Dunelm Medical Practice

Updated 7 November 2016

Dunelm Medical Practice provides General Medical Services to its practice population of 12,219 patients. They are also contracted to provide other enhanced services for example: minor surgery, extended hours access and actively reducing unplanned admissions to accident and emergency. The practice population lives in one of the least deprived areas in England according to the National Census Data in 2011.

The practice has three surgeries one in Durham City Centre at Gilesgate and two on the outskirts of Durham City at Bearpark and Framwellgate. There are car parks at all surgeries and car parking is available for patients who may have mobility restrictions. There is access and accessible toilets. There is a hearing loop for patients who have difficulties with their hearing. We only visited the Bearpark surgery on the day of the inspection.

There are eight GP partners (male and female). There is one nurse practitioner, three practice nurses and three healthcare assistants, all female. There is a business manager, two practice development managers who job share, an IT manager and two office managers who are supported by senior administrators and reception and administration staff. This is a training practice where qualified doctors are trained to become GPs.

The surgeries are open at the following times:

Bearpark: 8.30-6pm Monday - Friday.

Gilesgate: 8.45-6pm Monday - Friday.

Framwellgate: 8.45-6pm Monday to Friday and on Saturday from 8am-1pm.

Patients can make appointments on-line, via the telephone and in person. Pre-bookable appointments are bookable up to four weeks in advance. There are allocated on the day appointments and there is same day urgent access with an on-call duty GP at each surgery. In addition patients can book a telephone consultation after morning surgery; for specific issues which are detailed on the practice website and in the practice leaflet. There is Saturday morning surgery each Saturday at Framwellgate with 15 prebookable appointments and five walk in. Each week a GP is in attendance and alternate weeks there is a practice nurse available. The practice uses SMS text message alerts for those patients who have signed an agreement. Not only do they remind patients of their appointments but they also send details of when the practice will be closed for extended periods such as Christmas so that patients can request their prescriptions in a timely manner. When the practice is closed patients are directed to NHS 111 who provides the Out of Hours service.

Updated 7 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dunelm Medical Practice on 14 September 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. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).

There were several areas of outstanding practice:

• The practice worked with many organisations to increase quality and reduce inequalities. This included working with the Royal National Institute of Blind People (RNIB) to convert non confidential information into braille. Such as: health promotion information.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification was lower than the CCG average and the national average in 2014-2015. We were provided with evidence of an 80% improvement in this data as a consequence of training a health care assistant in foot examinations. Improving the uptake of the podiatrist appointments at each site by tasking the receptionists to contact patients directly. 116 more diabetic, or pre-diabetic patients had had their feet examined from 2015-2016.

• The practice had a ‘Health Trainer’ attached to the practice to support patients to improve their ‘Well-being for life’ commissioned by Durham County Council.

• The percentage of women aged 25-64 whose notes record that cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was lower than the CCG average and the national average. We saw evidence of the changes made by the practice to increase this uptake. They had taken advice from Cancer Research and now send their invites on pink paper which had increased their uptake by 11%, from April 2016-August 2016.

• The practice had a ‘Pathway to Work’ service for patients to access for support to gain employment or to return to employment.

• The practice was involved with a national humanitarian project working with the local authority to provide suitable clinics and screening for this vulnerable group of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 November 2016

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

• Nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients had their own individualised care plansand review appointments were available during the week and on Saturdays for patient flexibility. Non-attenders were re-invited as appointments were sent weekly and reviewed.

• 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 (01/04/2014 to 31/03/2015) was 80% compared to the CCG average of 81% and the national average of 77%.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 73% which was lower than the CCG average of 87% and the national average of 88%. However, we were shown evidence of an 80% improvement in this data as a consequence of training a health care assistant in foot examinations. Improving the uptake of the podiatrist appointments at each site by tasking the receptionists to contact patients directly. 116 more diabetic, or pre-diabetic patients had had their feet examined from 2015-2016.

• Patient specific longer appointments were identified with a ‘pop up screen’ for receptionists to assure the correct appointment time was allocated.

• The practice now had a ‘Health Trainer’ attached to the practice to support patients to improve their ‘Well-being for life’ commissioned by Durham County Council.

• Home visits were available when needed.

• All of 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 7 November 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.

• The percentage of women aged 25-64 whose notes record that cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 80% which was lower than the CCG average of 83% and the national average of 81%. We saw evidence of the changes made by the practice to increase this uptake. They had taken advice from Cancer Research and now send their invites on pink paper which had increased their uptake by 11%, from April 2016-August 2016.

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

• Children who were unwell could be seen at the end of morning and afternoon surgeries.

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

Updated 7 November 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 patients 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 had introduced a number of initiatives to improve the care of older patients. They had identified an increasing number of older people and organised care to better meet their needs. This included early memory loss reviews and avoiding unplanned admissions .

Specific practice protocols were in place, developed by the practice pharmacist, to assist GPs when weekly medications were issued when using the Electronic Prescribing System.

Updated 7 November 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 7 November 2016

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

• 74% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%.

• The practice had an up to date register with patients who had been diagnosed with dementia. They used the CCG Dementia Quality Toolkit to identify patients.

• Dementia Friends had recently held an education session to increase awareness of clinical and administration staff.

• 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 percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (01/04/2014 to 31/03/2015) was 93% which was higher than the CCG and national averages of 90%.

• The practice held a register of patients who had a diagnosis of mental health problems. They were invited for an annual review and non-attenders were followed up.

• Staff had a good understanding of how to support patients with mental health needs. They had completed training in Mental Health First Aid which provided them with confidence and competence to cope with crisis situations.

• Receptionists had been trained to offer appointments at quieter times for this group of patients.

• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations. When appropriate direct referrals were made to the mental health team.

• There was an in house counselling service for patients over the age of 18.

• The practice had systems in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 7 November 2016

The practice is rated as outstanding 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.
• The practice had strong links with the local refuge and had a bespoke way for registering these patients who may not be in the area for long.
• The practice was involved with a national humanitarian project working with the local authority to provide suitable clinics and screening for this vulnerable group.
• The practice had a register of all patients who did not have English as their first language; many of these patients were supported by interpreters.
• The practice was registered with the police as a ‘Safe Place’ for people who were in vulnerable circumstances.
• 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.
• The practice had a ‘Pathway to Work’ service for patients to access for support to gain employment or to return to employment.
• The practice worked with many organisations to increase quality and reduce inequalities. This included working with the Royal National Institute of Blind People (RNIB) to convert non confidential information into braille. Such as: health promotion information.