Murton Medical Group Also known as Murton Medical Group

Updated 26 January 2017

Dr DS Rangar and partners provides care and treatment to approximately 7,658 patients from the Murton area of County Durham. The practice is part of the NHS Durham Dales, Easington and Sedgefield Clinical Commissioning Group (CCG) and operates on a Personal Medical Services (PMS) contract.

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

Murton Medical Centre

20 Woods Terrace East

Seaham

County Durham

SR7 9AB

The surgery is located in an ex residential property which underwent a major extension and refit in 2011. All reception and consultation rooms are fully accessible for patients with mobility issues and there is an elevator for patients needing to access the lower or upper floors of the building. An on-site car park is available to the rear of the building.

The surgery is open from 8am to 6pm on a Monday, Wednesday, Thursday and Friday (appointments from 8am to midday than 1pm to 6pm) and from 8am to 8.30pm on a Tuesday (appointments from 8am to midday then 1pm to 8.30pm). Patients registered with the practice are also able to access an emergency clinic at a local primary care centre on a Saturday morning.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service.

Dr D S Rangar and partners offer a range of services and clinic appointments including long term condition, smoking cessation, family planning, childhood health and cervical cytology clinics. The practice also offers minor surgery, joint injections and anticoagulation management.

The practice consists of:

• Three GP partners (two male and one female)
• Three salaried GPs (all female)
• One nurse practitioners (female)
• Three practice nurses (female)
• One pharmacist (female)
• Two health care assistants (female)
• 12 non-clinical members of staff including a practice manager, assistant practice manager, practice secretaries, practice administrators, a summariser and receptionists.

The practice is a teaching practice and involved in the teaching of undergraduate medical students learning about GP practice. It also hosts student nurses to help them gain a basic understanding of general practice whilst studying for their nursing degree.

The practice is a member of the South Durham Health Community Interest GP Federation which is a group of 13 practices working collaboratively to co-commission services and to share responsibility for developing and delivering high quality, patient focused services for the local community.

The average life expectancy for the male practice population is 77 (CCG average 77 and national average 79) and for the female population 81 (CCG average 81 and national average 83).At 51% the practice had slightly more female patients than male patients.

At 61%, the percentage of the practice population reported as having a long standing health condition was higher than the CCG average of 59.4% and national average of 54%. Generally a higher percentage of patients with a long standing health condition can lead to an increased demand for GP services. At 50.7% the percentage of the practice population recorded as being in paid work or full time education was lower than the CCG average of 54.4% and national average of 61.5%). The practice area is in the fourth most deprived decile. Deprivation levels affecting children were comparable to the local CCG average but higher than the national average. Deprivation levels affecting adults were lower than the local CCG average but higher than the national average.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr D S Rangar and Partners, Murton Medical Group on 17 November 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. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• Feedback from patients about their care was better than local and national averages. Patients reported that they were treated with compassion, dignity and respect.
• Patient feedback in relation to access was lower than local clinical commissioning group and national averages.
• Patients were able to access same day appointments. Pre-bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice was proactive in their approach to encouraging patients to use online services. Over 20% of the patient population had registered for online services.
• The practice had proactively sought feedback from patients and implemented suggestions for improvement and made changes to the way they delivered services in response to feedback.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved an overall result which was lower than local and national averages. However, their clinical exception rate was also lower than local and national averages.
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

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’s computer system was used to flag when patients were due for review. Patients with multiple long term conditions were offered one fully comprehensive review in their birthday month whenever possible.

The QOF data for 2015/16 provided by the practice showed that they had achieved mixed outcomes in relation to 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 kidney disease, depression and hypertension but had scored below local and national averages for asthma, chronic obstructive pulmonary disease and rheumatoid arthritis.

The practice offered an insulin initiation service for diabetic patients as well as in house anticoagulation monitoring and spirometry.

Updated 26 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 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, such as those who did not attend for childhood vaccinations or had visited A&E. The needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as the community midwife.

Appointments were available outside of school hours and the premises were suitable for children and babies. The practice was participating in a breast feeding friendly scheme and had pledged to ensure that mothers wishing to breastfed were provided with a clean, comfortable environment in which to do so.

Data available for 2015/16 showed that the practice childhood immunisation rates for the vaccinations given to two year olds ranged from 95.7% to 100% (compared with the CCG range of 95.5% to 99% and national range of 73.3% to 95.1%). For five year olds this ranged from 97.9% to 98.9% (compared to CCG range of 96.6% to 99.3% and national range of 81.4% to 95.1%).

At 76.2%, 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 comparable with the CCG average of 82.5% and national average of 81.8%.

Pregnant women were able to access a full range of antenatal and post-natal services at the practice.

Updated 26 January 2017

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

Nationally reported Quality and Outcomes Framework (QOF) data for 2015/16 showed the practice had achieved 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 experiencing heart failure and osteoporosis and for those requiring palliative care.

Together with other GP practices in the area the practice had developed the Vulnerable Adults Wrap Around Service (VAWAS) team. This was a team of advanced nurse practitioners who visited frail elderly patients in their own home or care home to ensure they were receiving appropriate health and support services to enable them to avoid unplanned admission to hospital or A&E attendances.

Two of the GPs had undertaken additional training in palliative care and developed effective working relationships with local consultants.

Updated 26 January 2017

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 surgery was open from 8am to 6pm on a Monday, Wednesday, Thursday and Friday (appointments from 8am to midday then 1pm to 6pm) and from 8am to 8.30pm on a Tuesday (appointments from 8am to midday then 1pm to 8.30pm). Patients registered with the practice were also able to access an emergency clinic at a local primary care centre on a Saturday morning.

The practice offered sexual health and contraception services, travel advice, childhood immunisation service, antenatal services and long term condition reviews. They also offered new patient, NHS health checks (for patients aged 40-74) and over 75 health checks.

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. A computerised ‘health pod’ was available in reception which enabled patients to record their own patient data, such as carer responsibilities and take readings such as blood pressure, height and weight. The results were then automatically saved to a patient’s medical record and a system was in place to ensure any out of range results were reviewed by a practice clinician.

Updated 26 January 2017

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

QOF data for 2015/16 provided by the practice showed that they had achieved the maximum score available for caring for patients with depression but below local and national averages for caring for patients with dementia and mental health conditions.

The practice had developed a dementia pack for patients with dementia and their carers which they were given at their annual dementia review. This gave useful information on support services, lasting power of attorney and the Mental Capacity Act 2005.

Updated 26 January 2017

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 97 patients who had a learning disability. Patients with a learning disability were offered an annual health check and flu immunisation.

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. Staffs 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 identified carers and ensured they were offered appropriate advice and support and an annual health check and flu vaccination.

The practice was part of a local safe places scheme. This meant that they had been identified as a pace for vulnerable people to go for help and support if they were feeling unsafe whilst out and about in the local community.