Archived: Spring Terrace Health Centre

Updated 21 April 2016

Following our previous inspection, in March 2015, the practice was rated as inadequate and placed into Special Measures. We set a requirement notice in relation to staffing, and issued warning notices in response to breaches of the safe care and treatment and good governance regulations.

Spring Terrace Health Centre is a busy, medium sized practice providing care and treatment to approximately 6900 patients of all ages, based on a General Medical Services (GMS) contract. The practice is part of NHS North Tyneside Clinical Commissioning Group (CCG) and covers North Shields, Tynemouth, Cullercoats and Percy Main. Life expectancy for patients is lower than the local CCG and England averages. The practice serves an area where deprivation is higher than the local CCG and England averages. The practice is part of the local GP Federation. We visited the following location as part of the inspection:

• Spring Terrace Health Centre, North Shields, Tyne and Wear, NE29 0HD.

Spring Terrace Health Centre is located in purpose built premises and provides patients who have mobility needs with access to ground floor treatment and consultation rooms. The practice offers a range of chronic disease clinics, as well as services aimed at promoting patients’ health and wellbeing. There are four GP partners (all female), a practice manager, a lead receptionist, two practice nurses, a healthcare assistant, and a team of administrative and reception staff. The practice has made arrangements for patients who have specifically requested to see a male GP to be seen at a nearby GP surgery.

The practice’s core opening hours are Monday, Tuesday, Thursday and Friday between 8am and 6:30pm. On Wednesdays, the practice opens from 8am to 1pm and between 2pm and 6:30pm. An early morning surgery is provided once a week. The timing of this varies from week to week. A GP is on duty from 8am to 6.30pm every day (and from 7.30am one morning a week.)

GP appointments are available as follows:

Monday to Friday from 9am to 12 noon and from 2:30pm to 5:30pm. It is open from 7.30am one morning a week.

When the practice is closed patients can access out-of-hours care via the Northern Doctors Urgent Care Limited service, and the NHS 111 service.

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Spring Terrace Health Centre on 26 January 2016. Overall the practice is rated as good.

We found the practice had made many improvements since our previous inspection in March 2015 when they were rated as inadequate and placed into Special Measures. 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. Information about safety was recorded, monitored, appropriately reviewed and, where appropriate, concerns were addressed.

• All staff were actively engaged in monitoring and improving quality and outcomes for patients.

• Staff were committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

• Risks to patients and staff were assessed and well managed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and responsibilities.

• The practice was well equipped to treat patients and meet their needs.

• Information about how to complain was available and easy to understand.

• Improvements had been made to the practice’s appointment system. For example, additional staff had been appointed to provide patients with greater flexibility and choice and, a walk-in clinic had been introduced to help improve patients’ access to same-day urgent care.

• Staff had a clear vision and strategy to improve the quality of the services they provided, and they were committed to providing their patients with good quality care. There was a clear organisational structure and strong leadership was continuing to drive improvements at the practice.

• Good governance arrangements were in place, and these helped to keep patients safe.

There were areas of practice where the provider needs to make improvements. The provider should:

• Continue to take steps to address the concerns of patients raised in the NHS National GP Patient Survey about telephone access and appointment availability.

• Continue to develop services to build on the progress already made in promoting safe, high-quality, compassionate care.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 21 April 2016

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

Nationally reported data showed the practice had performed well in providing recommended care and treatment, for the clinical conditions commonly associated with this population group. For example, the practice had achieved 100% of the total Quality and Outcomes Framework (QOF) points available to them for providing recommended clinical care to patients diagnosed with hypertension. This was 1.9% above the local CCG average and 2.2% above the England average. There were effective systems in place which helped ensure patients with long-term conditions received a service which met their needs. The practice offered an annual review to all these patients so their needs could be assessed, and appropriate care and advice given about how to manage their health. A good recall system was in place which helped ensure that all patients requiring an annual review received one. Where patients failed to respond to an initial request to make an appointment, this was followed up by a further two letters requesting that they contact the practice.

The practice had put good arrangements in place to meet the needs of patients with diabetes. They had achieved 94.7% of the total QOF points available to them, for providing recommended clinical care to patients diagnosed with diabetes. This was 1.8% above the local CCG average and 5.5% above the England average. A weekly diabetic clinic was held involving a GP, a dietician and a practice nurse. These staff met before each clinic to review patients’ needs, including any changes that had occurred since the patients’ last visit. They also used these meetings to examine whether any learning could take place, which would benefit the patients they supported. Each patient had a comprehensive care plan, and received extended appointments.

The practice was taking active steps to reduce the number of unplanned emergency admissions into hospital. For example, staff had used a local intelligence system to identify patients with complex medical and social needs, who were at greater risk of an emergency admission into hospital. Emergency care plans had been put in place for the practice’s most vulnerable patients.

Updated 21 April 2016

The practice is rated as good for the care of families, children and young people.

Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data, for 2014/15, showed the practice had obtained 100% of the overall points available to them, for providing contraceptive services. This was 2.5% above the local CCG average and 3.9% above the England average.

Staff provided a range of services for families and younger patients, including family planning and contraceptive advice. The midwife attached to the practice held a weekly baby clinic at the practice which was also attended by a dedicated health visitor and one of the GPs. This clinic provided families with access to a full programme of childhood immunisations. Publicly available information showed they had performed very well in delivering childhood immunisations. For example, the nationally reported data that was available to us showed that the immunisation rates for 16 of the 17 childhood immunisations were over 90% and fourteen of these were 100%. In response to feedback from patients, new mothers were now able to receive their post-natal check-up at the same time as their baby’s six weekly check. A good range of health promotion leaflets was available in the patient waiting area, including information about the practice being breastfeeding friendly.

Monthly multi-disciplinary safeguarding meetings were held where the needs of vulnerable children and families were discussed. All staff had completed safeguarding training that was relevant to their roles and responsibilities.

Updated 21 April 2016

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

Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. For example, the practice had obtained 100% of the total points available to them, for providing recommended clinical care to patients who had cancer. This was 0.3% above the local clinical commissioning group (CCG) average and 2.1% above the England average.

The practice offered proactive, personalised care which met the needs of the older patients. For example, all patients over 75 years of age had a named GP who was responsible for their care. Clinical staff also undertook home visits for older patients who would benefit from these. Staff actively carried out healthcare reviews of patients who were housebound, and there were good systems in place to follow up any concerns identified. Practice staff collaborated with other health and social care staff, to make sure the needs of vulnerable older patients were met. Clinical staff carried out a dedicated monthly ‘ward round’ at local nursing home, to help ensure any health concerns were identified promptly and addressed.

Updated 21 April 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data, for 2014/15, showed the practice had obtained 100% of the overall points available to them for providing care and treatment to patients who had chronic kidney disease. This was 0.6% above the local CCG average and 2.2% above the England average. The practice had assessed the needs of this group of patients and had developed their services to make sure they were accessible, flexible and provided 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 of this group of patients. The practice held a weekly, early morning clinic to make it easier for working patients to obtain a convenient appointment. NHS health checks were offered to help promote the wellbeing of patients aged between 40 and 75 years of age.

Updated 21 April 2016

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

There were good arrangements for meeting the needs of patients with mental health needs. The QOF data, for 2014/15, showed the practice had performed well by obtaining 100% of the overall points available to them, for providing recommended care and treatment to these patients. This was 4.8% above the local CCG average and 7.2% above the England average. Patients with mental health needs were offered an annual health review and were provided with advice about how to access various support groups and voluntary organisations. They were also able to access ‘talking therapies’ which help meet the needs of patients with a range of mental health problems.

Good arrangements had also been made to meet the needs of patients with dementia. The QOF data, for 2014/15, showed the practice had performed well by obtaining 100% of the overall points available to them for providing recommended care and treatment to patients with dementia. This was 3.2% above the local CCG average and 5.5% above the England. Clinical staff carried out opportunistic dementia screening and completed care plans, to help make sure patients with dementia received appropriate support and treatment.

Updated 21 April 2016

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

There were good arrangements for meeting the needs of vulnerable patients. The QOF data, for 2014/15, showed the practice had performed well by obtaining 100% of the overall points available to them, for providing recommended care and treatment to patients with learning disabilities. This was in line with the local CCG average and 0.2% above the England average. Systems were in place to help reduce unplanned emergency admissions into hospital. The practice maintained a register of patients with learning disabilities, which they used to ensure they received an annual healthcare review. Extended appointments were offered to enable this to happen. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns. Staff actively collaborated with other health and social care staff to meet the needs of vulnerable patients. The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Good arrangements had been made to meet the needs of patients who were also carers.