Archived: Victoria Medical Centre

Updated 25 May 2016

Victoria Medical Centre provides Primary Medical Services to the town of Hebburn and the surrounding areas. The practice provides services to approximately 2950 patients from two locations:

• Victoria Medical Centre, 12-28 Glen Street, Hebburn, Tyne and Wear, NE31 1NU
• The Doctors Surgery, 158 Calf Close, Jarrow, Tyne and Wear, NE32 4DU

The main surgery in Hebburn is in purpose built premises. There was step free access at the front of the premises and a car park at the rear with dedicated disabled parking bays. The branch surgery in Jarrow is in a converted shop premises. At the time of our inspection the practice were in the process of working with NHS England to close the branch surgery. We visited both locations as part of the inspection.

The practice has two GP partners and one salaried GP, all of whom work part-time. Two are female and one male. There is a nurse practitioner and practice nurse both of whom are part time and a health care assistant. There is a practice manager, reception manager four reception and administration staff and one cleaner.

The practice is commissioned to provide services within a Personal Medical Services (PMS) contract with NHS England.

The main practice is open from 8am to midday and 1pm to 7.30pm on a Monday, 8am to midday and 1pm to 6pm on a Tuesday, Wednesday and Friday and from 8am to 2pm on a Thursday (telephone cover is provided until 6pm).

Consulting times vary during the week. Monday 9.30am – 11.30am, 3pm -5pm, 6pm until 7.10pm. Tuesday 9.30am – 11.50am, 3.30pm – 5.30pm. Wednesday 8.30am-10.40am, 2pm-4.10pm. Thursday 8.30am-10.30am, Friday 8.30am-10.40am, 2pm -4.10pm.

The branch surgery is open Monday 10am–11am, Tuesday 10am –11.30am and Friday 10am–12 noon, with appointments available during this time.

The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited.

Information taken from Public Health England placed the area in which the practice was located in the third most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The average male life expectancy is 76 years and the female is 80. Both of these are lower than the CCG average and national averages. The average male life expectancy in the CCG area is 77 and nationally 79. The average female life expectancy in the CCG area is 81 and nationally 83. The practice has a higher percentage of patients over the age of 45+ up to 85+, when compared to national averages. There were lower than average numbers of patient under the age of 44. The percentage of patients reporting with a long-standing health condition is higher than the national average (practice population is 61% compared to a national average of 54.0%). The proportion of patients who are in paid work or full-time employment or education is 54% compared to the CCG. average of 55% and the national average of 61.5%

Updated 25 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Victoria Medical Centre on 14 April 2016. Overall the practice is rated as requires improvement.

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. However, we found that the practice had not learned from some of their significant events or put plans in place to prevent them happening again.
• Some risks to patients were assessed and well managed. However, for example, there was no health and safety or fire safety risk assessment at the branch surgery. The nursing team had not been subject of DBS checks.
• Data showed patient outcomes were low compared to the national average. We saw that clinical audit was making improvements to patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a high number of carers coded on the practice system; this was 174 which was 5.9% of the practice population. The practice offered them health checks and flu immunisations.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a system in place for handling complaints and concerns and responded quickly to any complaints. However, the information given to patients on how to complain did not contain the information on the process to follow if the complainant remained unhappy with the outcome.
• There was a leadership structure in place and staff felt supported by management. However, the partners could not demonstrate an active involvement in the governance or day to day running of the practice.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• Feedback from patients was limited. There was no patient participation group and no recent survey of patients on general feedback for the practice.
• The practice had done well to identify carers amongst its patient population. (5.9% of their practice population)

The areas where the practice must make improvements are;

• Ensure systems and processes are established and operated effectively.
• Ensuring learning from significant events is shared and acted upon in order to minimise the risk of events being repeated.
• Ensure that the performance of the practice is understood in relation to QOF to improve patient care.
• Ensure they follow systems and processes in relation to infection control and training and carry out a legionella risk assessment.
• Ensure DBS checks are carried out where appropriate.
• Ensure staff receive appropriate training in order to carry out the duties they perform and maintain accurate records of this.

The areas where the provider should make improvements are:

• Consider updating the recruitment policy to contain full information on recruitment checks.
• Consider how they obtain and act on feedback from patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 May 2016

The practice is rated as requires improvement for the care of patients with long-term conditions. There are aspects of the practice that require improvement which therefore has an impact on all population groups. There were, however, examples of good practice.

The practice had a register of patient with long term conditions which they monitored for recall appointments for health checks. The practice nurses were responsible for this. There were specific chronic disease clinics as well as flexible appointments, including extended opening hours and home visits were available when needed. Patients within this group had a named GP. The practice nurses specialised in asthma, diabetes and chronic obstructive pulmonary disease (COPD).

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice outcomes in relation to the conditions commonly associated with this population group were lower than local and national averages. For example, performance in relation to indicators for patients with COPD were below the national average (72.1% compared to 96% nationally).

Updated 25 May 2016

The practice is rated as requires improvement for the care of families, children and young people. There are aspects of the practice that require improvement which therefore has an impact on all population groups. There were, however, examples of good practice.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Immunisation rates were higher than CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds were 100% with the exception for one vaccination out of five which was 86%, compared to the CCG averages of 85% to 99% and for five year olds 100%, except for one vaccination out of 10 which was 95.8%, compared to CCG averages of 91.5% to 100%.

The practice had a cervical screening programme. The practice’s uptake for the cervical screening programme was 73.4%, which was below the national average of 81.8%. Appointments were available outside of school hours and the premises were suitable for children and babies.

The 6-8 week baby check and post-natal maternal checks were usually booked together with the GP at the same time as the baby immunisations.

Updated 25 May 2016

The practice is rated as requires improvement for the care of older people. There are aspects of the practice that require improvement which therefore has an impact on all population groups. There were, however, examples of good practice.

Nationally reported data showed that outcomes for patients for conditions commonly found in older people were lower than local and national averages. For example, the practice had obtained 96.9% of the points available to them for providing recommended care and treatment for patients with heart failure. This was below the local clinical commissioning group (CCG) average (98.9%) and below the England average (97.9%). However, the practice offered proactive, personalised care to meet the needs of the older people in its population. For example, patients at high risk of hospital admission and those in vulnerable circumstances had care plans in place.

The practice was responsive to the needs of older people, including offering home visits. All patients over the age of 75 had a named GP and were offered an over 75 health check. Prescriptions could be sent to any local pharmacy electronically.

The practice provided care to patients in, and was the nominated lead practice for a care home in the area. The same GP visited this care home every week to ensure continuity of care. The manager of the care home had attended multi-disciplinary meetings at the practice.

The practice maintained a palliative care register and end of life care plans were in place for those patients it was appropriate for. They offered immunisations for pneumonia and shingles to older people.

Updated 25 May 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). There are aspects of the practice that require improvement which therefore has an impact on all population groups. There were, however, examples of good practice.

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 which included appointment booking, and ordering repeat prescriptions. There were telephone appointments available. There was a full range of health promotion and screening that reflected the needs for this age group. Flexible appointments were available as well as extended opening hours. The practice offered travel vaccinations and there was a drop in phlebotomy clinic four days a week.

Updated 25 May 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). There are aspects of the practice that require improvement which therefore has an impact on all population groups. There were, however, examples of good practice.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health. The practice maintained a register of patients experiencing poor mental health and recalled them for regular reviews. They told them how to access various support groups and voluntary organisations.

Performance for mental health related indicators was below the national average (59.4% compared to 92.8% nationally). For example, 50% of patients with schizophrenia, bipolar affective disorder and other psychosis had a comprehensive agreed care plan documented within the preceding 12 months. This compared to a national average of 88.5%. Data for the 2015/16 year showed that patients with a care plan in place had improved to 78%.

The practice told us they identified patients at risk of dementia and ad-hoc screening took place. However, performance for dementia indicators was below the national average (76.9% compared to 94.5% nationally). The percentage of patients diagnosed with dementia whose care was reviewed in a face-to-face review within the preceding 12 months was 75.6%, compared to the national average of 84%.

Updated 25 May 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. There are aspects of the practice that require improvement which therefore has an impact on all population groups. There were, however, examples of good practice.

The practice had registers in place for those in vulnerable circumstances, for example patients with learning difficulties. These patients were offered an annual review with appointments to suit the patient.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. They had told vulnerable patients about how to access various support groups and voluntary organisations. Patients were signposted to drug and alcohol services where appropriate and could access a support worker in the practice.

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’s computer system alerted GPs if a patient was a carer. The practice did not have a formal carers register but did opportunistically offer support to carers which included health checks and flu immunisations. The number of carers coded on the practice system was 174 which was 5.9% of the practice population.