Monkwearmouth Health Centre

Updated 3 February 2017

Drs Gellia and Balaraman are located within Monkwearmouth Health Centre in a residential area of Sunderland north of the River Wear. The practice provides care and treatment to around 2,000 patients from the Monkwearmouth and surrounding area of Sunderland. It is part of the NHS Sunderland clinical commissioning group (CCG) and operates on a Personal Medical Services (PMS) contract agreement for general practice.

The practice provides services from the following address:

Monkwearmouth Health Centre, Dundas street, Monkwearmouth, Sunderland, SR6 0AB.

The practice is located in a single storey purpose built building which it shares with other NHS health providers including a dental surgery, chiropodist and diabetic eye and foot clinic. All communal areas, waiting areas and consultation rooms are fully accessible for patients with mobility issues. Car parking facilities, including disabled car parking spaces and lockable bike storage are available on site. The practice is open between 8am and 6pm on a Monday, Tuesday and Friday; from 8am to 7pm on a Wednesday and from 7.30am to 1pm on a Thursday. One of the GPs remains ‘on-call’ on a Thursday afternoon to deal with requests for emergency appointments.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Vocare (known locally as Northern Doctors Urgent Care).

Drs Gellia and Balaraman offer a range of services and clinic appointments including chronic disease management clinics, antenatal clinics, baby clinics, well women clinics, travel vaccinations and childhood immunisations. The practice consists of:

• Two GP partners (one male and one female)
• One practice nurse (female)
• One health care assistant who also acts as an administrator
• A practice manager
• An administrator
• Two medical receptionists

The practice is a teaching practice and provides training to third year medical students.

The area in which the practice is located is in the fourth 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 showed a lower percentages of patients aged over 44 and under than the national average and a higher number of patients aged over 45. Average life expectancy for the male practice population was 77 (national average 79) and for the female population 83 (national average 83).

Updated 3 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Monkwearmouth Health Centre on 3 September 2015, which resulted in the practice being rated as good overall but as requiring improvement for providing safe services. The full comprehensive report can be found by selecting the ‘all reports’ link for Monkwearmouth Health Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out in December 2016 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection in September 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is rated as good overall; including for providing safe services.

Our key findings were as follows:

• Pre-employment checks had been carried out for new staff.
• Staff had received appropriate chaperone and infection control training.
• Sharps boxes were appropriately labelled and fire extinguishers were serviced within designated timescales.
• Infection control audits were carried out regularly. The practice manager had arranged to accompany the domestic supervisor on a quarterly inspection of cleaning standards. One inspection had been carried out in October 2015; due to other commitments the practice manager had not attended the following three inspections but had arranged to attend in early December 2016.
• All staff had received an annual appraisal.
• A business plan had been drafted and was awaiting final approval from the GP partners.

The area where the provider should make improvements is:

• Take steps to ensure quarterly inspections of cleaning standards are carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 December 2015

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

The practice had systems in place to ensure patients with long term conditions were recalled for review when required. Home visit reviews were available for housebound patients. The practice nurse was a nurse prescriber which meant that they were able to review and prescribe most medication following a long term condition review without GP intervention. This not only reduced the time patients waited for a prescription but also reduced pressure on the GPs.

The practice had supported and empowered one of its administrative staff to complete smoking cessation training. This member of staff now delivered a weekly in-house smoking cessation clinic. At the time of our inspection they had delivered the programme to 12 patients, four of whom had successfully completed the programme and stopped smoking entirely.

Chronic disease management clinics were held to cover a wide variety of diseases and the practice had ensured that self-held care plans were in place for a number of patients including those at risk of an unplanned admission to hospital.

Updated 10 December 2015

The practice is rated as good 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 looked after children or children subject of a child protection plan. The practice had identified one of the GPs as safeguarding lead who was responsible for providing information to and attending multi-agency safeguarding meetings. The practice also held quarterly meetings with health visitors and school nurses to discuss safeguarding cases and concerns.

The practice had a recall system in place for childhood immunisations and rates were in line with or above local averages for all standard childhood immunisations. Appointments were available outside of school hours, starting at 7:30am and up to 7:00pm one day per week. Cervical screening rates for women aged 25-64 were above local and national averages.

An area of the practice had been dedicated to providing a young person specific notice board which contained a range of health information leaflets and contact information for services including sexual health, puberty, mental health, drugs and alcohol. The practice proactively identified and supported young carers and had produced a leaflet for young carers which was available in the practice. In conjunction with its patient participation group (PPG) the practice had also arranged for two local pharmacies to attach a copy of the leaflet to prescription orders for a period of time.

Updated 10 December 2015

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

Nationally reported data showed the practice had achieved good outcomes in relation to the conditions commonly associated with older people. Patients over the age of 75 had a named GP and were routinely invited to attend an over 75 health check. Home visits were available.

The percentage of patients aged 65 and older who had received a seasonal flu vaccination was higher than the national average and the practice was proactive in offering annual flu and one-off pneumococcal and shingles vaccinations.

The practice actively identified and flagged palliative care patients to ensure they were supported appropriately and multi-agency palliative care meetings were held on a quarterly basis.

The practice had taken steps to ensure care plans were in place for its frail and elderly patients and for those resident in local nursing homes.

Updated 10 December 2015

The practice is rated as good for the care of working age patients (including those recently retired and students).

Nationally reported data showed that 52.3% of the practice population either worked or was in full time education (national average 60.2%). The practice was proactive in meeting the needs of these patients by offering online services such as being able to order repeat prescriptions, book appointments and view parts of their medical records. The practice was open from 8.00am to 6.00pm on a Monday, Tuesday and Friday; from 8.00am to 7.00pm on a Wednesday and from 7.30am to 1.00pm on a Thursday. One of the GPs remained ‘on-call’ on a Thursday afternoon to deal with requests for emergency appointments. Repeat prescriptions could be ordered at any time either online, in person or by telephone. The practice was also involved in the choose and book scheme which enabled patients referred to a hospital or clinic to choose the provider of their choice and at date and time which is convenient.

Updated 10 December 2015

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

The practice had exceeded the national average in ensuring comprehensive and agreed care plans were in place for patients with schizophrenia, bipolar affected disorder and other psychoses (92.3% compared to an England average of 86%) and for ensuring patients diagnosed with dementia had received a face-to-face review within the preceding 12 months (87.5% compared to an England average of 83.8%).

Practice staff had undertaken dementia awareness training to ensure they had a greater understanding of the needs of patients with dementia. The practice had signed up to deliver an enhanced service to dementia patients and was committed to ensuring patients suffering from dementia were referred to the local memory clinic in a timely manner. The practice had developed an effective working relationship with a local care home where the majority of its patients suffered from dementia and were considering a ward round approach to reviewing and treating residents.

Practice clinicians were aware of their responsibilities under the Mental Capacity Act (2005) and in respect of gaining consent to care and treatment.

Updated 10 December 2015

The practice is rated as good for the population group of patients whose circumstances may make them vulnerable.

The practice had a register of patients aged 18 or over with a learning disability and had a recall system in place to ensure these patients were offered an annual health check. The practice was working with the local clinical commissioning group (CCG) to improve services for patients with a learning disability and were planning to host the Sunderland People First Team (a self-advocacy group for the learning disabled population of Sunderland) in the near future. The aim of this was to review how the practice services, premises and staff accommodated and interacted with people with a learning disability. The Practice had also developed an effective working relationship with a local residential home for people with a learning disability and were flexible in their approach to requests for home visits from the residents.

Staff knew how to recognise signs of abuse in vulnerable adults and children and how to raise safeguarding concerns with the relevant agencies. The practice had identified a clinical lead for dealing with vulnerable adult and vulnerable children cases and all practice staff had undertaken safeguarding training at a level appropriate to their role.

The practice was proactive in identifying and responding to the needs of carers and had participated in the Carer’s Incentive Scheme promoted by Sunderland Carer’s Centre and the CCG. This scheme was aimed at proactively identifying carer’s and offering support by way of a referral to the carer’s association.

The practice ensured that a note of a patient’s first spoken language was recorded on the records of their non-English speaking patients to ensure that an appropriate interpreter was booked for their appointment. These patients were automatically offered a longer appointment.