Archived: The Rothbury Practice

Updated 16 May 2016

The Rothbury Practice is registered with the Care Quality Commission to provide primary care services.

The practice provides services to approximately 5,500 patients from two locations:

• 3 Market Place, Rothbury, Northumberland, NE65 7UW.
• Longframlington, Morpeth, Northumberland, NE65 8AD.

These are the locations we visited on the day of our inspection. The practice has also recently taken over the contract to provide two sessions a week at Harbottle Surgery, Harbottle, Northumberland, NE65 7DG. We did not visit these premises on the day of our inspection, as this location was recently inspected whilst under a different provider.

The practice in Rothbury is based in a converted listed building in the centre of the village. Part of the building is owned and managed by the practice, part is rented. Consulting rooms where patients are seen are located on the ground floor and first floor. Due to the age and layout of the building there is no lift to the first floor, and all services for patients who are unable to manage stairs are offered on the ground floor. On-street parking was available outside the practice building. The branch practice at Longframlington is in a purpose built, single storey building owned by the practice. There is a car park for patients to use and level entry access.

There are 24 members of staff, comprising four GP Partners (two female, two male), one salaried GP (female), one GP registrar (male), one nurse practitioner (female), three practice nurses (all female), one healthcare assistant (female), a medicines manager, practice manager and 10 admin/reception staff.

The Rothbury Practice is part of Northumberland clinical commissioning group (CCG). Information taken from Public Health England placed the area in which the practice was located in the third least deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The practice at Rothbury is open between 8am and 6.30pm Monday to Friday, with extended opening hours offered until 8pm on every third Thursday of the month, and from 7.15am to 8am on Wednesdays. The branch surgery at Longframlington is open from 8.30am to 12pm from Monday to Friday, as well as from 2.30pm to 5.30pm on Wednesday afternoons. Harbottle Surgery is open from 9am to 11am on Tuesdays and 9.30am to 11.30am on Thursdays. The telephone lines operate at all times during the opening hours of the main surgery at Rothbury. Outside of these times, a message on the surgery phone line directs patients to out of hours care, NHS 111 or 999 emergency services as appropriate.

The practice provides services to patients of all ages based on a Personal Medical Services (PMS) contract agreement for general practice. The practice population differs greatly from national averages, with a much higher than average patient population over the age of 50 (especially between the ages of 60 and 64) and a lower number of patients aged under 40. The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited.

Updated 16 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Rothbury Practice on 11 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.
• 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 they acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw some areas of outstanding practice:

• The practice responded quickly to provide care to approximately 450 extra patients from a nearby practice, which was closed down at short notice last autumn. This represented an 8% increase in the patient list size of the practice. Both clinical and administration staff worked extra hours to ensure that all of these patients were registered quickly and that nobody was overlooked. Extra staff were recruited to ensure medical records and prescriptions were transferred correctly. The practice has managed this task without negatively impacting on the 450 patients or their existing patient population.

• The practice provided end-of-life care, in conjunction with the local palliative care team, which had a strong, visible, person-centred approach. Patients were assigned to a named GP who oversaw their care, while another GP was assigned to offer support to family members. The practice had also developed a template to improve communication between services involved in managing the end-of-life care of their patients. We saw evidence and received feedback from patients to show that this end-of-life service was greatly appreciated.

The areas where the provider should make improvement are:

• Provide appropriate training to staff who act as chaperones to assist them to perform this role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 May 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 better than the CCG and national average. For example, the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (1 April 2014 to 31 March 2015) was 90.2%, compared to the national average of 77.5%. IFCC-HbA1c is a test to measure blood glucose levels.
• The practice ran a “complex clinic” to review patients with more than one diagnosis at one appointment, to save them having to visit the practice multiple times.
• 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 16 May 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.
• 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 16 May 2016

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

• 79% of the practice population is over 65 years old, with almost double the number of patients between the ages of 60 and 69 than the national average. The practice offered proactive, personalised care to meet the needs of this group.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• In the 30 months prior to March 2015 the practice had screened 69% of patients aged 60-69 for bowel cancer, (clinical commissioning group average 64.3%, national average 58.3%).
• The practice provided their own end-of-life care in conjunction with the palliative care team.
• The practice had a higher-than-average prevalence of cancer, due in part to the higher prevalence of cancer among older people. The practice had managed to achieve a rate of 54.3% of new cancers being treated following diagnosis via two week wait referrals (local average 44.4%, national average 48.8%).

Updated 16 May 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.
• Cervical screening uptake was 83.1%, which was comparable to the national average of 81.9%.

Updated 16 May 2016

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

• Performance for mental health related indicators was similar to the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (1 April 2014 to 31 March 2015) was 93.3%, compared to the national average of 89.6%.
• 76% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 84%.
• 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.

Updated 16 May 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 homeless people, travellers and those with a learning disability.
• The practice had achieved the highest uptake of influenza vaccinations in the county among patients with a learning disability.
• The practice offered longer appointments for patients who needed them.
• 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.