Second Street Surgery

Updated 3 November 2016

Dr Selwyn Brian Bolel officially took over Second Street Surgery in April 2016 and provides care and treatment to approximately 3014 patients predominantly from the Crawcrook, Blaydon, Wardley, Whickham, Chopwell and Gateshead areas of Tyne and Wear. The practice is part of the NHS Newcastle Gateshead Clinical Commissioning Group (CCG) and operates on a General Medical Services (GMS) contract.

The practice provides services from the following address, which we visited during this inspection:

Second Street Surgery

Second Street

Bensham

Tyne and Wear

NE8 2UR

The surgery is located in a single storey purpose-built building. All reception and consultation rooms are fully accessible for patients with mobility issues. However, the two entrance doors to the premises were offset with a small entrance hall in between and not electronically operated which could present difficulties for patients with mobility issues. An on-site car park is available which includes a dedicated disabled car parking spaces.

The surgery is open from 9am to 5.30 and 6.30pm to 7.45pm on a Monday; 9am to 5.30pm on a Tuesday, Wednesday and Friday; 9am to 12 midday on a Thursday. Appointment availability with a GP was generally available from 9.30am to 12.15pm then from 3pm to 5.30pm. However, we were told that the GP was always on site between 8am and 9.30am; 12.15pm to 3pm and on Thursday afternoons to deal with urgent appointment, advice and home visit requests. Appointments with the nurse were available from 9am to 5.30pm on a Monday, Tuesday, Wednesday and Friday and from 9am to midday on a Thursday. Patients registered with the practice were also able to access pre bookable appointments with a GP at one of three local health centres from 8am and 8pm on a weekday and 9am to 2pm on a weekend.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Gateshead Community Based Care Limited (known locally as GatDoc).

Second Street Surgery offers a range of services and clinic appointments including contraception advice, travel clinics, childhood immunisation service, long term condition reviews, minor surgery and smoking cessation advice.

The practice consists of:

• One single hand GP (male)
• One practice nurse (female)
• One health care assistant (female)
• One practice pharmacist (female)
• Five non-clinical members of staff including a practice manager and receptionists

The average life expectancy for the male practice population is 74 (CCG average 77 and national average 79) and for the female population 81 (CCG average 81 and national average 83).

At 40.6%, the percentage of the practice population reported as having a long standing health condition was lower than the CCG average of 56.9% and national average of 54%. Generally a higher percentage of patients with a long standing health condition can lead to an increased demand for GP services. 71.2% of the practice population were recorded as being in paid work or full time education (CCG average 60.5% and national average 61.5%). Deprivation levels affecting children were lower than the local CCG average but higher than the national average. Deprivation levels affecting older people were higher that local and national averages.

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Second Street Surgery on 15 September 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 to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• Feedback from patients about their care was consistently positive and results of the National GP Patient Survey in relation to this were higher than local and national averages. Patients reported that they were treated with compassion, dignity and respect. Patient feedback in relation to access was comparable with local clinical commissioning group and national averages.
• Patients were able to access same day appointments. Pre-bookable appointments were available within acceptable timescales.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
• The practice had proactively sought feedback from patients and implemented suggestions for improvement and made changes to the way they delivered services in response to feedback.
• The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved an overall result which was higher than local and national averages.
• Information about services and how to complain was available and easy to understand.
• The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed.

We saw some areas of outstanding practice:

• The practice participated in a telephone support service scheme to ensure vulnerable and other relevant patients were able to access regular support to help them make positive changes in their lives. This was a voluntary service created as part of an informal arrangement with three other practices in the area and with financial support from a local charity and enabled patients referred to the service to receive weekly telephone or skype calls for up to 12 weeks to offer support on issues such as isolation and loneliness

• The practice had identified a member of staff as a primary care navigator to ensure there was a holistic approach to ensuring a patient’s medical and social needs were met and patients discharged from hospital were well supported. This included ensuring relevant patients were signposted to appropriate support services such as a befriending service, or practice telephone support service.
• The practice identified carers and ensured they were offered an annual health check and influenza vaccination and signposted to appropriate advice and support services. The practice had worked with a local carer’s charity to aid the identification of their young carers. They were able to demonstrate that they were the highest Carer Pathway referrer in the Gateshead area for the period April 2015 to September 2015.

However, there were also areas where the provider should make improvements. Importantly, the provider should:

• Continue to promote and seek membership for a patient participation group.
• Regularly review the length of time patients wait to be called in for their appointments
• Ensure the cord mechanisms on vertical blinds in communal and clinical areas are tethered to prevent the risk of accidental choking for young children.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 November 2016

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

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review and the practice had commissioned an external provider to ensure that the recall system for long term conditions was efficient and robust. Patients with multiple long term conditions were offered an annual comorbidity (multiple condition) review when possible in their birthday month. These reviews were conducted as a home visit when required to ensure the same quality of care for housebound patients.

The QOF data for 2015/16 provided by the practice showed that they had achieved good outcomes in relation to the conditions commonly associated with this population group. For example:

• The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma.
• The practice had obtained 100% of the points available to them in respect of hypertension.

Care plans were in place for patients most at risk of deteriorating health. Patients with certain long term conditions such as asthma and chronic obstructive pulmonary were issues with rescue packs to prevent an exacerbation of their condition.

Updated 3 November 2016

The practice is rated as good for the care of families, children and young people.

The practice had identified the needs of families, children and young people, and put plans in place to meet them. 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.

Data available for 2014/15 showed that the practice childhood immunisation rates for the vaccinations given to two year olds ranged from 16.7% to 100% (compared with the CCG range of 64.7% to 93.5%). For five year olds this ranged from 57.1% to 85.7% (compared to CCG range of 90.1% to 97.3%)

At 78%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was lower than the CCG average of 81% and national average of 82%.

Pregnant women were able to access a full range of antenatal and post-natal services at the practice.

The practice had appointed a Young People’s Champion who had been involved in designing a young patients section of the practice website and a young people’s practice information leaflet.

Updated 3 November 2016

The practice is rated as good for the care of older people.

Nationally reported Quality and Outcomes Framework (QOF) data for 2015/16 provided by the practice (the data had not yet been published) showed the practice had achieved good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients experiencing heart failure, stroke and transient ischaemic attack and for secondary prevention of coronary heart disease.

The practice health care assistant had the dual role of being the practice primary care navigator. This role involved a holistic approach to ensuring a patient’s medical and social needs were referred or signposted to appropriate support services such as a befriending service, or practice telephone support service. The role also involved ensuring that patients discharged from hospital received a telephone call within three days of discharge to ensure that they were receiving appropriate post discharge support.

The telephone support service is a voluntary service created as part of an informal arrangement with three other practices in the area and with financial support from a local charity. This enables patients referred to the service to receive weekly telephone or Skype calls for up to 12 weeks to offer support on issues such as isolation and loneliness.

Updated 3 November 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 and students had been met. The surgery was open from 9am to 5.30pm and 6.30pm to 7.45om on a Monday; 9am to 5.30pm on a Tuesday, Wednesday and Friday and 9am to 12 midday on a Thursday. Appointment availability with a GP was generally available from 9.30am to 12.15pm then from 3pm to 5.30pm. However, a GP was always on site between 8am and 9.30am and 12.15pm to 3pm and on Thursday afternoons to deal with urgent appointment, advice and home visit requests. Patients registered with the practice were also able to access pre bookable appointments with a GP at one of three local health centres from 8am and 8pm on a weekday and 9am to 2pm on a weekend.

The practice offered sexual health and contraception services, travel advice, childhood immunisation service, minor surgery, antenatal services, smoking cessation advice and long term condition reviews. They also offered new patient and NHS health checks (for patients aged 40-74).

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. A text messaging service was available which was used to remind patients of their appointments. Pre-bookable telephone consultations were available on request.

From the end of September 2016 the practice were introducing a 24 hour per day/seven day per week service called patient partner which would enable patients to book, cancel and rearrange appointments using an automated telephone service.

Updated 3 November 2016

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

QOF data for 2015/16 provided by the practice showed that they had achieved the maximum score available for caring for patients with dementia, depression and mental health conditions:

Patients experiencing poor mental health were invited for an annual review with the health care assistant and GP which covered health surveillance, preventative advice and social prescribing. Patients were also signposted to various support groups and third sector organisations, such as local wellbeing and psychological support services.

The practice manager acted as the practice mental health champion and had previous experience of working with and supporting patients with mental health issues. The practice nurse acted as the dementia champion for the practice and ensured that support and advice was available for patients with dementia and their family and carers.

Updated 3 November 2016

The practice is rated as good for the care of people whose circumstances make them vulnerable.

The practice held a register of patients living in vulnerable circumstances, including 9 patients who had a learning disability. Patients with a learning disability were offered an annual health check and flu immunisation.

The practice had established effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.

The practice identified carers and ensured they were offered appropriate advice and support and an annual health check and flu vaccination. The practice were the highest carer pathway referrer in the Gateshead area for the period April 2015 to September 2015.

Vulnerable patients, including those experiencing bereavement, homeless patients and veterans, were able to access support through the practice telephone support service.