Chastleton Medical Group

Updated 15 September 2016

Chastleton Medical Group Practice provides General Medical Services to its practice population of 11,567 patients. They are also contracted to provide other enhances services for example: minor surgery, extended hours access and providing care and support to patients with a Learning Disability. The practice population lives in one of the least deprived areas according to the National Census Data in 2011.

The practice is located in a residential area on the northern outskirts of Durham City. There is a car park, a bike rack and car parking for patients who may have mobility restrictions. There is level access and accessible toilets. Patients can use the self-check-in which is available in a number of different languages. Alternatively they can speak with the receptionists.

There are four GP partners and four salaried GPs (in total 3 male and 5 female). There are three practice nurses and two healthcare assistants, all female. There is a practice manager, two senior administrative staff and 11 reception and administration staff.

The practice is open on Monday, Wednesday and Friday from 8.30am-6pm. On Tuesday and Thursday the practice is open from 8.30am-8pm. The extended hours service is for pre-booked appointments only. Patients can make appointments on-line, via the telephone and in person. Pre-bookable appointments are bookable two weeks in advance. There are allocated on the day bookings and there is same day urgent access to the on call GP. When the practice is closed patients are directed to NHS 111 who provide the Out of Hours service.

Updated 15 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chastleton Medical Group Practice on Monday 22 August 2106. 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 areas where the provider should make improvement are:

• Implement the guidance from NHS England in relation to updating the cold chain policy within the practice. This has now been completed.

• Ensure all nursing staff have up to date training, annually, for vaccinations and immunisations.

• Review the checking and recording of the temperatures of the vaccination refrigerators in line with current guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 September 2016

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

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

• 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 83% compared to the CCG average of 81% and the national average of 76%.

• 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 88% which was comparable to the CCG average of 87% and the national average of 88%.

• Longer appointments and home visits were available when needed.

• All 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 15 September 2016

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

• The practice had recently achieved the ‘Investors in Children’ award as they had implemented the changes recommended by the children who visited the practice. This included a specific young people’s leaflet, noticeboard, allocated website area and ideas on how to provide educational information in a better way.

• 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 recorded that cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 81% which was lower than the CCG average of 83% but was comparable to the national average of 81%.

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

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

Updated 15 September 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 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 had five care homes within the area where their patients resided; there was a named GP for each care home to maintain continuity of care.

• Recent changes to the provision of Nurse Practitioners to support care home staff had not had time to be embedded. The GPs intended to work closely with them to assure the best care for their patients.

Updated 15 September 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 15 September 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 worse than the national average of 84%.

• 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 79% which was lower than the CCG and national averages of 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 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.

Updated 15 September 2016

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 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.

• The practice was making progress to participate in the CCG commissioned Frail Elderly Scheme. This highlights the most vulnerable 1% of the patient list to support them in their homes and reduce the risk of admission to hospital.