Archived: Pennywell Medical Centre Also known as IntraHealth Limited

Updated 31 March 2016

Pennywell Medical Centre is registered with the Care Quality Commission to provide primary care services. The practice is located in the Pennywell area of Sunderland.

The practice provides services to around 2,800 patients from one location:

• Pennywell Medical Centre, Portsmouth Road, Sunderland, Tyne and Wear, SR4 9AS.

We visited this address as part of the inspection.

Pennywell Medical Centre is based in purpose built premises that are shared with external community services. 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.

The provider of the service is Intrahealth, a corporate provider of NHS primary care services. The practice has a temporary part-time and two locum GP’s (all male).The practice employs a practice manager, two pharmacists, two advance nurse practitioners, one senior primary care nurse, a healthcare assistant, four staff who undertake administrative or reception roles and an apprentice administrator. The practice provides services based on an Alternative Provider Medical Services (APMS) contract agreement for general practice.

Pennywell Medical Centre is open at the following times:

• Monday 8am and 8pm.
• Tuesday to Friday 8am and 6:30pm.

The telephones are answered by the practice during these times.

Appointments are available at Pennywell Medical Centre at the following times:

• Monday 8am to 1pm and 1:30pm to 7:30pm.
• Tuesday to Friday 8am to 1pm and 1:30pm to 6pm.

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 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 81 years compared to the national average of 83 years.

The proportion of patients with a long-standing health condition is above average (56% compared to the national average of 54%). The proportion of patients who are in paid work or full-time employment is below average (50% compared to the national average of 60%). The proportion of patients who are unemployed is above average (19% compared to the national average of 6%).

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

Updated 31 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pennywell Medical Centre on 21 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. Lessons were learned when incidents and near misses occurred.
• Risks to patients were assessed and well managed with the exception of infection control. The practice had not completed an infection control audit in the last two years.
• 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.
• The majority of 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.
• Urgent appointments were usually available on the day they were requested. 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.
• The practice did not have any permanent GP staff. Over the last 10 months, locum and temporary GPs had covered clinical sessions. Although the practice was able to provide clinical care, patients expressed concerns about the lack of continuity of care, and access to a named GP. The practice was actively recruiting permanent GPs; however, they had not managed to recruit at the time of our inspection.
• The practice had a number of policies and procedures (provided by the provider) to govern activity, however, some were overdue for review.
• The provider was aware of and had complied with the requirements of the Duty of Candour regulation.

There is one area where the provider must make improvements:

• Improve the approach to clinical audit to ensure standards are clearly defined, and there is a clear link between audits and improvement in the quality of the service.

There are three areas where the provider should make improvements:

The provider should:

• Put in place appropriate arrangements to monitor and review the effectiveness of the practice infection control arrangements.
• Review the management of complaints at the practice, verbal complaints should be recorded in line with their agreed complaints policy.
• Review the policies and procedures in place at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2016

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

• Patients at risk of hospital admission were identified as a priority for care and support by the practice.
• The practice pharmacist provided medicine reviews for patients.
• Nationally reported data showed the practice had achieved good outcomes in relation to most of the conditions commonly associated with this population group. For example, the practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 6.5% above the local CCG average and 10.8% above the national average.
• 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 31 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.
• Arrangements had been made for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 93% to 98% (CCG average 96% to 100%) and for five year olds ranged from 83% to 98% (CCG average 32% to 99%).
• Urgent appointments for children 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.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
• 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 2.9% above the local CCG average and 2.6% above the national average.
• The practice’s uptake for cervical screening was 86%, which was above the local CCG and national averages of 82%.
• The practice provided a full range of contraceptive services and held regular ‘well women’ and ‘well man’ clinics at the practice.

Updated 31 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.
• Patients over the age of 75 and carers were offered an annual health check.
• The practice was responsive to the needs of older people; they 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 varied. For example, the practice had achieved 90% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 9% below the local clinical commissioning group (CCG) average and 8.2% below the national average. However, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with COPD (chronic obstructive pulmonary disease). This was 3.9% above the local clinical commissioning group (CCG) average and 4% above the national average.
• The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Updated 31 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, students had been identified, and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Extended hours appointments were available each Monday evening until 7:30pm with an advanced nurse practitioner.
• 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, travel vaccinations and minor surgery were provided.
• The practice website provided a wide range of health promotion advice and information.

Updated 31 March 2016

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

• The practice held a register for patients experiencing poor mental health and had identified nearly 1% of their patient population as requiring inclusion. Patients attending for a new patient health check were asked if they had any mental health issues, they were then referred to appropriate support if required.
• Nationally reported data showed that outcomes for patients with mental health conditions were above average. The practice had achieved 96% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was above the local CCG average of 92% and the national average of 93%.
• Nationally reported data showed that outcomes for patients with dementia were below average. The practice had achieved 77% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was below the local CCG average of 96% and the national average of 95%. Only 75% 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.
• 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. Local mental health support services were available at the practice on a regular basis.
• 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.
• The practice had been awarded the dementia friends accreditation.

Updated 31 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.
• 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.
• 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. Information for carers was available on the practice’s website and the practice had a carers’ champion who supported carers and acted as a key contact for carer information at the practice.