Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northumberland Park Medical Group, Shiremoor Resource Centre on 24 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was outstanding for providing services for the population group of people with long-term conditions. It was also good for providing services for the following population groups: Older people; Families, children and young people; Working age people (including those recently retired and students); People whose circumstances may make them vulnerable; People experiencing poor mental health (including people with dementia).

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• The majority of patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• The practice offered pre-bookable early morning appointments on Tuesdays, Wednesdays and Fridays which improved access for patients who worked full time through the week.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place for clinical areas and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.
• The administrative and support staff worked well together as a team.

We saw the following areas of outstanding practice:

• The practice had achieved significantly higher cervical screening rates (93.8%) compared to the national average (81.9%). The practice nurse led on this and opportunistically reviewed their patients’ last screening date, when this was appropriate to do so, during their patients’ appointments. If they noticed they were approaching their due date, they would offer to make an appointment for the patient while they were there. This showed the practice were not simply reliant on the central recall process for cervical screening, but were taking responsibility for managing this process locally too.
• In total, we were told that 866 patients registered with the practice had some form of care plan agreed and in place. This represented 16% of the practice population and included all patients with chronic diseases, those identified to be at high risk of hospital admission and patients identified as being in vulnerable circumstances.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Improve the systems used to centrally record, monitor and review significant events within the practice.
• Continue to review the appointments process as feedback from a number of sources indicated it was difficult to get a same day appointment with a GP when patients felt their need was urgent.
• Endeavour to improve team working within the practice between clinical and non-clinical staff on management and business matters.

• Review its arrangements for nursing provision; especially to provide cover for holidays.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We found that appropriate measures were in place to monitor and maintain cleanliness and infection control within the practice. The practice had a designated individual with responsibility for infection control. Regular weekly audits were undertaken to ensure that the practice was clean and that there was adequate equipment available for staff to work safely and effectively. All staff had received Hepatitis B immunisations to protect them in the event of injury.

People expressed their views and were involved in making decisions about their care and treatment. We saw that staff dealt with enquiries from patients as discretely as possible. One patient told us, “The doctor sat for ages explaining things.”

Patients we spoke with were complimentary about the care they received. We saw there were systems in place to monitor and review people's care and treatment. One patient told us, “This practice is great. There is a massive difference here from my last practice. The whole quality of the visit is better”

The practice had in place safeguarding policies for both children and vulnerable adults. There was an identified lead clinician and regular discussion between staff about any safeguarding or concerning situations.

The practice was well organised and presented as clean, tidy and generally well maintained. However, processes to reduce the risk of infection were not always in place or adhered to.

The provider had a recruitment policy in place. General practitioners and nurses employed within the practice were checked to ensure they had an up to date registration with the appropriate professional body.

We carried out an announced comprehensive inspection at Northumberland Park Medical Group, on 22 and 29 January 2019, as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected.
• information from our ongoing monitoring of data about services and,
• information from the provider, patients and other organisations.

The practice was rated as requires improvement for providing safe services because:

• The arrangements for documenting the outcomes of the practice’s multi-disciplinary team safeguarding meetings and significant events were not effective. Although staff told us lessons were learnt when things went wrong, it was not always clear whether agreed changes had been reviewed and implemented, to make sure they had helped to drive improvements.

• Immunisation histories had not been obtained for some non-clinical staff.

• The practice’s health and safety risk assessment did not comprehensively address risks to patients’ safety.
• The practice’s locum GP pack was out-of-date and there was no lead GP to oversee the performance of locum and salaried GPs.

The practice was rated as requires improvement for providing effective services because:

• The practice did not have a comprehensive programme of quality improvement activity.
• The practice did not have an effective staff appraisal system.
• The practice’s arrangements for documenting staff inductions were not effective.
• The Quality and Outcome Framework long-term conditions clinical indicators relating to the treatment of patients with asthma and atrial fibrillation, were lower than the local clinical commissioning group and national averages.
• Follow-up consultations did not always take place following a patient’s discharge from hospital.

Because these concerns impacted on all population groups, we have rated them as requires improvement for providing effective services.

The practice was rated as good for providing caring services because:

• Feedback from people who used the service was positive about the way that staff treated them.
• Staff treated patients with kindness and respect and involved them in decisions about their care and treatment. Most of the practice’s results from the national GP patient survey, regarding how patients were treated, were higher than the local clinical commissioning group and national averages.

The practice was rated as good for proving responsive services because:

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way, that ensured choice and continuity of care.
• Most patients told us they could access care and treatment in a timely way.

The practice was rated as requires improvement for well-led because:

• The practice did not have a clear vision and credible strategy to provide high quality sustainable care.
• Leaders had not identified the actions needed to address the challenges they faced, regarding the delivery of high-quality care and the sustainability of the service. A development programme for leaders was not in place.
• The practice’s governance arrangements were not always effective. There were shortfalls in the practice’s systems and processes, and in the leadership oversight of these, which could place some patients at risk of not receiving appropriate care and treatment.

We also found that:

• Effective arrangements were in place to maintain a safe patient environment. Regular checks were carried out to make sure clinical, and other equipment, was safe to use.
• The practice had effective systems for the appropriate and safe use of medicines.
• Arrangements had been made to ensure care and treatment was delivered in line with current legislation, standards and evidence-based guidance.
• Most outcomes for people who use the service were positive, consistent and met expectations.

The overall rating for this practice was requires improvement due to concerns in providing safe, effective and well-led services. We are rating the practice as good overall for providing responsive services, including all the population groups, because patients could access timely care and treatment which had been tailored to meet their needs.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance, in accordance with the Fundamental Standards of Care.
• Ensure persons employed in the provision of the regulated activity receive appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

The areas where the provider should make improvements are:

• Improve how patients who are also carers are identified, to enable this group of patients to access appropriate care and support.
• Provide patients with access to information about complaints in the reception waiting areas.
• Review the arrangements for monitoring emergency hospital admissions, sharing information with community services and social services, and identifying patients at risk of suicide or self-harm.
• Review the effectiveness of the practice’s performance management system.
• Review the arrangements on the practice’s website for providing patients with information about support groups.
• Consider providing the practice’s infection lead with advanced training in the prevention and management of infection control.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice