Evenwood Medical Practice

Updated 3 March 2017

Evenwood Medical Practice, Copeland Lane, DL14 9SU is a dispensing practice situated in the Bishop Auckland area of County Durham in a semi-rural village. The practice is situated in a purpose built medical centre which is owned by NHS Property Services. Evenwood Medical Practice and its neighbouring GP practice share tenancy of the building. There is a private car park for patients with plenty of accessible parking. The practice is served by public transport, although there is a very limited bus service which operates within the village of Evenwood.

There are four GP partners (two are female and two are male), a male salaried GP, two advanced nurse practitioners (female), one practice nurse, a healthcare assistant and two chronic disease management nurses (both female). In addition to the Evenwood Practice, the partners own a larger practice, Bishopgate, located five miles away. Although these two practices are separate and have separate patient lists, the GPs, nurses and management team work across both locations. Patients from Evenwood are also invited to attend the Bishopgate practice when this suits their needs. Bishopgate is well served by public transport and is situated next to a major supermarket.

The registered list size is approximately 2020 patients who predominantly identify their ethnicity as White British. The practice is ranked in the third most deprived decile (one being the most deprived and ten being the least deprived), significantly above the national average. The practice age profile differs from the England average, having a higher number of patients in the 50 to 85 age range and a lower number in the 0 to 44 age range. There is a higher than average number of patients from the traveller community, as there are Gypsy, Romany and Traveller sites surrounding the village.

The practice is open from 8am Monday to Friday. It closes at lunchtime on Tuesdays and Wednesdays. On Tuesday afternoons all patients requiring appointments are seen by the neighbouring GP Practice in the next village, to maximise patient access to appointments. On Wednesday afternoons patients are offered the choice of attending the Bishopgate Practice. Evenwood Medical Practice is open from:

• 8am to 6pm on Mondays,
• 8am to 12pm on Tuesdays,
• 8am until 1pm on Wednesdays,
• 8am to 6pm on Thursdays
• 8am to 5pm on Fridays

When the practice is closed the telephone is diverted to Bishopgate or Woodview (the neighbouring GP practice) practices between 8am and 6pm. Outside of these times out of hours care can be accessed by the NHS 111 service. On Saturdays, patients can access appointments at an alternative practice as part of a scheme set up by the federation.

Each weekday except Tuesday and Wednesday, appointment slots with a GP are available from 8.30am until approximately 11am. Home visits and care home visits take place from 11am until 3pm. Afternoon appointment slots with a GP run from 3pm until approximately 5.30pm. Nurse appointments are available from 8am until approximately 5.30pm.

Updated 3 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Evenwood Medical Practice on 30 November 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, all test results were actioned daily before 10.30am. This was done from Bishopgate, a practice owned and ran by the Evenwood partners, freeing time for GPs at Evenwood to offer more consultation time to patients.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs, for example, liaising with key educational staff to improve school attendance and provide psychosocial support.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• 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 areas of outstanding practice:

• There was a strong visible, person-centred culture. Relationships between people who use the service, those close to them and staff were strong, caring and supportive. For example, some patients with literacy difficulties regularly asked reception staff to assist them in reading their correspondence.
• Two dedicated chronic disease nurses were employed.
• The standard of diabetes care was significantly higher than local and national averages. For example, The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c result was 64 mmol/mol or less, in the preceding 12 months, was 91% compared to the local CCG and national averages of 78%.
• Both nurses were able to prescribe and initiate insulin therapy.
• A one stop shop for older people was provided so there was no need for repeat journeys, for example, if blood tests were required they would be done immediately before leaving the practice.
• The practice liaised closely with a local children’s home and a local school to ensure the best outcomes for younger patients.

The areas where the provider should make improvement are:

• Ensure that the treatment room refrigerator thermometer is calibrated monthly or that a second thermometer is used to cross check the accuracy of the temperature, as per guidance.
• Ensure that temperatures in the treatment room fridge are recorded daily.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2017

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

• Two dedicated chronic disease nurses were employed and patients at risk of hospital admission were identified as a priority
• Both of these nurses were able to prescribe and initiate insulin therapy.
• Nationally reported data from 2014/2015 showed that the percentage of patients with diabetes, on the register, in whom the last blood pressure reading was 140/80 mmHg or less was 85% (local CCG average 77%) (England average 78%)
• Longer appointments and home visits were available when needed.
• GPs and the nurse practitioner visited the local care home on a daily basis.
• Approximately 90% of the patients from the local care home were registered at Evenwood Medical Practice. Many of these patients had a severe brain injury or challenging behaviours.
• All 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.
• Practice staff had an in depth knowledge of their patients with long term conditions, and found there were few barriers to accessibility of care due to their good relationships with these patients.
• The practice offered same-day, no wait, no appointment blood tests to all patients who required them.
• All test results were looked at and actioned before 10.30am on the same day of receipt.
• All clinical administration work was handled from the Bishopgate practice, freeing up the GPs and nurses to care for patients during Evenwood’s opening times.
• Patients with long term conditions were given a personalised management plan to take away with them, ensuring that they have something to refer to if unsure about medications or when to take action.

Updated 3 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.
• The practice followed up every missed hospital appointment by their patients and documented this in the patient record.
• 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.
• Nationally reported data from 2014/2015 showed that the percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 82% (local CCG average 83%) (England average 82%)
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There was a dedicated private baby changing facility.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 3 March 2017

The practice is rated as outstanding 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 offered a ‘one stop shop’ approach to appointments and clinics, which reduced the need for older patients from having to make repeated journeys to the practice.
• Home visits were conducted earlier in the day by a duty doctor, rather than the patient having to wait until later in the afternoon for their visit.
• The practice was part of the Vulnerable Adults Wrap Around Service. This was a service provided to vulnerable patients living in residential units, the housebound or those at high risk of admission. They were cared for by a GP in conjunction with Advanced Nurse Practitioners and district nurses. This was a Federation initiative through the CCG to ensure the needs assessment of vulnerable patients remained up to date.
• We saw documented evidence that, due to a limited public transport service, patients in this population group often arrived up to sixty minutes late for an appointment and were always welcomed and seen on arrival.

Updated 3 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 reflects the needs for this age group.

Updated 3 March 2017

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

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG and national averages (local CCG average 83%) (England average 84%)
• Nationally reported data also showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been

recorded in the preceding 12 months was 96% (CCG and England averages 90%)

• 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.

Staff actively promoted the dementia café located within the village.

Updated 3 March 2017

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 offered longer appointments for patients with a learning disability.
• 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.