Archived: Hylton Medical Group

Updated 20 April 2017

Hylton Medical Group covers the City of Sunderland area. The practice provides services from Hylton Medical Group, Pallion Health Centre, Hylton Road, Sunderland, SR4 7XF. We visited this location as part of this inspection.

Pallion Healthcare Centre is purpose built and accommodates two other GP practices, an urgent healthcare service and other healthcare professionals such as community nursing staff and health visitors. The premises are fully accessible to patients with mobility needs.

The practice has one male GP who is a sole trader and works 10 sessions. There have been two long term locum GPs working at the practice, since November 2016, both are male, one works 10 sessions and the other seven sessions per week. There were arrangements with a neighbouring practice for patients to see a female GP if required. There are two full time practice nurses, a pharmacist and healthcare assistant, both who work part time. There is an acting practice manager and six administrative staff.

The practice provides services to approximately 5,700 patients of all ages. The practice is commissioned to provide services within a Personal Medical Services (PMS) agreement with NHS England.

The practice is open, Monday 7:30am to 7:30pm, Wednesday 7:30am to 6pm and Tuesday, Thursday and Friday 8am until 6pm.Consulting times with GPs and practice nurses ranged from Monday and Wednesday 7:30am, Tuesday, Thursday and Friday 8:30am until 11:30am. Afternoon surgery commences at 2:30pm and runs to 6pm every evening except a Monday when consultation run to 7:30pm.

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 Limited.

Updated 20 April 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of this practice on 21 April 2015. The practice was judged to be inadequate and placed in special measures. After this inspection the practice wrote to us to say what action they would take to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.
• Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing.
• Regulation 19 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed.

On 4 February 2016 we carried out an announced comprehensive inspection at Hylton Medical Group a nd found that improvements had been made since the previous inspection of April 2015. In recognition of the improvements made the practice was rated overall as requires improvement, having being judged as requires improvement for Effective and Well Led services. The full comprehensive reports for both inspections can be found by selecting the ‘all reports’ link for Hylton Medical Group on our website at www.cqc.org.uk .

This announced comprehensive inspection was carried out on the 2 February 2017 in order to see that action had been taken by the practice to make improvements from the inspection in February 2016. Overall the practice has been rated as inadequate from this inspection as it has failed to address a number of issues identified in the previous inspection and further issues were identified.

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.
• Risks to patients were assessed and managed.
• Outcomes for patients who use services were improving, for example for the 2016/17 QOF year so far the practice was currently achieving 96.1% of the overall points available to them.
• There was no programme of clinical audit to improve patient outcomes. The lead GP said clearly they were not interested in being involved in clinical audit they preferred to see patients.
• W e were not assured that there was discussion and leadership around best practice and clinical guidelines at practice level.
• We confirmed that staff had received training appropriate to their role. However, the practice nurses had not received any information governance training. There was no record of the lead GP carrying out information governance training​.
• Staff were proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available.
• Patients who completed comment cards said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There were mixed views from patients regarding obtaining an appointment from the comment cards completed. The practice told us they had recently improved the appointment system.
• The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.
• We were not assured that the lead GP and registered manager were providing clinical leadership and had a comprehensive understanding of the practice.
• The practice was aware of and complied with the requirements of the Duty of Candour regulation.

We identified regulatory breaches within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. They are Regulation 17 Good Governance and Regulation 18 Staffing. The Care Quality Commission is unable to take enforcement action against the provider regarding these breaches as they are incorrectly registered with the Care Quality Commission. They are currently registered as a partnership but, as the previous partner left some time ago, the current provider is working as a sole provider. We have written to the provider separately about this. We have made NHS England and the Clinical Commissioning Group aware of this position.

The provider must;

• Have the knowledge and capacity to lead effectively.
• Ensure there is discussion and leadership around best practice and clinical guidelines at practice level.
• Ensure there is a programme of clinical improvement initiatives.
• Ensure there is clinical input into the practice nurses appraisals.
• Ensure all staff receive training appropriate to their role.

The areas where the provider should make improvements are:

• Make all staff aware of the safeguarding lead.
• Take steps to be more proactive in identifying carers and to offer support to them.

On the basis of the ratings given to this practice at this inspection and the concerns identified at previous inspections on 21 April 2015 and 4 February 2016, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel their registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 2017

The practice is rated as inadequate for the care of people with long-term conditions. There are aspects of the practice that are inadequate which therefore impact on all population groups. There were, however, examples of good practice.

The practice maintained registers of patients with long term conditions. The patients were invited into the practice for structured examinations at least yearly. The practice had overhauled and worked hard on its recall systems for patients. The practice nurses had gone through the lists of patients who required review. Where necessary letters had been hand delivered and the lead GP had visited some patients. Diabetes was an area of special interest for the practice and some diabetic patients whose test results were outside the normal range were cared for by the practice in close consultation with the diabetes consultant at the local hospital.

Nationally reported QOF data showed the practice were on course to achieve good outcomes in relation to the conditions commonly associated with this population group. For example, in 2015/16 the practice had obtained 66.3% of the points available to them for providing recommended care and treatment for patients with asthma. They were currently on course to achieve 96.1% for 2016/17.

Updated 20 April 2017

The practice is rated as inadequate for the care of families, children and young people. There are aspects of the practice that are inadequate which therefore impact on all population groups. There were, however, examples of good practice.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Childhood immunisation rates for the vaccinations given were in line with CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds achieved the 90% target in 4 out of 4 sub-indicators. Child immunisation clinics were held on a weekly basis. There were also six week mother and baby checks. Appointments were available outside of school hours and the premises were suitable for children and babies. There was a baby change and separate breast feeding room on the same floor as the practice.

The practice took part in a catch up immunisation programme for students aged 17 for measles, mumps and rubella (MMR) and meningococcal group C (Men C) vaccines. Patients between 15 and 24 years were encouraged to have chlamydia testing as appropriate. Testing kits were available and promoted in the practice. The practice had a cervical screening programme. The practice’s uptake for the cervical screening programme was 80.5%, which was comparable with the national average of 81.4%.

We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 20 April 2017

The practice is rated as inadequate for the care of older people. There are aspects of the practice that are inadequate which therefore impact on all population groups. There were, however, examples of good practice.

The practice was responsive to the needs of older people, including offering home visits and longer appointments. Patients over the age of 75 had a named GP. They were included in the practice’s avoiding unplanned admissions to hospital register and had personalised care plans in place. Care plans were reviewed at the practice’s multi-disciplinary (MDT) meetings. The practice liaised with older persons services to help patients such as social services. Prescriptions could be sent to any local pharmacy electronically.

The practice had a linked residential care home where most of the patients were registered at the practice. The lead GP visited the home at least monthly and care plans were in place for the patients. The home manager had access to a private number to the practice in case of need.

The practice maintained a palliative care register and end of life care plans were in place for those patients it was appropriate for. They offered immunisations for pneumonia and shingles to older people, which included housebound patients.

Updated 20 April 2017

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). There are aspects of the practice that are inadequate which therefore impact on all population groups. There were, however, examples of good practice.

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. The practice was proactive in offering online services which included appointment booking, test results and ordering repeat prescriptions. There was a full range of health promotion and screening that reflected the needs for this age group. There were extended opening hours on a Monday evening and Monday and Wednesday mornings.

Updated 20 April 2017

The practice is rated as inadequate or the care of people experiencing poor mental health (including people with dementia). There are aspects of the practice that are inadequate which therefore impact on all population groups. There were, however, examples of good practice.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health. QOF data was on course for 2016/17 to be higher than the previous year (2015/16) when it was 55.4% for mental health indicators, the practice were currently at 98.5%.The practice also worked together with their carers to assess their needs. Patients were advised how to access various support groups and voluntary organisations.

Updated 20 April 2017

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. There are aspects of the practice that are inadequate which therefore impact on all population groups. There were, however, examples of good practice.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. They carried out annual health checks for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. They had told 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. However, some of the staff we spoke with during the inspection were not aware as to whom had the safeguarding lead responsibility.