Stanley Medical Group - Clifford Road

Updated 16 January 2017

The Care Quality Commission has registered Stanley Medical Group to provide primary care services.

The practice provides services to approximately just under 11,200 patients from two locations:

• Main Surgery: Stanley Primary Care Centre, Stanley, County Durham, DH9 0AB
• Branch Surgery : Front Street, 16 Front Street, Annfield Plain, Stanley, Co Durham, DH9 8HY

We visited both locations during this inspection.

Stanley Medical Group is a large practice providing care and treatment to patients of all ages, based on a Personal Medical Services (PMS) contract agreement for general practice. The practice is part of the NHS North Durham clinical commissioning group (CCG).

Information taken from Public Health England placed the area in which the practice was located in the third most deprived decile. (A decile is a method of dividing up a set of ranked data into 10 equally large subsections). In general, people living in more deprived areas tend to have greater need for health services. The average male life expectancy is 77 years and the average female life expectancy is 81 years, both of which are two years lower than the England average.

The percentage of patients reporting with a long-standing health condition is slightly higher than the national average (practice population is 55.2 % compared to a national average of 54.0%). The percentage of patients over the age of 65+ (at 19.2%) is higher than the England average of 17.1%.

The practice has one GP partner (male) and one practice manager partner. There are also five salaried GPs (four female and one male), a regular locum GP (female), three nurse practitioners (female), three practice nurses (female), three healthcare assistants (female) and 15 administrative support staff. Some of the GPs work part time and as such the whole time equivalent for GPs is 6.75.

The opening hours of the main surgery at Stanley Medical Centre is as follows:

• Monday 08:00 - 18:00
• Tuesday 08:00 - 19:15
• Wednesday 08:00 - 18:00
• Thursday 07:30 - 18:00
• Friday 08:00 - 18:00

Appointments are from 8:00am to 11:30am and 1pm to 5:40pm on a Monday, Wednesday and Friday. On a Tuesday they are available from 8:00am to 11:30am and 1pm to 7:15pm and on a Thursday from 7:30am to 11:30am and 1pm to 5:40pm. This includes a mix of GP, nurse practitioner, practice nurse and healthcare assistant appointments. Phone lines are open from 8:30am to 5:30pm. An emergency line is available from 5:30pm to 6:00pm. There is a local contract with the out of hour’s service to provide telephone cover between 6 and 6:30pm.

The opening hours for the branch surgery on Front Street Stanley are:

• Monday 08:30 - 12:30
• Tuesday 08:30 - 12:30
• Wednesday 08:30 - 12:30
• Thursday 08:30 - 12:30
• Friday 08:30 - 12:30

Appointments are available from 8:30am to 12:30pm daily.

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

Updated 16 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stanley Medical Group on 19 October 2016. Overall, the practice is rated as outstanding.

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 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.
• We found the practice governance and performance management arrangements were proactively reviewed and reflected best practice. The practice had invested in the arrangements to support improvement within the practice. They used a method of streamlining their processes to improve effectiveness and efficiency.
• We found the leadership, governance and culture were used to drive and improve the delivery of an efficient and effective service. They drove continuous improvement and supported staff to deliver.
• The provider was aware of and complied with the requirements of the duty of candour.
• There was a strong focus on continuous learning and improvement at all levels. We found safe innovation was celebrated. There was a clear proactive approach to seeking out and embedding new ways of providing care and treatment.

We saw areas of outstanding practice:

• The practice had adapted a process used in industry, called lean methodologies, to streamline their own systems and processes. This had resulted in demonstrable improvements in the management of clinical access for patients and the management of cardio vascular health checks.
• Between 2014 and 2016, the practice invested finances in upskilling GPs within the practice in six clinical areas. The areas were dermatology, gynaecological, ophthalmology, orthopaedics, urology and ear nose and throat conditions. These were the areas the practice had assessed as areas for improvement for managing referrals. The practice could show the impact of this activity through audits of their referrals, which demonstrated improved quality and focus of referral activity.
• The practice was part of a local pilot scheme to identify patients at high risk of developing diabetes, and take a proactive approach to identifying, reviewing, engaging patients in the prevention of onset for diabetes, and offering diabetes education via the local Diabetes Prevention Program. The practice had identified 575 patients with impaired glucose regulation. Less than 8% (42 patients) were subsequently confirmed as diabetic. The remaining 92% were included in the practices recall for a review, under the long term condition review process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 January 2017

The practice is rated as outstanding for the care of patients with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
• Longer appointments and home visits were available when needed. The practice’s electronic 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 had regular reviews to check health and medicines needs were being met. The practice had lower performance than local and national averages for some long-term conditions. The practice told us this was most likely due to the demographics and deprivation levels of the local area. Patients were less likely to engage in chronic disease management and would not attend for appointments. The practice continued to send multiple invites to patients to encourage them to attend. The practice had also implemented improvement plans in those areas of QOF where they were below comparators, to improve achievements.
• The practice was part of a pilot scheme to identify patients who were at high risk of diabetes, whose needs would not have otherwise been reviewed. This helped them identified patients who were at high risk of diabetes, include them in recalls for regular reviews, engage them in the prevention of onset for diabetes, and offer diabetes education via the local Diabetes Prevention Program.
• For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 16 January 2017

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 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. Childhood immunisation rates for the vaccinations given were mostly higher than CCG averages.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice’s uptake for the cervical screening programme was 82.5%, which was similar to the CCG average of 83.2% and the national average of 81.4%.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 16 January 2017

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. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.

Updated 16 January 2017

The practice is rated as outstanding 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 and flexible. Extended hours surgeries were offered on Tuesday until 7:15pm and on a Thursday from Thursday from 7:30am for working patients who could not attend during normal opening hours.
• There was direct access to physiotherapy, which had provided quicker access to this service for patients.
• The practice was effective at supporting patients to stop smoking. In 2015-16, the practice had a quit rate of 62%, which was the highest quit rate across County Durham.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
• Additional services were provided such as health checks for the over 40s and travel vaccinations.

Updated 16 January 2017

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

• The practice had identified 0.9% of their population with enduring mental health conditions on a patient register to enable them to plan and deliver relevant services.
• The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
• Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
• The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.
• They 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 people with mental health needs and dementia. The practice carried out advance care planning for patients with dementia.

Updated 16 January 2017

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 had identified 0.9% of their population with a learning disability on a patient register to enable them to plan and deliver relevant services.

• Patients with learning disabilities were invited to attend the practice for annual health checks and were offered longer appointments, if required.
• The practice had 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 had systems in place for identifying carers. The practice had identified their approach to supporting carers as an area where they could further improve.