Cheviot Medical Group

Updated 11 May 2018

The Cheviot Medical Group is located in the Wooler area of Northumberland and provides care and treatment to 2448 patients of all ages, based on a General Medical Services (GMS) contract. The practice is part of the NHS Northumberland clinical commissioning group (CCG). A dispensing service was provided for those patients who were eligible to be on the practice’s dispensing list, i.e. those who lived further than one mile away from the surgery. We visited the following location as part of the inspection:

Cheviot Primary Care Centre, Padgepool Place, Wooler, Northumberland, NE71 6BL.

The practice serves an area where deprivation is lower than the England average. In general, people living in more deprived areas tend to have a greater need for health services. Cheviot Medical Group has fewer patients aged under 18 years of age, and more patients over 65 years, than the England averages. The percentage of patients with a long-standing health condition, and patients with caring responsibilities, are above the England average. Life expectancy for women and men is similar to the England averages. National data showed that 0.6% of the population are from non-white ethnic groups.

The practice occupies part of a large purpose built building. All consultation and treatment rooms are on the ground floor. Disabled access is provided via a ramp at the front of the premises, for patients with disabilities. The building also accommodates district nursing, physiotherapy and chiropody staff, as well as a 24-hour emergency paramedic ambulance service. The practice provides a range of services and clinics including, for example, clinics for patients with heart disease, hypertension and asthma. The practice consists of two GP partners (one male and one female), a practice manager, a practice nurse (female), and a small team of reception and dispensing staff.

The practice is open Monday to Friday between 8:30am and 6pm. Extended hours appointments are provided in collaboration with other local GP practices. As part of their contribution to the new local out-of-hours scheme, the practice provides appointments between 6pm and 8pm on Tuesdays. On other weekdays and Saturday mornings, patients are able to access out-of-hours appointments at the other GP practices involved in the scheme.

When the practice is closed patients can access out-of-hours care via Vocare, known locally as Northern Doctors, and the NHS 111 service.

Updated 11 May 2018

Letter from the Chief Inspector of General Practice

At our previous inspection on 23 and 24 October 2014, we rated the practice as good overall and outstanding for people with long-term conditions. At this inspection, we have also rated the practice as good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Cheviot Medical Group on 16 January 2018 to check that the provider continues to meet the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and made improvements.

• The practice routinely reviewed the effectiveness and appropriateness of the care and treatment they provided. Staff ensured that care and treatment was delivered in line with evidence- based guidelines.

• Quality Outcomes Framework (QOF) data, for 2016/17 showed the practice had performed well in achieving 100% of the points available to them for providing recommended treatments for the most commonly found key clinical conditions.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Feedback from patients about access to appointments, the practice’s opening hours and the quality of their care and treatment was continuously very positive. The results of the NHS National GP Patient Survey, published in July 2017, showed patients rated the practice higher for almost all aspects of care, when compared to the local clinical commissioning group (CCG) and national averages. This high level of achievement had been sustained over a number of years.
• Leadership at the practice was compassionate, inclusive and effective at all levels. Leaders were able to demonstrate they had the high levels of experience, capacity, capability and skills needed to deliver very high-quality, sustainable care.
• The culture of the practice was to deliver person-centred care and treatment. All the staff were highly committed to delivering a quality service.
• There was a very strong focus on continuous learning and improvement at all levels of the organisation. The practice proactively used performance information to drive improvement.
• There were rigorous systems and processes in place that supported learning, continuous improvement and innovation. Safe innovation was celebrated and there was a clear and proactive approach to seeking out and embedding more effective ways of working.
• The practice had a clear vision and credible strategy to deliver high-quality care and promote good outcomes for patients, and leaders demonstrated a clear commitment to system-wide collaboration and leadership.

We also saw areas of outstanding practice:

• People can access services and appointments in a way and at a time that suits them. The practice had a very responsive appointment system. They used a ‘patient-decided’ consultation approach that actively encouraged patients to choose the length of their appointments. This had resulted in a high level of patient satisfaction as demonstrated by the results of the most recent national GP Patient Survey. Leaders had reviewed the effectiveness of this approach and had published their findings so learning could be shared nationally to promote improvement.

• There was an innovative approach to providing responsive, integrated person-centred care, particularly for older people and people with complex needs. The practice understood that these patients were at more risk, if emergency services were delayed because of their rural location. To address this, the practice had collaborated with the local ambulance service to set up a rural community paramedic service. Clinical staff had provided training and clinical support to the paramedic team for which they received no extra funding. There was also a telephone ‘hot-line’ which paramedics could use to obtain clinical advice and support from the GPs. This had helped to significantly reduce the number of accident and emergency attendances. For example, in 2014/15, there had been 726 attendances. In 2017/18, this had reduced to 453 attendances.

The areas where the provider should make improvements are:

• In addition to the routine environmental audits carried out by the local trust, carry out regular infection control audits.

• Review the arrangements for using non-clinical staff as chaperones so that they are in line with the guidance issued by the General Medical Council.

• Carry out a risk assessment to determine whether non-clinical staff carrying out chaperone duties should undergo a Disclosure and Barring Service check.

• Record refrigerator temperatures in line with the practice’s standard operating procedure.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 February 2015

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

Nationally reported data showed the practice had achieved good outcomes in relation to those patients with commonly found long-term conditions. The practice had taken steps to reduce unplanned hospital admissions by improving services for patients with complex healthcare conditions. All patients on the practice’s long-term conditions registers received healthcare reviews that reflected the severity and complexity of their needs. Person-centred care plans had been completed for each patient. These included details of the outcome of any assessments patients had undergone, as well as the support and treatment that would be provided by the practice. The practice nurse had received the training they needed to provide good outcomes for patients with long-term conditions. Cheviot Medical Group had been accredited as a research practice and was carrying out research to help improve patient outcomes.

Updated 5 February 2015

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

Nationally reported data showed the practice had achieved good outcomes in relation to child health surveillance, contraception and maternity services. 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 multidisciplinary meetings involving child care professionals, such as school nurses and health visitors. Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. New mothers had access to twice monthly child development clinics, where child health checks were carried out by a health visitor. Ante-natal clinics were also provided.

Updated 5 February 2015

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

Nationally reported data showed the practice had achieved good outcomes in relation to the conditions commonly associated with older people. The practice offered proactive, personalised care to meet the needs of older people. It provided a range of enhanced services including, for example, end of life care and a named GP who was responsible for their care. Clinical staff had received the training they needed to provide good outcomes for older patients.

Updated 5 February 2015

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

The needs of this group of patients had been identified and steps taken to provide accessible and flexible care and treatment. The practice was proactive in offering on-line services to patients. Repeat prescriptions could be ordered, and appointments booked, on-line. Appointments were available until 6.00pm each weekday and an extended hours service was provided once a week. Health promotion information was available in the waiting area and on the practice web site. The practice provided additional services such as travel information and vaccinations, smoking cessation support and minor surgery.

Updated 5 February 2015

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

The practice had achieved good outcomes in relation to meeting the needs of patients with mental health needs. The practice kept a register of these patients which it used to ensure they received relevant checks and tests. Where appropriate, a comprehensive care plan had been completed for patients who were on the register. The care plans had been agreed with patients and their carers. The practice referred patients with alcohol and drugs addictions to appropriate support services. The practice regularly worked with multi-disciplinary teams to help meet the needs of vulnerable patients.

Updated 5 February 2015

The practice is rated as good for the population group of patients whose circumstances may make them vulnerable.

The practice had achieved good outcomes in relation to meeting the needs of patients with learning disabilities. The practice held a register which identified which patients fell into this group, and used this information to ensure they received an annual healthcare review and access to other relevant checks and tests. Staff worked with multi-disciplinary teams to help meet the needs of vulnerable patients. The practice sign-posted vulnerable patients to various support groups and other relevant organisations. Staff knew how to recognise and report signs of abuse in vulnerable adults and children. They were also aware of their responsibilities regarding information sharing when reporting a concern and how to contact relevant agencies, in and out of hours.