Old Forge Surgery

Updated 28 March 2017

Old Forge Surgery, Middleton-on-Teesdale, Barnard Castle, County Durham, DL12 0QE

is located in the picturesque village of Middleton-on-Teesdale.

The practice provides services under a Personal Medical Services (PMS) contract providing service to the practice population of 2682, covering patients of all ages. The practice covers a large rural area of 320 square miles in rural Teesdale. The practice is a ‘dispensing practice’ and is able to dispense medicines for patients who live more than one mile from the nearest pharmacy.

The proportion of the practice population in the 65 years and over age group is above the England average. The practice population in the under 18 age group is below the England average. The practice scored six on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

The practice has three GP’s, one of who is a partner and two who are salaried. One is male and the other two female. There are three practice nurses. There is a practice manager, who is also a partner and a team of administration and dispensing staff.

The practice is a GP training practice. They also mentor Carer Start Nurses.

The Old Forge Surgery is open between 8am to 6pm Monday to Friday. The practice operates ‘open surgeries’ every week day morning and two afternoons per week.

Updated 28 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Forge Surgery on 20 and 22 September 2016. 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they were able to get same day appointments.
• 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.
• The practice had a very active patient participation group (PPG), which worked with the practice to make improvements.

We saw areas of outstanding practice.

A member of the practice staff had set up a ‘books on prescription’ system. This is a scheme run by The Reading Agency for the provision of a range of self-help books for people who were suffering a mental health condition.

The practice had really embracing community spirit and worked very closely with community groups. An example included the work they did with the Upper Teesdale Agricultural Support Service (UTASS), a local group who have a premise in the village, where they provide a range of service to several of the population groups.

5% of the practice population had been identified as carers and were being provided with options of health care, treatment and support.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Review frequency of Controlled Drug Checks in line with their practice standard operating procedures.

• Ensure medicines requiring refrigeration records of refrigerator temperatures are maintained in accordance with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 March 2017

The practice is rated as good for the care of people with long-term conditions (LTCs).

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 92%. This was 5% above the local CCG and 4% above the England average.

• Longer appointments and home visits were available when needed.

• Patients with LTCs had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• One of the practice nurse’s monitored patients on high risk medications on a monthly basis, had a system in place for reviewing their appointments and at last audit all patients had their next appointments booked.

Updated 28 March 2017

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 or who failed to attend hospital appointments.

• Immunisation rates were high for all standard childhood immunisations.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 81%. This was 2% below the local CCG average and 1% above the England average.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw good examples of joint working with midwives, health visitors and school nurses.

  The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns.

• The practice has been awarded the ‘Young Carers Charter Award’ (support systems for young people who are carers).

• The practice works closely with a local community group Upper Teesdale Agricultural Support Service (UTASS).Who amongst other activities offer youth drop in support in the premise they have in the village. The type of advice and support included education in regard to alcohol, drugs and sexual health.

• The practice offered a range of sexual health services where patients could get advice and treatment, for example contraception. Information and testing kits for sexually transmitted diseases were available in the practice.

Updated 28 March 2017

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.

• They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Nationally reported data for 2014/2015 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicator in respect of atrial fibrillation was 100%; this was 1% above the local CCG average and 2% above the England average.

• The practice worked closely with a local voluntary driving service to enable their less mobile patients to attend the practice to see the practice nurses and /or GPs.

• The practice was part of the Vulnerable Adults Wrap Around Service (VAWAS). This was a service provided to vulnerable patients who are housebound or those at high risk of admission to hospital. This was a Federation initiative through the CCG to ensure the needs assessment of vulnerable patients remained up to date.

Updated 28 March 2017

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 reflected the needs for this age group.

• Telephone consultations were available every day with a call back appointment arranged at a time to suit the patient, for example during their lunch break.

• Early morning nurse appointments were available from 8am.

• Open surgeries were available each morning and two afternoons a week with the latest routine arrival at 5.30pm.

Updated 28 March 2017

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

• Nationally reported data from 2014/2015 showed 89% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was 6% above the local CCG average and 5% above the England average.

• Nationally reported data from 2014/2015 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 83%. This was 7% below the local CCG average and the England average.

• 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 advanced 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 people with mental health needs and dementia.

• The practice had introduced a ‘book on prescription scheme’ and had 36 books available to patient on a range of self-help topics.

Updated 28 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held registers of patients living in vulnerable circumstances which included those with a learning disability.

• The practice offered longer appointments for people with a learning disability.

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

• The practice told 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.

• Telephone interpretation services were available and information leaflets in different languages were provided when required.

• The practice works closely with a local community group, the Upper Teesdale Agricultural Support Service (UTASS). They provided lunch clubs, carers support and neighbourhood support. Soft intelligence was shared with the practice where issues had been identified.