Coquet Medical Group

Updated 28 September 2016

Coquet Medical Group provides care and treatment to 11,243 patients of all ages, based on a Personal Medical Services (PMS) contract. The practice is part of the NHS Northumberland clinical commissioning group (CCG) and provides care and treatment to patients living in Amble and the surrounding areas. We visited the following locations as part of the inspection:

Amble Health Centre, Percy Drive, Amble, Morpeth, Northumberland. NE65 0HD.

Broomhill Health Centre, Hadston Road, South Broomhill, Morpeth, Northumberland. NE65 9SF.

The practice had a mostly white British population. Nationally reported data showed that 1.8% of the population were from non-white ethnic groups. The data also showed the practice had a higher percentage of people with long-standing health conditions than the England average, and more people with caring responsibilities. Life expectancy for men was just below the England average, and for women it was higher. There were higher levels of social deprivation, especially in relation to older people and children.

The Coquet Medical Group main practice and branch surgery are located in purpose built buildings which provide patients with fully accessible treatment and consultation rooms. The practice has six GP partners (four male and two female), three salaried GPs (one male and two female), a nurse practitioner (female), a practice nurse (female) three healthcare assistants (female), a practice manager, a practice administrator and a team of administrative and reception staff.

The practice and branch surgery are open as follows:

Monday to Friday between 8am and 6:30pm.

Saturday between 8:30am and 11.15am.

The reception desk is closed every Wednesday between 12 noon and 2pm for staff training. However, telephone calls are still answered during this time.

GP appointment times are as follows:

Monday: 8:30am to 11:40am and 2:20pm to 5:20pm.

Tuesday: 8:30am to 11:25am and 1pm to 6:20pm.

Wednesday: 8:10am to 11:30am and 2:30pm to 5:10pm.

Thursday: 8:10am to 11:25am and 2:30pm to 5:15pm.

Friday: 8:10am to 11:40am and 2:30pm to 5:30pm.

Saturday: 8:50am to 10:50am.

When the practice is closed patients can access out-of-hours care via Vocare, (known locally as Northern Doctors), and the NHS 111 service.

Updated 28 September 2016

Letter from the Chief Inspector of General Practice

We carried out a previous announced inspection of this practice on 23 February 2016. Overall, we rated the practice as good. However, a breach of legal requirement was found. This related to a failure to maintain the cold-chain for medicines requiring refrigeration. Also, some medicines had not been securely stored. After the comprehensive inspection the practice wrote to us to say what they would do to address the breach we identified.

We undertook this announced focussed inspection, on 17 August 2016, to check that the practice had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Coquet Medical Group on our website at www.cqc.org.uk.

Our key findings were as follows:

The provider had complied with the requirement notice we set following our last inspection visit. In particular, we found:

• Improvements had been made to the arrangements for monitoring vaccines. These included improved stock control arrangements and the use of appropriate validated cool boxes to transport vaccines. The provider had introduced an effective system which ensured that daily vaccine temperature checks were consistently carried out. Improved record keeping meant staff were able to demonstrate when vaccines were stored at the recommended temperature, and that they had taken appropriate action when they were not. Staff had received training to help maintain the improvements introduced.

• Action had been taken which ensured that all medicines kept at the practice were securely stored, to prevent unauthorised access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 March 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.

A higher proportion of patients on the practice list had been diagnosed with some long term conditions compared to local and national averages. For example, the prevalence rate of diabetes was 8.7%, compared to a local average of 6.7% and the national average of 6.4%. The practice had proactively engaged with a national diabetes charity to provide a support group for patients. The nearest group was over 25 miles away and was not convenient for patients. One of the GP partners worked with a member of the administrative team to organise a local meeting. An initial meeting was well attended; subsequent events were held in bigger premises to allow more people to attend. Staff told us they planned to carry out a similar scheme for patients with asthma.

Nationally reported QOF data (2014/15) showed the practice had achieved good outcomes in relation to 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 diabetes, compared to the local CCG average of 95% and the national average of 89.2%.

Updated 21 March 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 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 in line with the local averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 94.5% to 99% (compared to CCG averages of between 95.3% and 98.1%) and for five year olds ranged from 97.5 % to 100% (compared to CCG averages of between 94.9% and 98.5%).

The practice reached out to school age children. For example, the current flu campaign was advertised within the health centres by posters designed by local children. The practice offered confidential health checks for young people once they reached 15; over the past year around 30 patients had received the checks

The practice’s uptake for the cervical screening programme was 86.6%, which was above the CCG average of 83.5% and the national average of 81.8%. The practice had engaged with a national cancer charity to help promote and further increase the update of cervical smears. This involved sending out ‘pink letters’ to those patients who had not responded to previous invites, asking them to book an appointment. Since November 2015, 65 pink letters had been sent out and a total of 18 patients who had not previously responded to invites had received the test.

Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 21 March 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. This was slightly above local clinical commissioning group (CCG) average (98.1%) and the England average (97.9%).

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 patients at high risk of hospital admission and those in vulnerable circumstances had care plans. Several patients lived in local residential or nursing homes; there was a named GP for each home. They carried out weekly ward rounds and had regular phone contact with care home and community staff.

The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people. The district nursing team was based in the same buildings as the practice, which allowed for effective and regular communication between services. Fortnightly palliative care meetings were held where all deaths were discussed, as well as reviewing ongoing cases.

Updated 21 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 and flexible. Extended hours surgeries were offered every Saturday morning for working patients who could not attend during normal opening hours.

The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.

Additional services were provided such as health checks for the over 45s and travel vaccinations.

Updated 21 March 2016

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

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia. Patients experiencing poor mental health were sign posted to various support groups and third sector organisations. The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.

Nationally reported QOF data (2014/15) showed the practice had achieved good outcomes in relation to patients experiencing poor mental health. For example, the practice had obtained 100% of the QOF points available to them for providing recommended care and treatment for patients with poor mental health, compared to the CCG average of 96.5% and the national average of 92.8%. Performance for dementia related indicators was also above local and national averages (100% compared to 99.1% locally and 94.5% nationally).

Updated 21 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. Patients with learning disabilities were invited to attend the practice for annual health checks. The practice offered longer appointments for people with a learning disability, if required.

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.

Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check and referred for a carer’s assessment.