The Surgery - Great Lumley

Updated 17 October 2016

The Surgery, Great Lumley is a purpose built GP premises in Great Lumley, Chester-Le-Street, County Durham. They have a General Medical Services (GMS) contract and also offer enhanced services for example: minor surgery. The practice covers the area of Great Lumley, Chester-Le-Street and is situated approximately two miles from Chester-Le-Street town centre. Car parking facilities are good. Transport links are satisfactory. There is a pharmacy situated behind the practice. There are 4880 patients on the practice list and the majority of patients are of white British background. The practice catchment area is classed as 7 out of 10 in the Indices of Multiple Deprivation (The lower the Indices of Multiple Deprivation (IMD) decile the more deprived an area is). The area is an ex-mining community.

The practice consists of two GP partners, both female. There are also two salaried GPs (one female and one male). One of the salaried GPs is hoping to join the partnership soon. The practice has seen a turnover in staff in the last year as the Senior Partner retired and the Practice Manager left.

The practice is supported by a practice manager along with reception and administration staff. There is a nurse practitioner an independent prescriber, two practice nurses and a health care assistant all of which are female. The practice employs a pharmacist.

The practice is a teaching and training practice, patients are able to be seen by GP’s, doctors training to become a GP and Foundation Year two doctors.

The practice is open between 8.15am and 5.45pm Monday to Friday with phone lines open from 8am to 6pm. Appointments are from 8.30am to 5.30pm daily. Extended hours appointments were offered every Saturday from 8am to 10.45am.

Patients requiring a GP outside of normal working hours are advised to contact NHS 111 who will refer them to the GP out of hours service commissioned by North Durham CCG. The Group have an agreement with the CCG that the out of hours service will cover between the hours of 6pm to 6.30pm.

Updated 17 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery, Great Lumley on 25 August 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• Kindness and compassion was fundamental to the practice ethos and we were told that patients were at the centre of what they did. This was corroborated by patient survey results, what we were told by patients on the day and via completed questionnaires.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example they had taken on the role of extended diabetes care for patients in the local area due to an identified need for the service; this included insulin initiation and had required extra staff training. GPs had also undertaken extra training in gynaecology, dermatology and cardiology following identification of a high number of their patients requiring this care. This increase in expertise showed a reduction in referrals to secondary care in these areas because of this.

• The practice funded care for pre-diabetic patients and performed reviews on these patients in order to prevent disease progression. They had provided this service for two years.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example they worked closely with local charities and the Carer’s Association, enabling their patients to benefit from services they had to offer.

• The practice had a clear vision which had quality and safety as its top priority. The strategy was regularly reviewed and discussed with staff. Staff told us that there was no hierarchy in the team and that they felt supported and valued.
• Following the loss of two key members of staff the practice had recognised that staff were unsettled due to the uncertainty and change and they had completed a team forming and building exercise. They had also introduced staff reward schemes.

• The practice had strong and visible clinical and managerial leadership and governance arrangements. Leadership was a priority at the practice and they were busy developing their new business plan, which was to be shared with staff. Continuous improvement was embedded into the culture of the practice. In response to the Patient Survey results, the practice had had a whole team effort focussing on shared decision making with patients. The results in this area had improved substantially following this.

We saw several areas of outstanding practice:

The practice had purchased equipment to provide near patient testing to patients. This ensured correct treatment with antibiotics was provided and had reduced antibiotic prescribing figures in line with national guidance.

The practice worked strongly with the local community and patients told us there was a strong family feel and sense of community spirit. The practice had implemented a scheme whereby patients in need were provided with hygiene packs made up by the Women’s Union if they were admitted to hospital. These included essential toiletries.

The leadership in the practice drove continuous improvement and staff were accountable for delivering change. Safe innovation was celebrated. There was a clear proactive approach to seeking out and embedding new ways of providing care and treatment. The practice had introduced the ‘Extra Mile’ and ‘Make a Difference’ schemes to incentivise and reward staff and recognise compassionate care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 October 2016

OUTSTANDING

The practice is rated as outstanding 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, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less (01/04/2014 to 31/03/2015) was 81% which was in line with local figures of 81% and national figures of 81%.

• 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 to 31/03/2015) was 86% which was above local figures of 81% and national figures 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.

• The practice staff had undertaken extra training in diabetes and were responsible for providing a new service to their own patients and also diabetic patients in the federation area. This was in response to the present service being discontinued and was due to commence shortly.

• Patients benefitted from near patient testing due to equipment purchased by the practice. This ensured that they were treated appropriately with antibiotics.

• The practice pharmacist carried out reviews for patients on multiple medications.

Updated 17 October 2016

OUTSTANDING

The practice is rated as outstanding 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 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 (01/04/2014 to 31/03/2015) was 85% which was in line with local figures of 83% and national figures 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 provided knitted teddy bears to babies and children who were distressed or poorly.

• The practice ran a well woman clinic with extended contraceptive and women’s health advice including endometrial sampling, which was overseen by a GP with extended training in gynaecology.

Updated 17 October 2016

OUTSTANDING

The practice is rated as outstanding 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.

• The practice participated in a frail and elderly scheme in conjunction with the Clinical Commissioning Group whereby trained practice nurses carried out home assessments. Those assessed as having further needs were signposted onwards as appropriate.

• The practice offered a weekend support for vulnerable patient’s scheme in conjunction with the Clinical Commissioning Group. Patients identified as potentially needing contact over the weekend were informed of the scheme and telephone contacts or visits were arranged.

• GPs had extended their skills in cardiology, gynaecology and dermatology to improve the service to their patients.

• The practice pharmacist carried out reviews for elderly patients on multiple medications in their own home including patients who were not housebound.

Updated 17 October 2016

OUTSTANDING

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, 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.

• Patients at risk of developing diabetes had been identified by the practice and were called in for regular reviews. This had been originally been implemented two years ago as part of the ‘improving outcomes scheme’ with the CCG but had been continued and had now been funded by the practice for six months.

Updated 17 October 2016

OUTSTANDING

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 93% which was above the local average of 90% and the national average of 88%.

• 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. They had strong links with the local mental health charity.

• 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 17 October 2016

OUTSTANDING

The practice is rated as outstanding 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. We were told that the practice staff knew their patients and could identify causes for concern.

• Vulnerable patients who were admitted to hospital were provided with a hygiene pack which included toiletries.

• 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.