Archived: Infirmary Drive Medical Group

Updated 21 April 2016

The practice is located in a semi-rural area in the market town of Alnwick, approximately 35 miles north of Newcastle-Upon-Tyne. The practice provides care and treatment to 9,577 patients from Alnwick and the surrounding areas. It is part of the NHS Northumberland Clinical Commissioning Group (CCG) and operates on a Personal Medical Services (PMS) contract. The practice is a part-dispensing practice and dispenses to patients from the Alnham, Edlingham, Hedgley, Ingram and Whittingham areas.

The practice provides services from the following address, which we visited during this inspection:

Infirmary Drive Medical Group, The Consulting Rooms, Alnwick, Northumberland, NE66 2NR

The practice is located in a modern purpose-built single storey building on the same site as Alnwick Infirmary. The practice shares the building with district nursing staff, health visitors, speech and language therapists and a podiatrist. All reception and consultation rooms are fully accessible for patients with mobility issues. On-site parking is available, which includes dedicated disabled parking bays. The hospital pay and display car park is located adjacent to the practice.

The practice is open from 8am to 6pm on a Monday to Friday with appointments being available from 8.10am to 10.30am and 3pm to 5.20pm. The practice is also open after 6pm on Tuesday and alternate Wednesday evenings for pre bookable appointments only.

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

Infirmary Drive Medical Group offers a range of services and clinic appointments including chronic disease management clinics, cervical screening, family planning, childhood development and immunisations, cervical screening, travel advice, smoking cessation and minor surgery. The practice consists of:

• Four GP partners (two male and two female)
• Three salaried GPs (one male and two female)
• Five practice nurses
• Two health care assistants
• 28 non-clinical members of staff including an operational manager, IT manager, reception manager, dispenser, administration/reception staff, secretaries and cleaners.

The area in which the practice is located is in the eighth (out of ten) 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 shows fewer patients than the national average under the age of 44 and more patients than the national average over the age of 45. Average life expectancy for the male practice population is 78 (national average 79) and for the female population 82 (national average 83).

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Infirmary Drive Medical Group on 4 February 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.
• The practice regularly reviewed demand for appointments. Urgent appointments were 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.

However, there were some areas where the provider needs to make improvements. The provider should:

• Review and strengthen the process currently in place for checking the expiry dates of medicines held in GP bags
• Review and strengthen the stock control process in the dispensary
• Review and strengthen the arrangements currently in place for dealing with patient safety alerts
• Formalise the arrangements currently in place for carrying out infection control audits and continue with plans to ensure all staff receive infection control training as soon as possible

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 April 2016

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

Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Practice nurses were supported in undertaking additional training to help them understand and care for patients with certain long term conditions, such as diabetes.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to some of 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 (local CCG average of 99.3% and national average of 97.4%) and chronic obstructive pulmonary disease (CCG average 98.3% and national average 96%).

Diabetic patients were offered structured training on how to effectively self-manage their condition.

Updated 21 April 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 ‘supporting families’ meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were comparable with local and national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 93.9% to 98.8% (compared with the CCG range of 95.3% to 98.1%). For five year olds this ranged from 91.4% to 98.9% (compared to CCG range of 94.9% to 100%).

The practice’s uptake for the cervical screening programme was 78.4%, which was comparable to the CCG average of 79.1% and national average of 74.3%.

Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice. The practice also provided contraceptive advice and a intra uterine device fitting service

Updated 21 April 2016

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

Nationally reported data showed the practice had 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 with heart failure (local clinical commissioning group (CCG) average of 98.9% and the England average of 97.9%) and with osteoporosis (CCG average 93.4% and England average 81.4%).

The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, all patients over the age of 75 had a named GP and the practice was proactive in ensuring that patients over the age of 75 were offered an annual health check. Monthly multidisciplinary meetings were held to review the care and support provided to patients at high risk of admission to hospital and comprehensive care plans were developed. A lead GP for patients at high risk of admission to hospital had been identified whose role include attending monthly multidisciplinary meetings at a local care home

The practice maintained a palliative care register and held flu and shingles vaccination sessions.

Updated 21 April 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 practice was open from 8am to 6pm on a Monday to Friday with appointments being available from 8.10am to 10.30am and 3pm to 5.20pm. The practice was also open after 6pm on Tuesday and alternate Wednesday evenings for pre bookable appointments.

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.

Updated 21 April 2016

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

At 96% the percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was higher than the national average of 84%. However, only 65% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented within the previous 12 months (national average 88%). The practice felt that this had been due to a gap in having an identified GP lead for mental health conditions. This gap had now been filled and the practice were committed to improvement in this area.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Patients experiencing poor mental health were sign posted to various support groups and third sector organisations. Mental health counsellors, community psychiatric nurses, psychologists and alcohol support workers were able to use practice consultation rooms. The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests. Patients with complex mental health needs were allocated a named GP who worked with the patient to agree prescribing protocols and emergency attendance usage.

Updated 21 April 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. There was a designated nursing lead for patients with learning disabilities and these patients were invited to attend the practice for annual health checks and relevant vaccinations. Longer appointments for people with a learning disability were routinely available.

The practice had 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 was in the process of strengthening the arrangements in place to support patients who were carers and aimed to proactively rather than opportunistically identify carers. When carers were identified they were signposted to the local carers association for advice and support.