Northumberland Park Medical Group, Shiremoor Resource Centre

We carried out an announced comprehensive inspection at Northumberland Park Medical Group, on 22 and 29 January 2019, as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected.
• information from our ongoing monitoring of data about services and,
• information from the provider, patients and other organisations.

The practice was rated as requires improvement for providing safe services because:

• The arrangements for documenting the outcomes of the practice’s multi-disciplinary team safeguarding meetings and significant events were not effective. Although staff told us lessons were learnt when things went wrong, it was not always clear whether agreed changes had been reviewed and implemented, to make sure they had helped to drive improvements.
• Immunisation histories had not been obtained for some non-clinical staff.
• The practice’s health and safety risk assessment did not comprehensively address risks to patients’ safety.
• The practice’s locum GP pack was out-of-date and there was no lead GP to oversee the performance of locum and salaried GPs.

The practice was rated as requires improvement for providing effective services because:

• The practice did not have a comprehensive programme of quality improvement activity.
• The practice did not have an effective staff appraisal system.
• The practice’s arrangements for documenting staff inductions were not effective.
• The Quality and Outcome Framework long-term conditions clinical indicators relating to the treatment of patients with asthma and atrial fibrillation, were lower than the local clinical commissioning group and national averages.
• Follow-up consultations did not always take place following a patient’s discharge from hospital.

Because these concerns impacted on all population groups, we have rated them as requires improvement for providing effective services.

The practice was rated as good for providing caring services because:

• Feedback from people who used the service was positive about the way that staff treated them.
• Staff treated patients with kindness and respect and involved them in decisions about their care and treatment. Most of the practice’s results from the national GP patient survey, regarding how patients were treated, were higher than the local clinical commissioning group and national averages.

The practice was rated as good for proving responsive services because:

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way, that ensured choice and continuity of care.
• Most patients told us they could access care and treatment in a timely way.

The practice was rated as requires improvement for well-led because:

• The practice did not have a clear vision and credible strategy to provide high quality sustainable care.
• Leaders had not identified the actions needed to address the challenges they faced, regarding the delivery of high-quality care and the sustainability of the service. A development programme for leaders was not in place.
• The practice’s governance arrangements were not always effective. There were shortfalls in the practice’s systems and processes, and in the leadership oversight of these, which could place some patients at risk of not receiving appropriate care and treatment.

We also found that:

• Effective arrangements were in place to maintain a safe patient environment. Regular checks were carried out to make sure clinical, and other equipment, was safe to use.
• The practice had effective systems for the appropriate and safe use of medicines.
• Arrangements had been made to ensure care and treatment was delivered in line with current legislation, standards and evidence-based guidance.
• Most outcomes for people who use the service were positive, consistent and met expectations.

The overall rating for this practice was requires improvement due to concerns in providing safe, effective and well-led services. We are rating the practice as good overall for providing responsive services, including all the population groups, because patients could access timely care and treatment which had been tailored to meet their needs.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance, in accordance with the Fundamental Standards of Care.
• Ensure persons employed in the provision of the regulated activity receive appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

The areas where the provider should make improvements are:

• Improve how patients who are also carers are identified, to enable this group of patients to access appropriate care and support.
• Provide patients with access to information about complaints in the reception waiting areas.
• Review the arrangements for monitoring emergency hospital admissions, sharing information with community services and social services, and identifying patients at risk of suicide or self-harm.
• Review the effectiveness of the practice’s performance management system.
• Review the arrangements on the practice’s website for providing patients with information about support groups.
• Consider providing the practice’s infection lead with advanced training in the prevention and management of infection control.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice