Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Deerness Park Medical 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

This practice is rated as Good overall. (Previous inspection January 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at Deerness Park Medical Group on 05 April 2018 and 18 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines. We were able to see the positive impacts on patient care and outcomes. Innovation was valued and actively encouraged.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients did not always find the appointment system easy to use, the practice had responded to patient concerns and initiated changes to the appointment and telephone systems in response to these concerns.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Staff were heavily invested in their roles and were empowered to develop their skills. For example, nurses had developed lead roles in the care of diabetes and heart failure. These lead roles supported continuity of care and effective communication between primary and secondary care.
• Safe innovation was celebrated. There was a clear, systematic and proactive approach to seeking out and embedding new and more sustainable models of care. There was a strong record of sharing work.

We saw several areas of outstanding practice:

• The practice regularly supported local heath related projects. For example, the practice participated in a ‘boilers on prescription scheme’ that aimed to improve the health of patients with some long-term conditions by providing warm homes. Data provided by the practice showed in the last 18 months there had been a 60% reduction in the number of appointments needed by patients involved in this scheme. We also saw that attendances at A&E had reduced by 30% for patients involved in this scheme. Additionally, patients’ energy bills had reduced by an average of 14% because of the improvement work carried out in their homes.
• The practice had responded to the patient concerns about the availability of appointments. The practice had introduced a cancellation list that helped clinicians ‘safety-net’ patients who were unable to obtain a same-day, urgent appointment. Patients who requested a same-day, urgent appointment but were not offered one were added to this list and given guidance on what to do if their symptoms worsened. The GPs and advanced nurse practitioners (ANPs) regularly reviewed this list throughout the day and contacted patients if a consultation slot became available. Patients were then either offered a telephone consultation or a face-to-face appointment if this was judged clinically necessary. The practice had audited the effectiveness of this approach. This had showed that, over a period of four months, 820 patients had been placed on this list, of which 43% had subsequently been contacted by a GP or an ANP. Those contacted had been offered either a telephone consultation or an appointment at the practice.
• The practice aligned new initiatives and changes to practise with local and regional strategy such as NHSE’s Five Year Forward View. For example, the practice had introduced a new clinical skill mix model in August 2017. Administrative processes were also streamlined, and the introduction of the role of a supervising GP ensured the new clinical team and the practice nurses always had clinical support. A newly developed acute access team provided the majority of same day appointments and home visits. In total, these initiatives saved 160 hours of time per week. This enabled the GPs to focus on patients that required more complex clinical care, and the introduction of longer face-to-face GP appointments for most of the GPs. GPs faced fewer interruptions to their work.
• The practice had reviewed its antibiotic prescribing and taken action to support good antimicrobial stewardship in line with local and national guidance. Between November 2016 and March 2017, the practice took part in a clinical commissioning group (CCG) pilot to reduce antibacterial prescriptions by the introduction of an easy to use test for patients with a suspected lower respiratory tract infection. Data provided by the practice showed a reduction of between 7% (December 2016) and 38% (February 2017) compared to the same month the previous year for antibacterial prescriptions. The practice had continued this work as part of a wider antibiotic strategy. The practice shared the learning from this work with other local practices.
• The practice and the CCG had developed a digital version of the NEWS (National Early Warning Score). This system was designed to spot the early signs of illness in patients who lived in care homes. The system tracked medical observations, the score generated allowed the user to determine the appropriate level of care required. Requests for home visits were now backed up by a clear record of observations. The tracked information was shared with other healthcare professionals such as ambulance teams. Feedback from care homes was very positive. The project team was awarded a Health Service Journal award for Value and Improvement in Telehealth in 2016. The system was implemented at all of the care homes in Sunderland.
• All parents or guardians calling with concerns about a child under the age of five were offered a same day appointment. The practice had introduced a GP triage system for children under five. Following this, the practice had seen a 14% reduction in the number of patients under five that attended the local emergency department and a 15% reduction in the number that attend one of the local urgent care centers.

There two areas where the provider should make improvements are:

• Ensure the registration of the partnership with the Care Quality Commission accurately reflects the practice’s partnership arrangement.
• Continue work to improve telephone access to the practice.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice