The Surgery-Pelton

Updated 30 August 2016

The Surgery at Pelton is part of Pelton and Fellrose Medical Group. They provide services at the Lavender Centre site in Pelton and have a branch site and dispensary at Fellrose in Pelton Fell. Both sites were visited during the inspection.

The Lavender Centre is a purpose built (in 2012) GP premises in Pelton, Chester-Le-Street, County Durham. The practice shares a building with another GP practice and has premises on the first and second floor. The practice leases the building. They have a General Medical Services (GMS) contract and also offer enhanced services for example; minor surgery. The practice covers the area of Pelton, Chester-Le-Street and is situated nearly two miles from Chester-Le-Street town centre. Car parking facilities are good. Transport links are satisfactory. There are 8716 patients on the practice list and the majority of patients are of white British background. The practice catchment area is classed as 5 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 three GP partners, two male and one female. There are also two salaried GPs (both female) and a new salaried GP (male) is due to start at the practice in August 2016. The practice has struggled to recruit a new GP to the practice and existing GPs have been working extra sessions in order to negate the effect on patients. Staff and patients told us that it has been a difficult time and problems have existed with patients finding it difficult to get appointments and complaints made to staff regarding this. The practice has seen a high turnover in reception staff in the last year.

The practice is supported by a practice manager and an assistant practice manager along with reception, administration and dispensing staff at the Pelton Fell branch surgery. There is a nurse practitioner and independent prescriber, three practice nurses, a chronic disease nurse and a health care assistant all of which are female. The practice employs a pharmacist.

The practice has just become a training practice and will have their first GP Registrar in August.

The practice at the Lavender Centre is open from 8.30am to 6pm, with phone lines open from 8am. Extended hours are offered on Tuesdays from 6pm to 8pm. Fellrose branch surgery is open on Mondays, Tuesdays, Wednesdays and Fridays from 9am – 12pm and then from 2pm – 6pm. This branch is open from 9am to 12pm on Thursdays.

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 30 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery, Pelton on 5 July 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed, however we found that prescription pads were recorded but their usage was not monitored in line with national guidance. The practice was informed of this on the day of inspection and they agreed to implement a monitoring form in line with national guidance.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients on the day said they mainly found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had struggled to recruit a GP and Nurse Practitioner following staff leaving and had seen a negative impact on appointment availability because of this. However they had made every attempt to mitigate the effect of this on patients and staff. Measures included training staff in multiple roles to enable cover and the recruitment of a pharmacist to see patients who needed medication reviews in order to reduce the pressure on GP appointments. They had also recently managed to recruit both a newly qualified GP and a Nurse Practitioner who were due to start soon.

• The practice offered a Weekend Support for Vulnerable Patients 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.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a very clear leadership structure and staff felt well supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

The practice had a GP who had undertaken training in ophthalmology and the practice had invested in specific equipment to enable detailed eye examinations. This helped reduce attendance at Accident and Emergency departments.

The practice proactively reviewed governance and performance management arrangements in order to address staff shortages. Leadership at the practice motivated staff and drove continuous improvement and all staff were accountable for delivering change. The practice displayed a strong sense of valuing its staff and proactively looked at ways in which to retain them.

The areas where the provider should make improvement are:

The practice should monitor the new process of recording the usage of prescription pads via monitoring forms in line with national guidance to ensure it becomes embedded in practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 August 2016

The practice is rated as good 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. Staff with lead roles in chronic disease management were supported by a named GP and a member of administration staff.

• 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 85% 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 77% which was in line with 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 pharmacist reviewed patient's medicines to ensure they were receiving the most appropriate for their conditions and also offered appointments with patients to provide advice about their medicines and when best to take them.

• One of the GPs offered an acupuncture service to patients at the practice.

Updated 30 August 2016

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, children and young people who had a high number of A&E attendances. Immunisation rates were relatively 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 81% 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 ran a well woman clinic with extended contraceptive and women’s health advice which was overseen by a GP with extended training in gynaecology. Contraception, smears, implant fitting, coil fitting and ring pessary changes were provided.

Updated 30 August 2016

The practice is rated as good 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 Patients 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.

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

Updated 30 August 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 identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• One of the GPs had undertaken extra training in ophthalmology and was able to provide this service to patients at the practice.

• 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.

Updated 30 August 2016

The practice is rated as good 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 92% which was comparable to 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.

• 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.

Updated 30 August 2016

The practice is rated as good 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.

• 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.