Northgate Surgery

Updated 20 July 2017

Northgate Surgery is located in the centre of Uttoxeter, Staffordshire. The practice provides services to people living in the surrounding towns and villages. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

Northgate Surgery relocated to its current premises in June 2014, a purpose built building owned privately and leased to the partners. The premises are shared with the district nursing team, a physiotherapist, midwife, chiropody and counselling services. Rooms are situated on the ground floor and consist of a reception area, treatment rooms and consultation rooms. The practice has level access from the car park and is accessible for wheel chair users; there are disabled and baby changing facilities.

The practice area is one of lower deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 5,700 patients. Demographically the population is 98% white British with the remaining patients being Eastern European. The practice age distribution is similar to the national and CCG averages. For example, 19% of the patients are aged 65 and over compared to the CCG average of 19% and the national average of 17%. The percentage of patients with a long-standing health condition is 50% which is comparable with the local CCG average of 52% and the national average of 53%.

The practice staffing comprises:

• Three GP partners (two male, one female). 2.6 whole time equivalent (WTE).
• Two practice nurses (combined 58 hours per week, 1.4 WTE).
• A healthcare assistant (0.5 WTE).
• A practice manager and office manager.
• Three dispensary staff
• Eight Administrative staff working a range of hours.

The practice opens between 8am and 6.30pm Monday to Friday. Pre-bookable and same day appointments are made available each day. Appointments can be booked between 8.50am and 11.50am in the morning and between 3pm to 6.10pm each afternoon. Extended hours appointments are provided on a Monday when the practice remains open until 7.30pm. In addition, urgent same day appointments are added to morning and afternoon surgeries. Telephone consultations with a GP or nurse are available each day. Appointments can be pre-booked in advance (no set time limit) and urgent appointments are made available for those that needed them. The practice has opted out of providing cover to patients in the out-of-hours period. During this time services are provided by Staffordshire Doctors Urgent Care, patients accessed this service by calling NHS 111. An online facility to book appointments and request repeat prescriptions is available to those patients who had registered to use the service.

Updated 20 July 2017

Letter from the Chief Inspector of General Practice

We undertook an announced comprehensive inspection of Northgate Surgery on 19 June 2017. 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 for reporting and recording significant events.
• The practice had the majority of defined and embedded systems to minimise risks to patient safety. The exception was that the system for managing alerts did not include a check to ensure appropriate action had been taken.
• Staff were aware of and seen to be providing treatment in line with current evidence based guidance.
• Clinical staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The provider had a training programme that included all staff. We saw that training requirements had been completed or planned.
• Results from the national GP patient survey published in July 2016 showed most scores were above average when patients were asked if they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. The scores for access by telephone and availability of appointments were significantly higher than local and national averages.
• Information about services and how to complain was available and we saw improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure; GPs had leadership roles in specialist clinical areas and staff spoke positively about the support they received from the management team.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. We reviewed the process for managing significant events and complaints and saw evidence that the practice complied with these requirements.

The areas where the provider should make improvement are:

• Review the system for managing alerts to include a check that appropriate action has been taken.
• Review the policy for exception reporting patients to ensure that patients who require reviews remain highlighted on the clinical system.
• Explore ways to increase the number of patients identified as carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 July 2017

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

• Patients at risk of hospital admission were identified as a priority.

• 96% of patients with chronic obstructive pulmonary disease (COPD) had had a review undertaken including an assessment of breathlessness using a recognised scale in the preceding 12 months. This was the higher than the Clinical Commissiong Group (CCG) average of 91% and the national average of 90%.
• The percentage of patients with diabetes, on the register, whose last measured total cholesterol was within recommended limits, was 92%. This was higher than the CCG average of 82% and the national average of 80%. However the exception reporting rate of 26% was higher than the CCG and national averages of 13% meaning fewer patients had been included.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There was a system to recall patients with long term conditions for a structured annual review to check their health and medicines needs were being met.
• For patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Patients were supported to self-manage their diseases. For example, a rescue treatment pack was provided to patients with chronic obstructive pulmonary disorder (COPD).

Updated 20 July 2017

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

• There were systems and procedures in place to safeguard children from the risk of abuse. Alerts were placed on patient records to make staff aware of children who had a child protection plan in place. An alert was in place to inform staff of the parents and siblings of children with a child protection plan in place.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child development clinics.
• On the day appointments were available for children.
• There was a system in place to follow up children who did not attend (DNA) for hospital appointments.
• A contraception service was offered and condoms were available free of charge from the practice.
• Access was available to male and female clinicians on request.
• Monthly safeguarding meetings held with health visitors were extended to include the school nurses.

Updated 20 July 2017

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

• Patients aged 75 years or over had been advised of a named GP.
• The practice had identified their most frail and older patients and those with complex needs. The practice carried out monthly reviews for this group of patients, and their carers, to reduce avoidable hospital admissions and attendances to A&E.
• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population. For example, the surgery provided a bypass telephone number for urgent access.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The GPs carried out weekly reviews for those patients who resided in a care home. These included visits and virtual ward rounds (blocked off time weekly for a GP to review patients identified by the care home as in need of a review and/or visit).
• The practice followed up older patients discharged from hospital and liaised with GPs and district nursing staff so that patients’ care plans were updated to reflect any additional needs.
• The practice identified older patients who needed palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care and held monthly palliative care meetings with other health professionals.

Updated 20 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to respond to patients’ needs. For example, patients had access to an online service for booking appointments and ordering repeat medication.
• An extended hours service provided appointments with the GPs, nurses and healthcare assistant.
• Telephone consultations were offered daily with a GP or a nurse.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The provider offered NHS Healthchecks and had completed 143 since April 2017 (the target for 2017/18 was 209 per annum).

Updated 20 July 2017

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

• The practice had identified a higher percentage of their patients as having dementia (1.3%) when compared to the CCG and national averages (0.8%); and carried out advance care planning for patients living with dementia.
• 84% of patients diagnosed with dementia had a care plan in place that had been reviewed in a face-to-face review in the preceding 12 months. This was comparable with the Clinical Commissioning Group (CCG) average of 82% and the national average of 83%.
• The practice hosted an in-house clinic from a counsellor for minor mental health conditions.
• Staff had been provided ‘Dementia Friends’ training.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 95% of patients with a diagnosed mental health condition had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was the higher than the CCG average of 85% and the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Staff were aware of where to refer patients for supporting services. For example, a specialist postnatal mental health team.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations. For example, a counselling service hosted by the practice.

Updated 20 July 2017

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 carers, children at risk, vulnerable adults and military veterans. Extended appointments were offered to vulnerable patients.
• A register was maintained for those patients with a learning disability. The practice had regular communication with the community learning disabilities team who provided annual training for clinical staff. There were 48 patients on the register. Every patient had been invited for an annual health check and 38 had been completed in the previous 12 months.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies. Child safeguarding meetings were held monthly.
• A translation service and a hearing loop was available at the reception desk.
• The building had disabled facilities which included automated entrance doors to the building.