Archived: Chichester Practice

Updated 26 October 2016

Chichester Practice provides Primary Medical Services to the town of South Shields. The provider which is Farnham Medical Centre provides services from two locations;

• Chichester Practice, Stanhope Parade Health Centre, Gordon Street, South Shields, Tyne and Wear, NE33 4JP.
• Farnham Medical Centre, 435 Stanhope Road, South Shields, Tyne and Wear, NE33 4QY.

We visited both practices on the day of the inspection, the distance between the practices is approximately one mile.

The practices have two separate General Medical Services (GMS) contracts with NHS England. We have provided a separate inspection report for Farnham Medical Centre.

Chichester Practice provides services to approximately 2,600 patients of all ages. The surgery is located in a shared purpose built health care centre which is also occupied by two other GP practices and some secondary healthcare services. There is step free access at the front of the building and all facilities are on the ground floor with full disabled access. There is car parking to the front of the surgery including dedicated disabled parking bays.

The main practice has six GP partners and two salaried GPs. Four are female and four male. The practice is a training practice which has GP trainees allocated to the practice (fully qualified doctors allocated to the practice as part of a three-year postgraduate general practice vocational training programme) and F2 doctors (a medical practitioner undertaking a medical training programme which forms the bridge between medical school and specialist/general practice training). There are two nurse practitioners (one who works in the winter months only) two practice nurses and two health care assistants. There is a practice manager and assistant practice manager. There are eighteen members of administration staff and two cleaners. The staff from Farnham Medical Centre also work at the Chichester Practice.

Chichester Practice shares the same clinical computer system as Farnham Medical Centre. Chichester Practice has a separate telephone system. The same GPs tend to provide the services to Chichester Practice and there are two dedicated receptionists for the practice. Both practices share the same governance system and policies and procedures.

The practice is part of South Tyneside clinical commissioning group (CCG). 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 practice is open weekdays from 8am until 6pm Tuesday to Friday. There are extended opening hours until 7:15pm on Monday evenings.

Consulting times with the GPs and nurses range from 8:30am – 12noon and 3:20pm – 5:30pm. On extended opening days consulting times run to 7:10pm.

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

Updated 26 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chichester Practice on 22 September 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.
• Risks to patients were assessed and well managed.
• Outcomes for patients who use services were good.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available
• 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 system in place for handling complaints and concerns and responded quickly to any complaints.

{cke_protected_2}· Patients told us they were able to get an appointment with a GP when they needed one, with urgent appointments available on the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.
• Staff throughout the practice worked well together as a team.
• The practice was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice which was:

• The practice was part of a frailty/multi-morbidity project. This involved identifying patients who were either palliative or housebound who had polypharmacy and three or more long term conditions. Polypharmacy is the use of four or more medications by a patient. A visit was arranged to see the patient and an advanced care plan was compiled. Patients who had been seen so far in the project included 20 in nursing homes and 35 in their own home. This had resulted in medication reviews and as a result of this there were further investigations with referrals to the memory clinic, continence clinic and geriatric assessments.

The areas where the provider should make improvements are:

• Consider compiling a business continuity plan for the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 October 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to the conditions commonly associated with this population group. For example, performance for related indicators for patients with chronic obstructive pulmonary disease (COPD) were the same as the national average (96%).

The practice had a register of patient with long term conditions which they monitored closely for annual call and recall appointment for health checks. There were longer appointments available for these clinics. Extended opening hours and home visits were available when needed.

The clinical staff kept themselves updated with new guidance via educational meetings. There were dedicated chronic disease nurses and the GPs all had lead areas for example, COPD, asthma and diabetes.

Updated 26 October 2016

Updated 26 October 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population.

The practice was part of a frailty/multi-morbidity project. This involved identifying patients who were either palliative or housebound who had polypharmacy and three or more long term conditions. Polypharmacy is the use of four or more medications by a patient. A visit was arranged to see the patient and an advanced care plan was compiled. Patients who had been seen so far in the project included 20 in nursing homes and 35 in their own home. This had resulted in medication reviews and further investigations with referrals to the memory clinic, continence clinic and geriatric assessments.

The practice provided a dedicated GP to the three care homes which they provided services to. There were fortnightly ‘ward rounds’ at the care homes. There were reviews of all of these patients who had been discharged from hospital. The practice had also recently been awarded the contract to provide services to a newly opened re-enablement service.

The practice had a palliative care lead in the practice and a palliative register which was discussed at the weekly clinical meeting. There was a named and second GP for each patient on the register.

All patients over the age of 75 had a named GP. The practice offered home visits usually by the same GP. Prescriptions could be sent to any local pharmacy electronically.

Updated 26 October 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 which included appointment booking, test results and ordering repeat prescriptions. There was a full range of health promotion and screening that reflected the needs for this age group. Staff had been trained by Change for Life specialists to offer health advice and to sign post patients. This is an NHS organisation dedicated to the health and well-being of the public. Flexible appointments were available as well as extended opening hours.

Updated 26 October 2016

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

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. The patients were proactively contacted by the GP who knows them best regarding their review appointment. They told them how to access various support groups and voluntary organisations. Following notification of the patient attending accident and emergency at the hospital, if felt appropriate, the GP would contact the patient.

Performance for mental health related indicators was better than national average. For example performance for dementia indicators was above the national average (100% compared to 94.5% nationally).

Updated 26 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice held a register of 72 patients living in vulnerable circumstances. There was a nominated GP lead for learning disabilities and proactive booking of appointments for them with longer appointments offered.

The practice had close working relationship with the local drug and alcohol worker who consulted with patients at the practice with two nominated GPs who signed the prescriptions.

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. 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.

There were alerts added to patient’s records who had poor vision or hearing and staff knew to help them navigate through the appointment system. The practice had a homeless policy and specific pack available at reception for homeless patients.

The practice’s computer system alerted GPs if a patient was a carer. There was a practice register of all people who were carers and were being supported, for example, by offering health checks and referral for social services support. There was a specific carers lead in the practice. There were 70 patients on the carer’s register which was 2.7% of the practice population. Written information was available for carers to ensure they understood the various avenues of support available to them. Carer’s packs were given to new patients and a young carers group was advertised in the waiting area. The practice had close links with the local carers organisation.