North House Surgery

Updated 11 January 2018

North House Surgery, Hope Street, Crook, County Durham, DL15 9HU is located in the town of Crook, near to Bishop Auckland. The premises is owned and managed by Assura (property developers for primary care). There is ample free car parking to the rear of the practice.

The practice provides services under a General Medical Services (GMS) contract providing service to the practice population of 13,524, covering patients of all ages.

The proportion of the practice population in the 55 years and over age group is above the England average. The practice population in the under 18 age group is below the England average. The practice scored four 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 has seven GP’s (four of whom are partners), five male, two female. There are four advanced nurse practitioners, one nurse prescriber, three practice nurses and four health care assistants. There is a practice manager, an assistant practice manager and a team of 16 administration and reception staff. There is also a pharmacist available who works three mornings per week and a physiotherapist who works 18 hours per week.

North House Surgery is open between 8am to 6pm Monday to Friday, with appointments between 8.40am until 11.20am and 2.40pm and 6pm. The surgery is also open on Saturday mornings 8am until 12 noon. This is an acute surgery for acute problems only.

The practice is a member of the Durham Dales Health Federation, comprising 12 practices in the local area.

Updated 11 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North House Surgery on 17 February 2017. The overall rating for the practice was good, but was rated as requires improvement for providing safe services. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for North House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 February 2017. This report covers our findings in relation to those requirements.

The practice is rated as good overall including for providing safe services.

Our key findings were as follows:

• The practice had addressed the arrangements for medication reviews since the last inspection.

At our previous inspection in February 2017 we said the provider should make improvements in several areas. We saw at this inspection those that improvements had been made;

• The practice had improved their system for identifying carers, 1.8% of the practice population had been identified as carers compared to 0.5% at our previous inspection.

There were areas where the provider still needed to make improvements. At our previous inspection in February 2017 we said the practice did not have a strategy or a supporting business plan which outlined their vision and plans for the future. At this inspection we saw that this had not been yet been considered but arrangements had been made for a meeting regarding this in January 2018. We said that the infection control lead should have the appropriate training for this role. The lead nurse had recently left the practice and the new infection control lead was waiting to receive this training.

Therefore the provider should:

• Develop a written strategy and supporting business plan which outlines their vision and plans for the future.

• Ensure that appropriate training for the infection control lead is provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 March 2017

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

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with chronic obstructive pulmonary disease (COPD) who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months was 88%, which was comparable to the CCG average of 89% and the England average of 90%.

• Longer appointments and home visits were available when needed.

• Patients with LTCs had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice had robust systems for monitoring patients on anticoagulation medicine, NOACs and disease-modifying anti-rheumatic drugs (DMARDs). DMARDS are used in the treatment of rheumatoid arthritis and require regular monitoring and review of the patients.

• The practice has three dedicated diabetic clinics each week.They are working under the CCG diabetic scheme whereby staff received training from the diabetic specialist nurse.

Updated 28 March 2017

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 or who failed to attend hospital appointments.

• Immunisation rates were high for all standard childhood immunisations.

• Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 81%. This was 2% below the local CCG average and the same as the England average.

• 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 monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns.

• The practice has been awarded the ‘Young Carers Charter Award’ (support systems for young people who are carers). Within the last year, this award was re-evaluated and was awarded again.

• The practice offered a range of sexual health services where patients could get advice and treatment, for example contraception. Information and testing kits for sexually transmitted diseases were available in the practice.

Updated 28 March 2017

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.

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

• Nationally reported data for 2015/2016 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicator in respect of atrial fibrillation was 90%; this was the same as the local CCG average and 1% above the England average.

• The practice was part of the Vulnerable Adults Wrap Around Service (VAWAS). This was a service provided to vulnerable patients who are housebound or those at high risk of admission to hospital. This was a Federation initiative through the CCG to ensure the needs assessment of vulnerable patients remained up to date.

• The practice had employed a part-time pharmacist to help clinicians with medicine reviews and review of hospital discharge letters relating to medicine.

Updated 28 March 2017

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.

• Telephone consultations were available every day with a call back appointment arranged at a time to suit the patient.

Updated 28 March 2017

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

• Nationally reported data from 2015/2016 showed 82% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was 3% below the local CCG average and 2% below the England average.

• 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 86%. This was 6% below the local CCG average and 3% below England average.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advanced 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 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 people with mental health needs and dementia.

Updated 28 March 2017

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

• The practice held registers of patients living in vulnerable circumstances which included those with a learning disability.

• The practice offered longer appointments for people with a learning disability.

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

• The practice 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.

• Telephone interpretation services were available and information leaflets in different languages were provided when required.