Archived: Greenside Surgery

Updated 22 June 2016

Greenside Surgery is a branch of Crawcrook Medical Centre both of which are located in the Ryton area of Newcastle Upon Tyne. The practice provides care and treatment to 7,307 patients from Crawcrook, Greenside and the surrounding areas. It is part of the NHS Newcastle Gateshead Clinical Commissioning Group (CCG) and operates on a General Medical Services (GMS) contract.

The practice provides services from the following addresses, which we visited during this inspection:

Main surgery:

Crawcrook Medical Centre, Pattinson Drive, Crawcrook, Ryton, Tyne and Wear, NE40 4US

Branch surgery:

Greenside Branch Surgery, Greenside Community Centre, Greenside Road, Greenside, Tyne and Wear, NE40 4AA

A separate report has been produced for Crawcrook Medical Centre as this location is registered separately with the CQC.

The main surgery is located in purpose built premises which opened in 2012. All reception and consultation rooms are fully accessible for patients with mobility issues. Dedicated parking spaces are available to the rear and side of the premises.

The main practice opening and appointment times are:

Monday 8am to 6pm – Appointments from 8am to 4.40pm

Tuesday 7.30am to 7pm – Appointments from 8am to 6.40pm

Wednesday 8am to 7pm – Appointments from 8am to 6.40pm

Thursday 8am to 6pm – Appointments from 8am to 4.40pm

Friday 7.30am to 6pm – Appointments from 8am to 4.40pm

Greenside branch surgery is situated in a single storey converted miners welfare institute building which is now used as Greenside Community Centre. The reception and consultation room are accessible for patients with mobility issues and on street parking is available nearby. Only patients registered with the practice who live in the Greenside area (approximately 1500 patients) are able to request appointments at the branch surgery. They are also able to access appointments at the main surgery. The branch surgery is open 8am to 12.30pm on a Monday to Friday (appointments from 8am to 12.20pm)

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and GatDoc.

Crawcrook Medical Practice & Greenside Surgery offer a range of services and clinic appointments including chronic disease management clinics, antenatal clinics, childhood health surveillance and immunisations, travel vaccinations, teenage sexual health, smoking cessation, drug and alcohol dependency and cervical screening. The practice is a training practice and provides placements for GP registrars (fully qualified doctors with experience of hospital medicine who are training to become a GP).

The practice consists of:

• Two GP partners (one male and one female)
• Two salaried GPs (both female)
• An Advanced Nurse Practitioner partner (female)
• A practice nurse (female)
• Three health care assistants (all female)
• 15 non-clinical members of staff including a practice manager, a consultant manager, pharmacist, IT lead, secretary, administration and reception staff

The area in which the practice is located is in the eighth (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The practice’s age distribution profile showed fewer patients than the national average in the under 40 age groups and more patients than the national average in the over 40 age groups. Average life expectancy for the male practice population was 80 (CCG average 77 and national average 79) and for the female population 82 (CCG average 81 and national average 83).

56% of the practice population was recorded as having a long standing health condition (CCG average 56.9% and national average 54%). Higher percentages may result in an increased demand for GP services.

Updated 22 June 2016

We carried out an announced comprehensive inspection at Crawcrook Medical Centre on 3 March 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.
• 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.
• The majority of patients said they were treated with compassion, dignity and respect.
• Same day emergency appointments were usually available.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly
• The practice had proactively sought feedback from patients and had an active patient participation group.
• Information about services and how to complain was available and easy to understand.
• The practice was aware of patient dissatisfaction in respect of the appointment system and access to appointments but were taking steps to try and improve.

However there were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure the nursing staff are given the opportunity of an annual appraisal
• Ensure that there is a risk assessment in place detailing why it is not felt to be necessary to have a defibrillator or oxygen at the branch surgery.

The provider should also:

• Continue to monitor appointment availability and the effectiveness of the appointment system
• Satisfy themselves that all staff have received the appropriate level of safeguarding training
• Revise their policy to ensure that disposable privacy curtains are replaced every six months or sooner if visibly stained or dirty
• Continue with their plans to change and improve the culture of the practice

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 June 2016

The practice is rated as requires improvement for the care of people with long term conditions. The practice was rated as requires improvement for providing safe, effective and responsive services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However:

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. Patients with multiple long term conditions were offered a comorbidity review

Practice nurses were supported in undertaking additional training to help them understand and care for patients with certain long term conditions, such as chronic obstructive pulmonary disease (COPD) and asthma. Smoking cessation advice was available from the health care assistant. The practice had a proactive approach to treating patients with diabetes and had the lowest incidence of referrals for diabetic retinopathy (a complication of diabetes that can cause eye damage) in the Gateshead area.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to some of 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. This was 3.4 percentage points above the local CCG average and 2.6 points above the national average.
• The practice had obtained 100% of the points available to them in respect of hypertension. This was 2.2 percentage points above the local CCG average and 2.2 points above the national average.
• The practice had obtained 100% of the points available to them in respect of chronic obstructive pulmonary disease (4.6 points above the local CCG average and 5.3 points above the England average.

Updated 22 June 2016

The practice is rated as requires improvement for the care of families, children and young people. The practice was rated as requires improvement for providing safe, effective and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However:

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 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. Vaccination rates for 12 month and 24 month old babies and five year old children were comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 85.4% to 100% (compared with the CCG range of 81.3% to 97%). For five year olds this ranged from 91.5% to 100% (compared to CCG range of 89.8% to 97.9%).

Information from the National Cancer Intelligence Network (NCIN) published in March 2015 indicated that 77.6% of the 1485 female patients aged between 25 and 64 listed with the practice had attended cervical screening (compared to the CCG average of 76.6% and national average of 74.3%).

Pregnant women were able to access antenatal clinics provided by healthcare staff attached to the practice. The practice GPs carried out post-natal mother and baby checks.

The practice provided contraception advice and sexual health screening to young people or signposted them to a local young person resource centre. The practice was proactive in identifying young carers and information for young carers was displayed on the practice notice board.

Updated 22 June 2016

The practice is rated as requires improvement for the care of older people. The practice was rated as requires improvement for providing safe, effective and responsive services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However:

Nationally reported data showed the practice had 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 with heart failure. This was above the local clinical commissioning group (CCG) and England averages of 97.9%.

Patients aged over 75 had a named GP and the practice offered immunisations for flu, pneumonia and shingles to older people. The practice had a palliative care register and held regular multi-disciplinary meetings to discuss and plan end of life care.

The practice provided services to a number of patients in two local nursing homes and had developed a half day weekly ward round approach to visiting the homes. Home visits were readily available for long term housebound patients. The practice regularly referred older patients to the local falls clinic and various support organisations. The practice also worked with health care navigators to ensure older people received coordinated care and treatment to enable them to stay in their own homes and avoid non-elective admission to hospital.

Updated 22 June 2016

The practice is rated as requires improvement for the care of working age people. The practice was rated as requires improvement for providing safe, effective and responsive services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However:

The needs of the working age population, those recently retired and students had been met. The main surgery was open from 8am to 6pm on a Monday and Thursday, 7.30am to 7pm on a Tuesday, 8am to 7pm on a Wednesday and 7.30am to 6pm on a Friday. Greenside branch surgery was open from 8am to 12.30pm on a Monday to Friday. Patients unable to attend the surgery within these hours were able to access pre bookable appointments at a local GP led extended hours facility, Blaydon Hub up to 8pm on a weekday and on a weekend.

The practice offered a number of services including contraceptive advice, sexual health screening, foreign travel advice, cervical screening, smoking cessation and NHS health checks (for patients aged 40-74). The practice had installed a blood pressure machine in the waiting area of the main surgery which patients could use to record their own blood pressure, height and weight. A system was in place where a print out of the results could be reviewed by a clinical member of staff and appropriate action taken if necessary.

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. This included alcohol dependency identification and brief intervention.

Updated 22 June 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health. The practice was rated as requires improvement for providing safe, effective and responsive and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However:

The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 81.8%. This was comparable to the national average of 84%.

The practice hosted counsellors from a mental health support organisation on a weekly basis and encouraged patients with mental health issues to access the local psychological wellbeing service. The practice also hosted a substance and alcohol misuse recovery worker.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia.

Updated 22 June 2016

The practice is rated as requires improvement for the care of people whose circumstances make them vulnerable. The practice was rated as requires improvement for providing safe, effective and responsive services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However:

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. Patients with learning disabilities were invited to attend the practice for annual health check and were routinely offered longer appointments.

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 was proactive in identifying and supporting carers, including young carers. They had identified a member of staff as a carer’s champion whose role included providing information and support to carers. The waiting room contained useful information for carers.

The practice was registered as a safe place. Safe places is a scheme which provides vulnerable people with a place to go for help and support in dealing with any incident that takes place while they are out and about, regardless of whether they are registered with the practice.