Holmside Medical Group

Updated 14 January 2016

The main surgery is located within a residential area of inner West Newcastle. The branch surgery at Chapel House is located within a residential area of outer West Newcastle. The practice provides care and treatment to 9,118 patients from the surrounding areas that can access services at either location. It is part of the NHS Newcastle and Gateshead Clinical Commissioning Group (CCG) and operates on a General Medical Services (GMS) contract.

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

Main Surgery: 142 Armstrong Road, Newcastle Upon Tyne, NE4 8QB

Branch Surgery: Chapel House Primary Care Centre, Hillhead Parkway, Chapel House Estate, Newcastle Upon Tyne, NE5 1LJ.

The main surgery is located in a converted and extended terraced house with limited disabled access. On street parking is available nearby. The branch surgery is located in a purpose built medical centre which is shared with other health care providers. This surgery has good disabled access with all communal areas, waiting areas and consultation rooms being fully accessible for patients with mobility issues. Car parking facilities, including disabled car parking spaces are available on site.

The practice is open between 8.30am to 6.00pm on a Monday to Friday. The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited.

Holmside Medical Group offers a range of services and clinic appointments including chronic disease management clinics, antenatal clinics, baby clinics, young person’s sexual health, travel vaccinations and childhood immunisations. The practice consists of:

• Four GP partners (two male and two female)
• Three salaried GPs (one male and two female)
• A practice nurse (female)
• A treatment room nurse (female)
• A pharmacist
• Two health care assistants
• 16 non-clinical staff including a practice manager, assistant to the practice manager, practice co-ordinator, senior secretary and a secretary/ administration team supervisor

The practice is a teaching and training practice and provides training to third and fifth year medical students as well as GP trainees.

The area in which the practice is located is in the third 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 showed a higher percentage of patients aged 45 and over than the national average.

The practice is a member of the West End Family Health social community enterprise. This is a GP alliance who meet weekly and whose aims include working together to share ideas and meet the needs of the local community by providing services that could not be delivered in isolation.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holmside Medical Group on 8 October 2015. 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 understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses
• 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.
• Both the main and branch surgeries had good facilities and were 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. For example, apologies were issued where complaints had been upheld or errors discovered.

We saw one area of outstanding practice:

• The practice is rated as outstanding for the care of people with a long term condition. The practice had adopted the Year of Care approach to caring for its patients with long term conditions. As a result patients received one combined annual review in their birthday month and were actively involved in care planning and decision making.

There were also areas where the provider should make improvements. The practice should:

• Consider replacing the carpet in the phlebotomy room of the main surgery with easy clean flooring

• Review and strengthen the process for recording and monitoring computer prescriptions.

• Review the use of patient group directions (PGDs) and understanding of patient specific directions by the healthcare assistants

• Review the system currently in place for selecting topics for clinical audit and ensure that full two cycle audits are completed to demonstrate improvement

• Review the decision not to have a defibrillator in the main surgery. If the outcome is that a defibrillator is not felt to be necessary a risk assessment detailing why and recording mitigating actions should be created.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 2016

The practice is rated as outstanding for the care of people with long-term conditions.

Effective systems were in place which ensured that patients with long-term conditions received an appropriate service which met their needs. Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group.

Since 2012 the practice had implemented a single care and support planning process for patients with one or more long term conditions. They had subsequently worked to the Year of Care partnership model with staff receiving training which included the development of generic skills for nurses who had previously specialised in a particular long term condition. As a result the practice now ensured that all patients with long term conditions received a holistic patient centred annual review in their birthday month, with one combined review for patients with multiple long term conditions. Patients were encouraged to prepare for their review, be involved in discussions about their condition and contribute to a personally held care plan. These reviews comprised of an initial biometric test with a health care assistant together with the offer of a care and support planning meeting with the senior nurse. Flu vaccinations and smoking cessation sessions were available for all patients with a long term condition.

The practice had agreed to be a Patient Online Beacon Site with effect from October 2015. This NHS England initiative was aimed at encouraging patients with long term conditions to take greater control of their own health and wellbeing, supported by their GP practice, by offering a range of digital services.

The practice also participated in the CCG ‘Ways to Wellness’ social prescribing initiative which is a service designed to add to a patient’s medical support by supporting patients with a long term conditions to better manage their condition.

Updated 14 January 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 are the subject of child protection plans. The practice worked with the attached health visitor to ensure contact was made with the parents/carers of children who did not attend for appointments or immunisation. Monthly multi-disciplinary child safeguarding meetings were held involving the lead GP for safeguarding, the health visitor, midwife and school nurse. Immunisation rates were broadly in line with local CCG averages for all standard childhood immunisations. Appointments were available outside of school hours and the practice ensured that same-day emergency appointments were routinely available for all pre-school children. Emergency telephone consultations with a GP were also available. Cervical screening rates for women aged 25-64 were in line with local and national averages.

Updated 14 January 2016

The practice is rated as good for the care of older people. The practice had the largest population of elderly patients in the West of Newcastle and the practice had responded to this to ensure staff provided proactive, personalised care which met the needs of older patients. Patients aged 75 and over had been allocated a named GP to help ensure their needs were met. Those most at risk of unplanned admission to hospital had been identified and comprehensive care plans agreed. Arrangements had been made to meet the needs of ‘end of life’ patients. For example, staff held monthly palliative care meetings with community and Macmillan nursing staff to ensure these patients’ needs were identified and met. The practice participated in the local Clinical Commissioning Group’s (CCG) Care Homes Project and had developed an effective working relationship with a number of care homes in the local area. This made it possible to offer a greater continuity of care and more effective prevention of illness through regular visits to the homes. The practice offered home visits and longer appointment times where these were needed by older patients. Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group.

Updated 14 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). Patients were able to book appointments at either the main or branch surgery and a flexible appointment system was in operation, including requests for emergency or pre bookable telephone consultations with GPs. Patients were sent text message reminders of upcoming appointments. The practice offered a full range of online services including booking appointments, accessing test results and ordering repeat prescriptions. Links to a range of health prevention information was also available on the practice website. The practice used the EPS(2) system to send prescriptions electronically to a local pharmacy of the patients choice.

Updated 14 January 2016

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

• A GP lead had been identified for patients experiencing poor mental health or dementia.
• The practice provided an annual review to patients with a history of serious mental illness and those with dementia where physical as well as mental health was reviewed and personal care plans were developed. The practice was pro-active in contacting patients who failed to attend appointments
• The practice regularly signposted and referred patients experiencing poor mental health to various support groups and organisations, such as Newcastle Talking Therapies. Talking Therapies provides advice, support and information on coping strategies for people experiencing depression, anxiety, stress, anger, fear, bereavement and relationship difficulties
• A close working relationship had been developed with the mental health counsellor and Primary Care Mental Health worker attached to the practice.

Updated 14 January 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 with a learning disability and those with caring responsibilities.
• They routinely offered longer appointments for people with a learning disability. Longer appointments were also offered to non-English speaking patients who required a translation service.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people, such as palliative care patients and those with safeguarding concerns.
• 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.
• The practice had developed effective working relationships with a local residential home for people with severe physical and learning disabilities and a Home Office approved bail hostel. Residents were registered on a temporary basis as and when required and support was provided with issues such as substance abuse.