Archived: Elm Tree Medical Centre

Updated 7 July 2016

Elm Tree Medical Centre is in the older part of Thornaby. The practice is situated in a small building at the end of a row of shops. The practice size has grown and the building is no longer adequate to house the growing staff and patient needs. The practice currently houses administration staff in a porta cabin behind the practice building. There is no direct access from the practice into the porta cabin which means staff must go outside to gain access. The practice is awaiting a decision from NHS England to go forward with relocating into a large vacated library directly opposite . There are 3141 patients on the practice list. The practice scored two on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services. The practice population showed a higher than national average number of patients aged four years and under and a higher than national average number of patients under the age of 44 years.

There are two GP partners, male and female. There are two practice nurses, one locum nurse and one health care assistant (HCA) (all female). The practice have a practice manager and an office manager who have specific roles and are supported by a range of reception and administration staff.

The practice is open from 8am to 6pm, Monday to Friday and provides some extended hours on a Tuesday evening from 6pm until 7.30pm. We saw that appointments can be booked by walking into the practice, by the telephone and on line. The GPs had dedicated time allotted to contact patients requesting a telephone consultation. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Northern Doctors via the NHS 111 service. The practice has a General Medical Service (GMS) contract. The practice is close to Stockton town centre and there is parking available on the road near the practice and nearby. There are good transport links near and good access to public transport.

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Elm Tree Medical Centre on 24 May 2016. 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.
• There was limited space due to the small size of the practice and was planning to move into larger premises shortly. However the practice 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 July 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice provided chronic disease management clinics daily and late evening appointments, during extended hours, (which was on a Tuesday evening) to help patients who could not attend during core hours.

• 33% of the practice population suffered from a Long Term Condition.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 83 %. This was the same as the local CCG average and 2% above the England average.

• 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. The practice had signed up to the CCG enhanced services to provide healthy Lung and healthy heart checks.

• High risk of admission patients were routinely reviewed on a quarterly basis by the GP’s.

• Any high risk patients who had unplanned hospital admissions were reviewed within 48hrs of discharge by the GP. The patient care plan was reviewed and updated.

• The practice worked closely with the Community Matron who had open access to the GPs to discuss any patient concerns.

• One of the GPs had a special interest in Rheumatology and was trained to administer joint injections.

Updated 7 July 2016

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

• 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 for the 24 month age group were relatively good for all standard childhood immunisations. However the rates for five year olds were below the national average. The practice has undertaken some work in this area and identified it as being related to the high number of refugees and asylum seekers registered with the practice.

• The practice worked closely with the health visitor for asylum seekers.

• 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.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 85%. This was 2% above the local CCG average and 4% above the England average.

• 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.

• One of the GPs had a special interest Women’s Health and provided contraception advice and was trained in the fitting and removal of coils and implants.

Updated 7 July 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. All older patients had been allocated a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice regularly visited patients in care homes.

• All patients over 75yrs were offered an annual health check which comprised of an appointment with the Health Care Assistant (HCA) or nurse, who took an annual blood test and recorded patients BMI. The patient then saw the GP whodiscussed both the patient’s physical and mental health, and completed basic dementia screening, using the six item cognitive impairment test (6CIT). Where the GP indicated will offer to refer to the dementia screening service.

• During the reviews the GPalso discussed any social problems the patient may have andreferred to relevant services if the need required. Examples of these services were Stockton Navigation Service and Social Services.

• For those patients who required extra support a personalised care plan was agreed between the GP and patient.

Updated 7 July 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 reflected the needs for this age group.

Updated 7 July 2016

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

• 85% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average. The practice were involved in an initiative to try and increase the number of patients who were formally diagnosed with dementia andplaced on the Dementia Register.

• Nationally reported data from 2014/2015 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 100%, which was comparable to other local practices and above the national average.

• 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 and mental health problems. The personalised comprehensive care plan was discussed and reviewed during their annual review appointment with the GP.

• The practice had told patients experiencing poor mental health about 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.

• Patients suffering mental health problems were offered an annual flu vaccination.

• The practice offered an in-house counselling serviceon a weekly basis and offered patients, information on self-referral to Improving Access to Psychological Therapies (IAPT) and Alliance Counselling Services. Alliance Counselling Service provided a clinic weekly within the practice and patients were able to self-refer. The Improving Access to Psychological Therapies (IAPT) programme supported the frontline NHS in implementing National Institute for Health and Clinical Excellence (NICE) guidelines for people suffering from depression and anxiety disorders. One of the counsellors visiting the practice was multi- lingual which helped meet the needs of some patient groups.

Updated 7 July 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.

• All patients were offered alcohol screening during health checks and where required a referral to Life Line. This was a registered charity that worked with individuals, families and communities both to prevent and reduce harm, promote recovery, and reduce inequalities linked to alcohol and drug misuse.

• 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.