Willington Medical Group

Updated 15 December 2016

Willington Medical Group has a clinical team of a senior GP partner, five GP partners, one nurse practitioner, two practice nurses, three healthcare assistants and a phlebotomist. The practice is led by a practice manager with support from an IT and data quality lead, a secretary, an administrator and eight practice support workers. This is a teaching practice and regularly has a GP registrar in post. 

The practice is readily accessible for people who use wheelchairs and by parents with pushchairs. A portable hearing loop system is available and there are quiet waiting facilities for patients who find the main waiting area to cause anxiety. Private space is available for breast-feeding. Patients can check-in using a self-service kiosk, which provides instructions in several languages.

The practice services a patient list of 9209, 2.5% of which are registered carers and is in an area of high deprivation.

Appointments are from 7.30am to 6pm on Mondays and Wednesdays, 8am to 6pm on Tuesdays and Fridays and 8am to 7pm on Thursdays.

We had previously carried out an inspection at this practice as part of our pilot scheme of new inspection methods. At that time the practice was compliant with our regulation standards.

Updated 15 December 2016

We carried out an announced comprehensive inspection at Willington Medical Group on 27 June 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. The practice proactively identified opportunities for learning in all interactions with patients and service providers.
• Risks to patients were assessed and well managed based on national best practice guidance.
• 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 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.
• There was a consistent focus on continuity of care through named GPs for families and adherence to Royal College of General Practitioner guidance for older people. Urgent appointments were available the same day and patients whose condition meant they were unlikely to adhere to booked appointments were seen opportunistically.
• The practice had good facilities and was well equipped to treat patients and meet their needs. This was achieved through a sustained focus on accessibility by a member of the patient participation group (PPG). The practice demonstrated clearly how it made substantive environmental changes to meet the changing needs of the local population.
• 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.

We saw some areas of outstanding practice:

• To address the increasing rates of pre-diabetes in the local population as well as the risks of social isolation, the practice worked with an innovative partnership of local community leisure centre to provide patients with exercise and fitness opportunities in a relaxed, social environment.

• The senior team had a demonstrable commitment to staff wellbeing and welfare and worked within the ethos that staff would give their best if they were healthy and had a good work-life balance. In recognition of these efforts, the practice achieved the Northeast Better Health at Work bronze award in 2012, silver award in 2013 and gold standard in 2014. The practice also achieved the continuing excellence award in 2015 and a small business award in 2013.

• The practice had achieved Young Carers Charter status for its work with young people who were carers for relatives. In addition, a ‘carers prescription’ system was in place that enabled staff to refer patients or relatives to a carers association for further support, such as specialist advice or counselling.

• A member of the PPG carried out an accessibility audit to achieve 'Accessible for All' status. This audit led to an action plan to improve levels of access such as for wheelchairs or patients with a visual impairment. As a result rails and bright markings on accessible parking bays were implemented. The member of the PPG also supported the practice to implement the NHS England Accessible Information Standard. 

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 15 December 2016

The practice is rated as good for this population group.

• 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.

• Patients with chronic obstructive pulmonary disease, diabetes, asthma or heart failure had 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. Practice nurses visited patients who were at high risk of hospital admission at home to ensure their treatment was optimal.

• The practice responded to an increase in lifestyle-related diabetes in the local population by increasing the number of appointments available with a nurse practitioner who managed oral medicines and insulin injections.

Updated 15 December 2016

The practice is rated as good for this population group.

• 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.

• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Family members were registered with the same GP. This enabled the practice to provide continuity of care and helped GPs to identify any safeguarding or child protection concerns.

• Appointments were available outside of school hours and the premises were suitable for children and babies, including a private breast-feeding room.

• The practice participated in the ‘c-card’ scheme, which enabled young people to access contraceptive advice, sexual health advice and chlamydia screening.

• We saw evidence of positive examples of joint working with community professionals such as midwives, health visitors and school nurses.

• Weekly clinical meetings included a standard recurring agenda item for staff to review safeguarding or domestic violence instances.

• The practice had achieved Young Carers Charter Status, which meant young people who acted as carers were offered structured support and access to appointments in the practice.

Updated 15 December 2016

The practice is rated as good for this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

• Clinical staff conducted proactive and opportunistic screening for dementia, bowel cancer and breast cancer and immunisations for pneumonia, shingles and flu. Patients over the age of 65 were offered screening for atrial fibrillation.

• A nurse practitioner was qualified to fit and change ring pessaries.

• The practice participated in the unplanned admissions enhanced service. This meant the most vulnerable 2% of patients were monitored to ensure care and treatment was delivered in a way that reduced the risk they would be admitted to hospital.

• GPs conducted twice yearly formal health reviews for older patients who lived in care homes.

Staff worked with multidisciplinary teams to ensure end of life care plans were appropriate and met the needs of each individual.

Updated 15 December 2016

The practice is rated as good for this population group.

• 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. For example, the practice registered students as temporary residents if needed and also offered meningitis B vaccination.

• 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.

• During flu season the practice offered Saturday morning clinics and walk-in appointments.

• Health trainers, sexual health services, counselling, physiotherapy and drug and alcohol advice services were available on-site.

• Cervical screening was available Monday to Friday between 8am and 6pm, the flexibility of which had contributed to a high cytology rate. The practice achieved a cervical screening rate of 85% compared to the national average of 82%.

• The practice identified a significant increase in the rate of lifestyle-related diabetes in this age group. In response and to improve the detection of pre-diabetes, the practice offered a preventative education programme for patients at risk of developing this condition.

Updated 15 December 2016

The practice is rated as good for this population group.

• Walk-in appointments were available for patients who found it difficult to keep to scheduled appointments due to their circumstances.

• 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the clinical commissioning group average of 83% and the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Clinical staff could refer patients directly to talking therapies services and in-house cognitive behaviour therapy and bereavement services were available.

• Clinical staff were able to conduct depression assessments and followed up accordingly.

• The practice carried out advance care planning for patients with dementia and patients with bipolar affective disorder, schizophrenia and other psychoses had care plans in place.

• 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 and the practice was working towards ‘Dementia Friendly’ status.

Updated 15 December 2016

The practice is rated as good for this population group.

• The practice held a register of patients living in vulnerable circumstances including victims of domestic violence and those with a learning disability.

• The practice offered longer appointments or home visits, annual reviews, flu vaccines and health action plans 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.

• 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 and crisis teams.

• The practice had a close working relationship with a local substance misuse service and worked collaboratively to provide individualised care to patients.

• Patients with a visual impairment were highlighted on the appointment system and the booked GP or nurse provided a meet and escort service from the waiting room to the clinical area. A separate, quiet waiting room was also available for patients for whom the main waiting area caused anxiety or discomfort.

• Three members of staff, including one GP, were trained as domestic violence champions. This meant they acted as dedicated points of contact for patients with concerns or who were experiencing domestic violence.