Archived: Bunnyhill Customer Services & Primary Care Centre

Updated 10 March 2016

Bunnyhill Customer Services and Primary Care Centre is part of Deerness Park Medical Group which is registered with the Care Quality Commission to provide primary care services for around 14,100 patients from two locations in Sunderland:

• Deerness Park Medical Centre, Suffolk Street, Sunderland, SR2 8AD.
• Bunny Hill Health Customer Services and Primary Care Centre, Hylton Lane, Downhill, Sunderland, SR5 4BW.

We visited both of the addresses as part of the inspection.

Deerness Park Medical Centre is based in purpose built premises. All reception and consultation rooms are fully accessible and on one level. There is on-site parking and disabled parking. A disabled WC is available.

Bunny Hill Health Customer Services and Primary Care Centre is located within purpose built premises in the Downhill area of Sunderland. The service shares the premises with a walk-in centre and several external services. All reception and consultation rooms are fully accessible There is on-site parking and disabled parking. A disabled WC is available.

The practice has six partners and three salaried GPs (six male, three female).The practice employs a practice manager, an operations manager, five practice nurses, four healthcare assistants and 19 staff who undertake administrative or reception roles. The practice provides services based on a General Medical Services (GMS) contract agreement for general practice.

The practice is an approved training practice where qualified doctors gain experience in general practice; there were no trainee GPs employed at the time of the inspection.

Deerness Park Medical Centre is open at the following times:

• Monday - 7:30am to 7pm
• Tuesday - 7:30am to 6pm
• Wednesday, Thursday and Friday - 8am to 6pm

The telephones are answered by the practice during these times.

Appointments are available at Deerness Park Medical Centre at the following times:

• Monday 7:30am - 12:30pm and 2pm - 7pm
• Tuesday 7:30am - 12:30pm and 2pm - 6pm
• Wednesday 7:30am - 12:30pm and 2:15pm - 5:30pm
• Thursday 8am - 12:30pm and 2pm - 5:45pm
• Friday 8:15am - 12:30pm and 2pm - 5:30pm

Bunny Hill Health Customer Services and Primary Care Centre is open at the following times:

• Monday - 8pm to 6pm
• Tuesday - 8pm to 7pm
• Wednesday, Thursday and Friday - 7:30am to 6pm
• Saturday - 8am to 10am

Appointments are available at the Bunny Hill Health Customer Services and Primary Care Centre at the following times:

• Monday 8:30am - 12:30pm and 2pm - 7pm
• Tuesday 8:30am - 12:30pm and 2pm - 7pm
• Wednesday 7:30am - 12:30pm and 2:15pm – 5:30pm
• Thursday 7:30am - 12:30pm and 2pm – 5:30pm
• Friday 7:30am - 12:30pm and 2pm - 7pm
• Saturday 8am - 10am

In addition to the extended hours appointments each week day, the practice also participates in the locality extended hours scheme based at a local health centre. Patients can access a local GP between 6pm and 8pm Monday to Friday and from 9am to 2pm on Saturdays and Sundays.

The practice is part of NHS Sunderland clinical commission group (CCG). Information from Public Health England placed the area in which the practice is located in the second most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. Average male life expectancy at the practice is 74 years compared to the national average of 79 years. Average female life expectancy at the practice is 80 years compared to the national average of 83 years.

The proportion of patients with a long-standing health condition is above average (64% compared to the national average of 54%). The proportion of patients who are in paid work or full-time employment is below average (48% compared to the national average of 60%).

The NHS 111 service and Northern Doctors Urgent Care Limited provide the service for patients requiring urgent medical care out of hours. This information is available on the practice’s telephone message, website and the practice leaflet.

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bunnyhill Customer Services and Primary Care Centre on 7 January 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. All opportunities for learning from internal incidents were maximised.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• 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.
• Patients were able to access appointments at times that were convenient. A wide range of extended hour’s provision allowed patients access to GP services seven days a week.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs. For example, the practice implemented changes following suggestions from a local support agency for people with learning disabilities and was soon to refurbish the reception at Deerness Park to make it dementia friendly.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

There is one area of practice where the provider needs to make improvements.

The provider should:

• Improve the management of complaints in line with their agreed complaints policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

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

• Nursing staff and GP partners had lead roles in chronic disease management. Patients at risk of hospital admission were identified as a priority for care and support by the practice. Weekly clinics for patients living with diabetes and asthma were held at the practice.
• The practice was part of a project and was about to start holding weekly multi-disciplinary team meetings for patents at high risk of being admitted to hospital.
• The practice was the only local practice involved in the ‘boilers on prescription scheme’ that aimed to improve the health of patients with some long term conditions by providing warm homes.
• One of the nurses was the designated lead for heart failure. They had developed close working relationships with the community and secondary providers of care that ensured effective support for patients.
• Nationally reported data showed that outcomes for patients with some long term conditions were lower and some were higher than average. For example, the practice had achieved 74% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was below the local CCG average of 93% and the national average of 89%. However, the practice achieved 100% of the points available for providing the recommended care and treatment for patients living with cancer and rheumatoid arthritis.
• 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.

Updated 10 March 2016

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

• 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. The six week baby checks were carried out by a GP.
• Immunisation rates were relatively high for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 95% to 99% (CCG average 96% to 100%) and for five year olds ranged from 94% to 99% (CCG average 32% to 99%).
• Urgent appointments for children under the age of two were available on the same day.
• 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 showed that outcomes for patients with asthma were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was above the local CCG and national average of 97%.
• The practice’s uptake for cervical screening was 82%, which was slightly below the local CCG average of 83% and in line with the national average of 82%.

Updated 10 March 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 patients over the age of 75 had a named GP; there was a designated GP lead for palliative and elderly care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients with conditions commonly found in older people were good. For example, the practice had achieved 97% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was comparable to the local clinical commissioning group (CCG) average of 99% and the national average of 98%.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was 69%, which was below the local national average of 73%.

Updated 10 March 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 provided extended hours appointments each day. They were also part of a wider extended hours scheme that provided appointments every evening between 6pm and 8pm and on Saturday and Sunday mornings at a nearby health centre.
• Patients could order repeat prescriptions and book appointments on-line.
• Text message appointment reminders were available.
• Telephone appointments were available.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group.
• Additional services such as health checks for over 40’s and travel vaccinations were provided.
• The practice website provided a wide range of health promotion advice and information.

Updated 10 March 2016

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

• Nationally reported data showed that outcomes for patients with mental health conditions were lower than average. The practice had achieved 69% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was below the local CCG average of 92% and the national average of 93%.
• Nationally reported data showed that outcomes for patients with dementia were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was above the local CCG average of 96% and the national average of 95%. However, only 76% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• All staff had undertaken dementia friendly training and the practice had recently been awarded a grant to refurbish the practice to make it more suitable for patients with dementia. This would include work to improve the flooring in the reception area, the practice were taking expert advice to ensure appropriate changes were made.
• The practice 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. The practice had an in-house counsellor that patients could self-refer to.
• 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.

Updated 10 March 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 if required.
• A visit from a local support agency for people with learning disabilities found good practice around supporting patients with learning disabilities to access annual health checks. The practice took steps to encourage these patients to access routine health checks and screening. They also found the practice could make improvements to the appointment process, the practice had responded to this and made changes to the appointment system.
• The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. The practice had an in-house counsellor that patients could self-refer to.
• 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.
• Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check.
• The practice had acted upon the advice of a local learning disability group to improve access to the buildings and services.
• They had recently joined the Sunderland Safe Place scheme; this is a scheme for all vulnerable people and not limited to patients at the practice. Vulnerable people can ask for support and advice at any location that is part of the scheme.