Marsh House Medical Centre Also known as Marsh House Medical Practice

Updated 30 March 2016

Marsh House Medical Centre is near the centre of Billingham. The practice is housed in a purpose built medical centre housing and includes another two practices and a pharmacy. The practice staff were involved in the design of the building which is Eco friendly using solar energy and recycling rain water. There is a drive in pharmacy which means people do not leave their cars when handing in or collecting their prescriptions. There are 8500 patients on the practice list. The proportion of the practice population in the 45 to 65 years age group is slightly above the England average.

There are five GP partners, three female, and three practice nurses and one health care assistant. There is a practice manager who is supported by reception, medicines management, secretarial and other administration staff. The practice is an established training and teaching practice (teaching practices take medical students and training practices have GP trainees and F2 doctors. Foundation doctors are undergoing a two-year planned programme of training where doctors learn about working in the teams that deliver care in the NHS as well as the clinical aspects of caring for sick patients. It is a transition period of practice between being a student and undertaking more specialised training for a future career in a specialist branch of medicine such as general practice or hospital medicine.).The practice also offers a placement for pharmacy students. There were two GP registrars in the practice on the day of inspection.

The practice is open from 8am to 6pm, Monday to Friday. Appointments are available during these times. Each of the GP partners have their own lists and appointment times are different for each time. The practice provides extended hours on a Monday and Tuesday evening until 19.30. We saw that appointments can be booked by walking into the practice, online and by the telephone. The practice did not use a telephone triage system. However telephone slots where patients requested a call back from the GP or nurse were booked at the end of each surgery. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Northern Doctors Urgent Care via the NHS 111 service. The practice has a General Medical Service (GMS) contract. The practice is close to the town centre and there is parking available at the practice and nearby. There are good links to public transport.

Updated 30 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Marsh House Medical Centre on 21January 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt 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. This means providers must be open and transparent with service users about their care and treatment, including when it goes wrong.

We saw one area of outstanding practice:

• The GP partners held a personal patient list, which meant the GPs always saw their own patients. The exception would be such things as when a GP was on annual leave. When the GP was not available another GPs provided buddy cover. This meant patients were seen by their named GPs even when requesting an emergency appointment. This enabled good relationships to be built between the patient, and the named GP.

However the area of practice where the provider should make improvement are:

• Review the process for checking the collection of patient’s prescriptions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 March 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.

• The nurses were trained to manage all long term conditions and there were designated GPs who liaised with the nurses to provide patients with timely, appropriate care.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the proportion of patients on the diabetes register with a record of foot examinations in the preceding 12 months was 93% which was above the national average of 88%.

• Longer appointments and home visits were available when needed. More complex patients were reviewed more frequently.

• 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.

Updated 30 March 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.

• Nationally reported data from 2014/2015 showed 74% of patients diagnosed with asthma, on the register, had had an asthma review in the last 12 months which is just below the national average of 75.

• 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.

• Nationally reported data from 2014/2015 showed the proportion of women aged 24 -64 who had had cervical screening performed was 81% which was the same as the national average of 81%.

• 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.

Updated 30 March 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 named GP monitored their housebound patients.

• The practice identified poorly and vulnerable patients who required open access to the clinician. There was a separate telephone number for high risk patients to access urgent care.

• There were named GPs for individual care homes with regular weekly contact by telephone or visit.

• Every patient over the age of 75 had a named GP.

Updated 30 March 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.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 30 March 2016

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

• 97% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which isabove thenational average.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 and dementia. The practice worked with the pharmacist to audit mental health prescribing to ensure continued safe practice.

Updated 30 March 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 multi-disciplinary teams in the case management of vulnerable people.

• 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.