with the local CCG the practice offered Saturday morning GP and nurse appointments.

• The practice offered extended hours every other weekend with GP and nurse appointments available. This was available by pre-booking or also by walk-ins. They also offered extended hours three evenings per week until 8pm.

• The Practice nurse had undertaken extra training to provide a cryotherapy service to patients to reduce referrals to secondary care and provide care closer to home.

Updated 21 April 2016

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

• Nationally reported data from 2014-2015 showed 82% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 92% compared to a national average of 88%

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

• The practice had regular meetings with the local psychiatry service to discuss patient management.

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

Updated 21 April 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 and those who were homeless.
• The practice offered longer appointments for patients with a learning disability, and offered these patients the option of being seen in their own home.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed 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.
• The practice had developed a support network for veterans and held a register of these patients. There was a ‘veteran coordinator’ who ensured that support was offered to these patients. This included posters with information in the waiting room with links to ‘help the heroes’ and post-traumatic stress help.
• The practice had a register of patients who were homeless and communicated monthly with the local hostels to keep up to date with this transient patient group.
• The practice had identified that the process for patients requiring social housing was not clear and had shared this information with other practices in the area. They signposted patients to the correct process used by most social housing providers in Durham to ensure a more efficient service.