Archived: Millennium Family Practice

Updated 29 November 2016

Millennium Family Practice provides care and treatment to approximately 3458 patients from the Teams, Team Valley, Chowdene, Beacon Lough, Wrekenton, Windy Nook, Sheriff Hill, Heworth, Felling, Deckham, Bensham and Mount Pleasant areas of Gateshead, Tyne and Wear. The practice 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:

Trinity Health Centre

24 West Street

Trinity Square

Gateshead

Tyne and Wear

NE8 1AD

The surgery is located in a purpose built health centre which they share with another GP practice, sexual health clinic and diabetes, podiatry and X-Ray services. All reception and consultation rooms are fully accessible for patients with mobility issues. An on-site car park is available which includes dedicated disabled car parking spaces.

The surgery is open from 8am to 6pm on a Monday, Tuesday, Wednesday and Friday (appointments from 8.30am to 5.30pm) and from 8am to 7.15pm on a Thursday (appointments from 8.30am to 7.10pm). Patients registered with the practice were also able to access pre bookable appointments with a GP at one of three local health centres from 8am and 8pm on a weekday and 9am to 2pm on a weekend.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Gateshead Community Based Care Limited (known locally as GatDoc).

Millennium Family Practice offers a range of services and clinic appointments including contraception advice, travel clinics, childhood immunisation service, long term condition reviews, minor surgery and cervical screening. The practice offered working placements for student paramedics.

The practice consists of:

• One single handed GP (male)
• One practice nurse (female)
• One health care assistant (female)
• One practice pharmacist
• Nine non-clinical members of staff including a practice manager, secretary, administrator/primary care navigator and receptionists.

The practice also employed three locum GPs on a regular basis (two male and one female) and a 3rd year nursing student on an ad-hoc basis to assist with administrative and health care related tasks.

56% of the practice patient population were male and 44% female. The average life expectancy for the male practice population is 76 (CCG average 77 and national average 79) and for the female population 81 (CCG average 81 and national average 83).

At 63.6%, the percentage of the practice population reported as having a long standing health condition was higher than the CCG average of 55.1% 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. 52.7% of the practice population were recorded as being in paid work or full time education (CCG average 59.3% and national average 61%). Levels of deprivation showed that the practice was in the third most deprived decile.

Updated 29 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Millennium Family Practice on 12 October 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 generally comparable with local and national averages. Patients reported that they were treated with compassion, dignity and respect. Patient feedback in relation to access was higher than, or comparable with 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 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 higher 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.

We saw an area of outstanding practice:

• Due to having a high number of university and college students registered with the practice they had developed a young people’s group. This group was involved in the advertising and promoting of health related services and members also delivered basic IT training to patients to enable them to access online services.

However, there were also areas where the provider should make improvements. Importantly, the provider should:

• Either arrange Disclosure and Barring Service (DBS) checks for all staff or have a risk assessment in place detailing why this is not felt to be necessary.
• Take steps to proactively identify carers.
• Make arrangements for all clinical staff to undertake Mental Capacity Act and Deprivation of Liberty Standards training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 November 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’s computer system was used to flag when patients were due for review and the practice had commissioned an external not-for-profit provider to ensure that the recall system for long term conditions was efficient and robust. The practice was in the process of ensuring that patients with multiple long term conditions were offered an annual comorbidity (multiple conditions) review whenever possible in their birthday month. .

The QOF data for 2015/16 provided by the practice showed that they had achieved good 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 asthma.
• The practice had obtained 100% of the points available to them in respect of hypertension.

The practice hosted a weekly exercise class for female ethnic minority patients at high risk of diabetes who were unable to attend a regular gym due to religious and cultural beliefs.

The practice offered in house electro cardiogram (ECG) and 24 hour blood pressure monitoring service.

Updated 29 November 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 the community midwife.

Appointments were available outside of school hours and the premises were suitable for children and babies.

Data available for 2014/15 showed that the practice childhood immunisation rates for the vaccinations given to two year olds were a consistent 100% (compared with the CCG range of 64.7% to 93.5%). For five year olds this ranged from 81.8% to 90.9% (compared to CCG range of 90.1% to 97.3%)

At 74%, 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 to the CCG average of 76% and national average of 77%.

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

Due to the high number of university and college students in the area the practice had developed a young person’s group to assist with advertising and promoting health related services and the practice had a young person specific noticeboard. The young person’s group were also involved in delivering basic IT training to practice patients to enable them to access online services. The practice had also run meningitis vaccination clinics.

Updated 29 November 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data for 2015/16 provided by the practice (the data had not been published at the time of our inspection) 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, stroke and transient ischaemic attack and osteoporosis.

A member of the non-clinical staff team had the dual role of being the practice primary care navigator. This role involved a holistic approach to ensuring a patient’s medical and social needs were referred or signposted to appropriate support services.

Updated 29 November 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 surgery was open from 8.30am to 6pm on a Monday, Tuesday, Wednesday and Friday (appointments from 8.30am to 5.30pm) and from 8.30am to 7.15pm on a Thursday (appointments from 8.30am to 7.10pm). The practice had taken steps to ensure samples taken during the late night surgery were collected the same day. Patients registered with the practice were also able to access pre bookable appointments with a GP at one of three local health centres from 8am and 8pm on a weekday and 9am to 2pm on a weekend.

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 and NHS health checks (for patients aged 40-74).

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 text message appointment reminder system was in operation.

The practice had a 24 hour answering machine service to enable patients to request repeat prescriptions. They were also in the process of implementing a 24 hour per day/seven day per week service called patient partner which would enable patients to book, cancel and rearrange appointments using an automated telephone service.

Updated 29 November 2016

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

QOF data for 2014/15 provided by the practice showed that they had achieved the maximum score available for caring for patients with dementia and depression. The practice had attained 92% in respect of caring for patients with a mental health condition, which was comparable with local and national averages.

Patients experiencing poor mental health were invited for an annual review where care plans were developed. A system was in place to ensure certain patients, including those experiencing poor mental health, to have high priority telephone access enabling them to speak to a GP within an hour of contacting the practice. Patients were also supported by the primary care navigator in accessing various support groups and third sector organisations, such as local wellbeing and psychological support services.

Updated 29 November 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 13 patients who had a learning disability. Patients with a learning disability were offered an annual health check and flu immunisation. The practice had worked with Health Quality checkers to design and implement an easy to understand pictorial registration form/information leaflet for patients with a learning disability. Together with another GP practice based in the same building the practice had appointed a young person with a learning disability as a non-clinical staff member on a temporary placement under an access to work scheme. The practice was registered as a safe haven to provide a temporary place of safety for people with a learning disability who may feel vulnerable whilst out and about in the local community.

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 identified carers and ensured they were offered appropriate advice and support and an annual health check and flu vaccination. A member of staff had been identified as a carer’s champion. However, at 0.9% of the patient population the number of carers identified was lower than we would expect.

The practice were actively engaged in identifying armed forces veterans who were then offered appropriate support in accessing relevant services by the practice primary care navigator. The practice also hosted advisors from the local Citizens Advice Bureau on a weekly basis.