Background to this inspection
Updated
9 January 2020
Carmel Medical Practice is located at Nunnery Lane, Darlington County Durham DL3 8SQ. . The surgery is situated in a purpose-built health care facility in on the outskirts of Darlington.
The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.
Carmel Medical Practice is situated within the NHS Darlington Clinical Commissioning Group (CCG) and provides services to approximately 10441 patients under the terms of a general medical services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.
The provider is a partnership of three GPs (two female and one male) and registered with the CQC in April 2013. The practice is part of a primary care network and as such is developing services in collaboration with other practices in the locality. This includes extended access to GP appointments where appointments are available on evenings and weekends.
The National General Practice Profile states that 3.5% of the practice population is from black, mixed or other non-white ethnic groups. Information published by Public Health England, rates the level of deprivation within the practice population group as seven, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 80 years compared to the national average of 79 years. Female life expectancy is 84 years compared to the national average of 83 years.
Updated
9 January 2020
- High performance was recognised by credible external bodies. Outcomes for people who use services were positive, consistent and regularly exceeded expectations.
- Staff, teams and services were committed to working collaboratively and had found innovative and efficient ways to deliver more joined-up care to people who use services.
- Staff were consistent in supporting people to live healthier lives, including identifying those who needed extra support, through a targeted and proactive approach to health promotion and prevention of ill-health, and they used every contact with people to do so.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
- The leaders at the practice were proactive and collaborated effectively with local stakeholders, including in the sharing of new developments.
We saw the following outstanding practice:
The approach to assessing, planning and delivering care and treatment people who used services was truly holistic. Outcomes for people who use services were consistently better than expected when compared with other similar services. The service made use of innovative and pioneering approaches to care and how it was delivered and actively encouraged this.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
People with long term conditions
Updated
16 July 2015
The practice is rated as outstanding for the care of people with long-term conditions.
Two GPs at the practice were GPs with special interests (GPSI); one in cardiology and the other respiratory. Both GPSIs worked closely with secondary care. The practice was able to manage more complex patients within the practice. The GPSIs encouraged peer to peer referrals between practices in the CCG. These roles helped the practice reduce referrals to secondary care. Both the GPSIs supported the CCG as clinical leads in their specialties. The practice offered dedicated respiratory and cardiac clinics for patients under the care of these GPs. The practice had run a respiratory pilot with an aim to improve the outcomes for patients in this area.
General Practice High Level Indicators (GPHLI) and QOF data showed outcomes for patients in this group were good. Patients were supported by GPs and nursing staff to manage their condition. The practice applied a holistic approach to the management of patients with long-term conditions. Reporting systems were in place to identify patients who were at high risk who may benefit from screening. Staff encouraged patient self-management when deemed appropriate and patients were seen to have self-management plans in place for COPD and asthma. The practice actively promoted national and local diabetic patient education schemes.
The practice had achieved and was following the gold standards framework for end of life care. It held monthly meetings to discuss those with end stage disease. The meetings were regularly attended by external partners such as district nurses, Marie Curie and the hospice.
Families, children and young people
Updated
16 July 2015
The practice is rated as good for the care of families, children and young people.
All staff had received training in safeguarding children and demonstrated an acute awareness of their responsibilities to raise safeguarding concerns. They also received training in child sexual exploitation and Clare’s Law. We were provided with examples where staff had raised safeguarding concerns that had been acted on. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. The practice held quarterly safeguarding meetings with attendance from health visitors, district nurses, school nurses and midwives. We saw areas such as children looked after, high number of A&E attendances and children who did not attend appointments, for example, immunisations were discussed and action taken. Children identified at risk were coded on practice records to alert staff to this fact.
The practice had comprehensive systems in place for monitoring and managing children who did not have their immunisations booked or who did not attend their appointment and for managing the uptake of cervical smears. Immunisation rates were high for all standard childhood immunisations and cervical smears.
The practice provided a range of contraceptive, pre-conceptual, maternity and child health services with some clinical staff holding specific qualifications in these areas. The practice had a dedicated young persons’ notice board in place at the practice which detailed the services available to them at the practice and the Darlington area.
GPs carried out an eight week mother and baby check and gave the appropriate vaccinations at the same time to reduce the need to attend at two separate clinics. Appointments were available outside of school hours and the premises were suitable for children and babies. Patients told us children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
Updated
16 July 2015
The practice is rated as good for the care of older people.
Nationally reported data showed outcomes for patients were good for conditions commonly found in older people, for example, data showed the uptake of flu vaccinations for the over 65 years was above the national average. 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 adopted a holistic approach to the care of patients in this group which was encouraged by working closely with other services, for example the Council run ‘Responsive Integrated Assessment Care Team’ (Riact) which provided people with support to live independently in their own homes.
Working age people (including those recently retired and students)
Updated
16 July 2015
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 extended opening hours and online services as well as a full range of health promotion and screening that reflected the needs for this age group. The local CCG was also piloting access to weekend appointments through the Challenge Fund.
Patients were offered cardiovascular disease (CVD) risk assessments and health checks. Patients identified at high risk or with a strong family history were invited to the practice to discuss the results. Lung health checks were also offered at these appointments and to all new patients.
People experiencing poor mental health (including people with dementia)
Updated
16 July 2015
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
Data from QOF showed the practice performed in line with the national average in most areas; some being slightly above and some slightly below.
The practice maintained a register of patients with mental ill health. Patients on this register were invited to the practice for a regular health check and alerts placed on patient’s records to remind staff that certain screening was required if the patient did not attend. The practice offered dementia screening and operated the dementia screening identification scheme.
The practice had a primary mental health link worker who provided a weekly session at the practice. The practice had access to a local mental health crisis team to support and intensively treat people in crisis and to avoid admission to secondary care. The practice had the facility to refer patients to a wide range of services, for example counselling and cognitive behavioural therapy.
People whose circumstances may make them vulnerable
Updated
16 July 2015
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. Patients with a learning disability had care plans in place that were regularly reviewed alongside as well as having their medicines reviewed. Appointments were arranged to suit the patients’ needs.
The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people, including attendance at multi-disciplinary meetings from the voluntary sector. 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.
Systems were in place to support carers and patients and families who were bereaved.