Fell Cottage Surgery

Updated 18 May 2016

Fell Cottage Surgery is located in the Low Fell area of Gateshead, Tyne and Wear. The practice provides care and treatment to 8,400 patients from Low Fell and the surrounding areas of High Fell, Chowdene, Deckham and Saltwell. It is part of the NHS Newcastle Gateshead Clinical Commissioning Group (CCG) and operates on a General Medical Services (GMS) contract.

The practice provides services from the following address, which we visited during this inspection:

Fell Cottage Surgery, 123 Kells Lane, Gateshead, NE9 5XY

The practice is located in a two-storey, Grade II listed building which has been converted from a residential property for use as a GP surgery. All reception and consultation rooms are fully accessible for patients with mobility issues. There is a small car park on-site and on-street parking available nearby.

The practice is open from 8.15am to 6pm on a Monday to Friday (appointments running from 8.30am to 11.30am and 2.30pm to 5.15pm) and one Saturday morning per month.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and GatDoc. The practice is one of a number of GP practices in the Gateshead area who are part of a not-for-profit social enterprise organisation known as Gateshead Community Based Care (CBC). CBC is a co-commissioned service created with support from the local clinical commission group to increase access to GP appointments at three extended access GP ‘hubs’ spread over the Gateshead area, operate a home visit service and coordinate some administrative functions for GP practices. The practice is therefore able to offer their patients a pre bookable GP appointment from 8am to 8pm on a weekday and from 9am to 2pm on a weekend at one of the hubs.

Fell Cottage Surgery offers a range of services and clinic appointments including chronic disease management clinics, antenatal clinics, childhood health surveillance and immunisations, travel vaccinations (including yellow fever), cervical screening and minor surgery. The practice is a teaching and training practice and provides tuition to F2 doctors (a qualified doctor undertaking additional training to enable them to become a GP) and medical students.

The practice consists of:

• Five GP partners (two male and three female)
• Two salaried GPs (one male and one female)
• Three practice/treatment room nurses (all female)
• Two health care assistants
• 12 non-clinical members of staff including a practice manager, deputy practice manager, senior receptionist. Receptionists, IT facilitator, secretaries and clerical assistant.

The area in which the practice is located is in the sixth (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The practice’s age distribution profile shows more patients than the national average in the over 40 age groups. Average life expectancy for the male practice population was 78 (national average 79) and for the female population 82 (national average 83).

46.8% of the practice patient population were recorded as having a long term health condition (CCG average 56.9% and national average 54%). In general a higher percentage can lead to an increased demand for GP services.

Updated 18 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fell Cottage Surgery on 15 March 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and was able to demonstrate improvements to patient care as a result of this.
• Patient satisfaction in respect of being treated with compassion, dignity and respect and being involved in decisions about their care was good.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly
• The practice had proactively sought feedback from patients and had recently reformed their patient participation group.
• The practice was aware of areas of patient dissatisfaction but had taken steps to Mke improvements in relation to these.
• The practice had effective systems in place to support patients with long term conditions.

However there were areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Consider routinely offering annual reviews to patients with a learning disability and carers.
• Share trends and themes and lessons learned from significant events and complaints with the entire staff group.
• Review and update the practice complaints leaflet and ensure information advising patients how to make a complaint is displayed within the practice in patient-accessible areas.
• Ensure all staff have received the appropriate level of safeguarding training in line with the latest guidance.
• Review the process for determining topics for clinical audit activity.
• Update their training matrix with completed online training details so they can monitor and assure themselves of the training staff have completed.
• Ensure that fire evacuation drills are carried out on a regular basis.
• Consider formalising discussions already already taking place at meetings about succession planning and future developments within the practice into a business plan and strategy discussion.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 May 2016

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

Longer appointments and home visits were available when needed. The practice was piloting a centrally organised system for issuing long term condition comorbidity review recall letters. Nursing staff had lead roles for certain long term conditions and used a standard template to ensure all of a patient's long term conditions were reviewed in one appointment.

The practice had signed up to the NHS Year of Care approach to working with patients with long term conditions. The Year of Care model supports patients to self-manage their conditions and uses proactive care planning as a central component in achieving this.

Practice nurses were supported in undertaking additional training to help them understand and care for patients with certain long term conditions and ran regular clinics for conditions such as chronic obstructive pulmonary disease (COPD) and asthma. The practice offered a diabetes insulin initiation service and had the equipment to enable them to carry out various medical tests and monitoring for a range of conditions.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved some good outcomes in relation to some of the conditions commonly associated with this population group. For example:

• The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with chronic obstructive pulmonary disease. This was 3 percentage points above the local CCG average and 4 points above the national average.
• The practice had obtained 99.4% of the points available to them in respect of hypertension. This was 1.6 percentage points above both the local CCG and national averages

However, the practice had only obtained 73.6% of the points available to them for asthma. This was 23 percentage points below the local CCG average and 23.8 points below the national average. The practice manager explained that although several review recall letters were sent to patients with asthma many of their younger asthma patients failed to attend review appointments.

Updated 18 May 2016

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 processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were higher than national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 95.3% to 100% (compared with the CCG range of 81.3% to 97%). For five year olds this ranged from 95.6% to 98.9% (compared to CCG range of 89.8% to 97.9%).

The percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 81.4% (national average 81.8%).

Pregnant women were able to access antenatal clinics provided by healthcare staff attached to the practice. Practice clinicians carried out post-natal mother and baby checks.

Updated 18 May 2016

The practice is rated as good for the care of older people.

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 97.9% and the England average of 97.9%.

Patients aged over 75 had a named GP and the practice offered immunisations for pneumonia and influenza to older people. The practice had a palliative care register and held regular multi-disciplinary meetings to discuss and plan end of life care. Palliative care patients were prescribed anticipatory medicines when appropriate.

The practice operated a weekly ward round approach to supporting their patients who were resident in local care homes and had ensured that all these patients had a care plan which included documenting discussions about resuscitation. The practice had also ensured that comprehensive care plans were in place for 2% of their patients most at risk of unplanned or avoidable admission to hospital.

One of the practice health care assistants supported patients with long term conditions who were housebound and unable to attend review appointments at the practice.

Updated 18 May 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 met. The practice was open from 8.15am to 6pm on a Monday to Friday (appointments available from 8.30am to 11.30am and 2.30pm to 5.15pm) and one Saturday morning per month. The practice was also able to offer their patients a pre bookable GP appointment from 8am to 8pm on a weekday and from 9am to 2pm on a weekend at one of three extended access GP ‘hubs’ in the Gateshead area.

The practice offered minor surgery, contraceptive services and travel immunisations (including yellow fever). Patients were able to book appointments and request repeat prescription online and a full range of health information was available on the practice web site.

Updated 18 May 2016

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

Data for 2014/15 showed that the percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 85.9%. This was comparable to the local clinical commissioning group (CCG) average of 86% and above the national average of 84%. However, the practice had only achieved 14.5% of the points available to them for ensuring patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive agreed care plan documented in their record in the preceding 12 months. This was below the CCG average of 84.7% and national average of 88.3%. Practice staff felt this was due to patients with mental health conditions failing to attend review appointments despite receiving regular recall letters and told us that their performance in this area had improved greatly. More recent results forwarded to us by the practice after our inspection showed that 73% of the 77 patients on their register of patients with a mental health issue had an agreed care plan in place.

Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as psychological support services. The practice hosted counsellors from a local mental health charity which provides confidential support services for people experiencing emotional or mental health problems.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. The practice carried out dementia screening and referred patients to a memory protection service and local support services.

Updated 18 May 2016

The practice is rated as good for the care of people whose circumstances make them vulnerable.

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. However, patients with a learning disability were not routinely offered an annual health review.

The practice had established 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 was proactive in identifying carers and ensuring they were offered flu vaccinations and referred to relevant support services. Carers were not routinely offered an annual health review.

The practice regularly hosted a drug and alcohol support worker.