Barnard Castle Surgery

Updated 21 July 2016

Dr White and partners, also known as Barnard Castle Surgery is the only practice within Barnard Castle serving a practice population of 10,375 patients. The practice catchment area is classed as within the group of least deprived areas in England relative to other local authorities. For example, income deprivation affecting children was 11% compared to the national average of 20%.

At the time of inspection there were ten GPs, of these five were male and five female. In addition the practice was a training practice and there were also three GP registrars. (A qualified doctor who is training to become a GP through a period of working and training in a practice). They will usually have spent at least two years working in a hospital before you see them in a practice and are closely supervised by a senior GP or trainer.) They are supported by six nurses, an advanced nurse practitioner, nurse practitioner, practice nurses and two healthcare assistants.

Clinical staff are supported by a practice manager, office manager and administration staff.

The male life expectancy for the area is 80 years compared with the CCG averages of 77 years and the national average of 79 years. The female life expectancy for the area is 84 years compared with the CCG average of 81 years and the national average of 83 years

The reception, waiting areas, consulting rooms and disabled toilet facilities are on the ground floor. There is step free access into the building and easy access for those in wheelchairs or with pushchairs. There is also a car park attached to the building.

The Practice is open between 8am -6.pm with exception of Thursday afternoon when the Practice is closed from 2.pm for Training. Appointments with GP’s are available between 8am – 6pm.

Out of hours care can be accessed via the surgery telephone number and is provided by GP Out of Hours Primary Care Centre operated by County Durham and Darlington NHS Foundation Trust or by calling the NHS 111 service.

At the time of the inspection the practice did not have a person registered with CQC (Registration) Regulations 2009, as a Registered Manager.

Updated 21 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr J. J. White and Partners known locally as Barnard Castle Surgery on 10 May 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.

We saw two areas of outstanding practice:

• The practice worked closely with the local volunteer driver service for the last ten years, ensuring that patients could access the practice or the local hospital. In the previous year the volunteer driver service had made 906 journeys for patients of the practice.

• Patients with minor injuries could be seen and treated at the practice rather than travelling over 16 miles to the nearest accident and emergency department.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 July 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.

• Performance for diabetes related indicators was higher than the national average. For example the percentage of patients with diabetes, on the register, who had had influenza immunisation in the preceding 1 April to 31 March (01/04/2014 to 31/03/2015) was 98% compared to the national average of 94%.

• Longer appointments and home visits were available when needed.

• 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 21 July 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.

• 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.

• In the last 5 years 82% of patients had received cervical screening compared with the national average of 82%.

• 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.

• The practice also provided GP services at a local private boarding school.

• The practice had also designed a specific health information leaflet for teenagers.

Updated 21 July 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 practice worked with a number of care homes to reduce numbers of unplanned admissions to hospital and we noted that care planning for older people was of high standard.

• The practice worked well with groups such as “Age UK”. One patient told us that after attending for a seasonal vaccination that they spoke with a representative from Age UK at the practice which resulted in the patient being assistedto reduce their home heating costs.

• As part of a Clinical Commissioning Group initiative the practice was involved in a local Vulnerable Adult Wrap Around Service (VAWAS) which identified people at risk, provided nurse led home visits to local nursing homes and housebound patients.

• Data reported nationally was that outcomes were comparable to that of other practices for conditions commonly found in older people.

Updated 21 July 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 reflects the needs for this age group.

Updated 21 July 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.

Updated 21 July 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 includingtravellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability; it also ensured that a specific member of the reception team dealt with all enquiries from those people with a learning disability and ensure that all reception staff had received training.

• Patients with a learning disability were seen for a 45 minutes annual review for physical and mental health checks and could be referred to the Community Eye Care Pathway (This Pathway is designed to enable people with learning disabilities to access NHS sight tests in the same way as the wider population.) This work was recognised nationally when the practice were finalists at the General Practice Awards in 2014.

• Flu vaccinations were also given to patients with learning disabilities in their home where this was appropriate.

• We were also told that a member of the practice visited local traveller communities to encourage them to attend for vaccinations, such as childhood immunisations.

• The practice provided a GP service at a local prison.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.