Jesmond Health Partnership Also known as Drs Davies, Nicholson and Smith

Updated 28 December 2016

The Surgery, Osborne Road provides care and treatment to approximately 5248 patients from the NE1, NE2, NE3, NE4 and parts of NE4 postcodes in Newcastle Upon Tyne (Jesmond, Gosforth and Heaton suberbs of Newcastle). The practice is part of the NHS Newcastle Gateshead clinical commissioning group (CCG) and operates on a General Medical Services (GMS) contract.

The practice, which is also known as Dr Browell and Partners, provides services from the following address, which we visited during this inspection:

The Surgery

200 Osborne Road

Jesmond

Newcastle upon Tyne

Tyne and Wear

NE2 3LD

The surgery is located in converted ex-residential premises. All reception and consultation rooms are on the ground floor and fully accessible for patients with mobility issues. Limited on street parking is available nearby.

The surgery is open from 8am to 6.30pm on a Monday, Thursday & Friday (appointments from 8.30am to approximately 5.20pm) and 8am to 8pm on a Tuesday and Wednesday (appointments from 8am to approximately 7.40pm). The practice closes for an hour on a Thursday lunchtime

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Vocare (known locally as Northern Doctors Urgent Care Ltd).

The Surgery, Osborne Road offers a range of services and clinic appointments including child health surveillance, family planning, foreign travel advice, minor surgery, long term condition reviews and cervical screening.

The practice consists of:

• Four GP partners (three female and one male)
• Two practice nurses (both female)
• Eight non-clinical members of staff including a practice manager, receptionists, secretary and a cleaner.

The practice is a training practice and involved in the taining of qualified doctors wishing to pursue a career in general practice. From December 2016 the practice was also due to be involved in the career start nursing programme.

The average life expectancy for the male practice population is 80 (CCG average 77 and national average 79) and for the female population 84 (CCG average 81 and national average 83).

At 39.6%, the percentage of the practice population reported as having a long standing health condition was lower than the CCG average of 56.9% and national average of 54%. Generally a higher percentage of patients with a long standing health condition can lead to an increased demand for GP services.

At 69.7%, the percentage of the practice population recorded as being in paid work or full time education was higher than the CCG average of 60.5% and national average of 61.5%.

Deprivation levels affecting children and adults were much lower than local and national averages and the practice was placed in the tenth most deprived decile.

The practice had a much higher than national average number of patients in the 20 to 24 year age group. Approximately 50% of the practice patient population consisted of patients aged between 20 and 45.

Updated 28 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Surgery, Osborne Road on 20 October 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 to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• Feedback from patients about their care and access was higher than local and national averages. The results of the most recent suvey, which took place in July 2016, showed that the practice had gained above local and national averages for all of the 22 indicators. The practice told us that they had been ranked the 19th best performing practice in relation to the survey out of 7708 practices in England. Patients consistently reported that they were treated with compassion, dignity and respect.
• Patients were able to access same day appointments. Pre-bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice regularly reviewed feedback from patients.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved an overall result which was higher than local and national averages.
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed.
• The practice did not have a specific process in place to support patients known to have experienced bereavement.

We saw areas of outstanding practice:

• The practice had developed a letter template to send to patients following NHS health checks. This included a summary report which gave patients information about their physical measurements, blood pressure, cholesterol, blood sugar and cardiovascular risk and what this meant. The letter also included relevant advice, such as dietary advice, and guidance.
• The practice were pro-active in their support of breastfeeding mothers. At 80% the percentage of mothers still breastfeeding at eight weeks was higher than the national average of 46%. One of the GPs was a member of the GP Infant Feeding Network which is committed to providing early support for breastfeeding mothers, particularly in primary care.   

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 December 2016

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

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review and patients with multiple long term conditions were offered one comprehensive review in their birthday month whenever possible.

The QOF data for 2015/16 provided by the practice showed that they 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 asthma.
• The practice had obtained 100% of the points available to them in respect of chronic obstructive pulmonary disease.

The practice had developed a system to ensure patients at risk of developing diabetes were appropriately monitored and provided with advice on how to avoid developing the condition.

The practice offered an in house 24 hour blood pressure monitoring service and monitoring of patients on disease modifying antirheumatic drugs (DMARDs). One of the GPs had a special interest in dermatology.

Updated 28 December 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 the community midwife.

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

Data available for 2015/16 showed that the practice childhood immunisation rates for the vaccinations given to two year olds ranged from 93.5% to 100% (compared to the CCG range of 64.7% to 93.5% and national range of 73.3% to 95.1%). For five year olds this ranged from 91.7% to 100% (compared to CCG range of 90.1% to 97.4% and national average of 81.4% to 95.1%).

At 75%, the percentage of women aged between 25 and 64 who had attended for cervical screening was above the CCG average of 73% and national average of 74%.

Pregnant women were able to access a full range of antenatal and post-natal services at the practice. A system was in place to ensure that all post natal women were contacted by one of the GPs. The practice was pro-active in their support of breastfeeding mothers. One of the practice GPs was an expert on breast feeding and had developed an effective working relationships with local lactation consultants as a member of the GP Infant Feeding Network. At 80%, the percentage of mothers still breastfeeding at eight weeks was above the national average of 46%. 

Updated 28 December 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data for 2015/16 provided by the practice (the data had not been published at the time of our inspection) showed the practice had achieved 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 experiencing heart failure, stroke and transient ischaemic attack and atrila fibrillation.

The practice had previously hosted representatives from a charity for older people within the practice. Although this was no longer the case the practice had maintained an effective working relationship with the charity which helped to ensure that patients and their carers were signposted to appropriate support services.

The practice offered dedicated influenza vaccination clinics.

Updated 28 December 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 met. The surgery was open from 8am to 6.30pm on a Monday, Thursday & Friday (appointments from 8.30am to approximately 5.20pm), 8am to 8pm on a Tuesday and Wednesday (appointments from 8am to approximately 7.40pm). The practice was closed for an hour on a Thursday lunchtime.

The practice offered sexual health and contraception services, travel advice, childhood immunisation service, antenatal services and long term condition reviews. They also offered new patient and NHS health checks (for patients aged 40-74). One of the GPs had a special interest in sexual health.

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. Pre bookable telephone consultations were available with a GP.

Updated 28 December 2016

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

QOF data for 2015/16 provided by the practice showed that they had achieved the maximum score available for caring for patients with depression. They had attained 98.3% and above local and national averages for caring for patients with dementia and 91.2% for caring for patients with a mental health condition, which was comparable with local and national averages.

Patients experiencing poor mental health were invited for an annual review. A system was in place to ensure patients with acute mental health issues were given a same day appointment or telephone consultation.

Updated 28 December 2016

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

The practice held a register of patients living in vulnerable circumstances, including 21 patients who had a learning disability. Patients with a learning disability were offered an annual health check and flu immunisation. The practice had worked with health quality checkers to ensure the practice was accessible for patients with a learning disability and had developed a number of easy to read leaflets. The practice was in the process of arranging dementia friends training for their staff and had recently ordered dementia friendly signage for the practice.

The practice had established 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.

The practice identified carers and ensured they were offered appropriate advice and support and an annual flu vaccination. They were not offered an annual health check. A member of staff had been identified as a carer’s champion. At 0.7% of the patient population the number of carers identified was lower than we would expect. However, this was attributed to the patient demographics at this practice.