Rockliffe Court Surgery

Updated 10 December 2015

Rockliffe Court Surgery is located in Hurworth which is a rural village near Darlington, County Durham. It has a practice list size of 5497 and a Personal Medical services contract. The majority of patients are of white British background. The practice has two GP partners (both female) and a salaried GP (male). There is a Nurse Practitioner, Practice Nurse, Health Care Assistant and Phlebotomist. The practice has a dispensary. There are dispensing staff, administrative staff, receptionist and a Practice Manager.

The practice is open between 8.30am and 6pm Monday to Friday and appointments are available between these times. Extended hours surgeries are offered on Tuesday and Thursday mornings between 7.30am and 8am. There is a walk in surgery every morning between 8.30am and 9.30am.

Patients are able to contact the surgery until 6pm. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Darlington CCG.

Updated 10 December 2015

GOOD

We carried out an announced comprehensive inspection at Rockliffe Court Surgery on 22 September 2015. 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 to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• The practice had initiated positive service improvements for its patients that were over and above its contractual obligations.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patient’s needs.

• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available 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 and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• Staff demonstrated they supported patient’s emotional and social needs and recognised they were as important as patient’s physical needs. Care needs were assessed and care was planned and delivered following best practice guidance.

• The practice demonstrated they were acutely aware of their population groups and responded to context. They focussed on the challenges faced by a rural community and planned their services around this.

• The practice responded and was engaged with notable local groups and stakeholders.

We saw a wide range of outstanding practice, examples of which included:

• The practice supported patients to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill health. The practice was actively involved in the local community; they had reached out to them to promote better health. For example, they had a stall at the village Fayre annually and had invited Healthwatch to contribute to raise patient awareness of services. The practice had also engaged with a local charity and organised medicine pots to place in patient’s homes (Message in a bottle project). These contained care plans so that emergency health services knew where to find this relevant patient information if they visited.

• The practice offered an e-mail consultation service. Patients using the electronic consultation usually received a response within one working day.

• The practice had taken numerous locally available opportunities to implement service improvements and manage delivery challenges to its population. For example they had collaborated with the local parish church to arrange a volunteer service for delivery of medicines in the rural area. The practice was also working with a new village charity to set up a befriending service for patients who needed it and could refer their patients in for extra support if they were vulnerable.

• A named GP had completed additional training with regard to autism to help ensure responsive and proactive care to adults with autism spectrum disorder in supported living. The GP had implemented a health promotion regime in diet and exercise that had resulted in the residents who lived there losing weight.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 December 2015

OUTSTANDING

The practice is rated as outstanding 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. Longer appointments and home visits were available when needed. These patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

People with long term conditions were offered the service the practice had initiated with a local charity, that of a medicine pot kept in their home with their care plan details available to health care professionals who visited them at home.

Performance indicators for patients with diabetes were better than the national average.

Updated 10 December 2015

OUTSTANDING

The practice is rated as outstanding 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 were relatively high for all standard childhood immunisations. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

The practice had responded to the suggestions by the PPG and provided a play room for children and their parents and carers. The practice had taken the opportunity to provide a notice board in the room to share information with parents about health promotion, for example childhood immunisations. There was also a dedicated teenage notice board.

Updated 10 December 2015

OUTSTANDING

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were above average for conditions commonly found in older people, for example diabetes. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice offered a daily walk in surgery. The practice had engaged with external stakeholders and local charities to improve services offered to older people.

Updated 10 December 2015

OUTSTANDING

The practice is rated as outstanding 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 reflects the needs for this age group.

The walk in surgery was available every morning and the practice had also implemented an extended hour’s surgery starting at 7.30am twice weekly. These services were highly valued by the patients in the comments cards that we received and in the patient survey scores.

The practice offered an e-mail and a telephone consultation service which was particularly useful to patients in this group. Patients using the electronic consultation usually received a response within one working day.

Updated 10 December 2015

OUTSTANDING

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). 83% of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

A named GP had received extra training with regard to mental health problems experienced in autism and elderly care. The GPs also attended meetings at the nearby mental health unit. Patients with mental health problems were included in the care plans in a medicine pot scheme with a local charity.

The practice undertook proactive case finding for new dementia diagnosis. The practice had done a recent audit which had demonstrated that all patients on the dementia register had been investigated and referred appropriately.

Updated 10 December 2015

People whose circumstances may make them vulnerable

OUTSTANDING

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability and 95% of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It 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.

The practice had a supported living home for adults with autism nearby and one of the GPs had received further training to increase knowledge and skills for this population group. We were told that in order to maintain continuity of care the same GP visited the home regularly. The GP had close links with the psychiatrist who cared for the patients. Most healthcare was offered at home to meet the care needs of this group.

One of the GPs had implemented a system which had been adopted across the wider area whereby a person subject to a Deprivation of Liberty Safeguard (DoLS) was flagged up on the system when they were seen by a health care professional.

The practice had engaged with several local charities to improve services for vulnerable people. An example of this was the implementation of a befriending service.