Archived: Freeman Clinics Limited

Updated 10 November 2016

Freeman Clinics Limited (also known locally as Battle Hill Health Centre) provides care and treatment to 3,791 patients of all ages, based on an Alternative Provider Medical Services (APMS) contract. (This is a locally negotiated contract open to both NHS practices and voluntary or private providers.) The practice is part of the NHS North Tyneside clinical commissioning group (CCG) and provides care and treatment to patients living in the Wallsend area of North Tyneside. We visited the following location as part of the inspection: Freeman Clinics Limited, Battle Hill Health Centre, Wallsend, North Tyneside, NE28 9DX.

Nationally reported data showed the practice had a lower percentage of people with long-standing health conditions than the England average, and less people with caring responsibilities. Life expectancies for both men and women were below the England average. There were higher levels of social deprivation, especially in relation to older people and children. The practice had a mostly white British population. National data showed that 1.6% of the population were from an Asian ethnic minority background, and 1.3% were from non-white ethnic groups.

The practice was located in a purpose built building which included adaptations to meet the needs of patients with disabilities. The provider also operated a walk-in-centre from the same building, which the practice’s patients could access.

The practice has two salaried GPs in post (one male and one female.) The male GP acts as the clinical lead. The female GP was on maternity leave at the time of the inspection and was being covered by a female long-term GP locum. The practice has a vacant GP post (nine sessions) which they have just appointed to. There is also a practice nurse (female), a healthcare assistant (female), a practice manager, an assistant practice manager and a team of administrative and reception staff.

Opening times are as follows:

GP practice: 8am to 6:30pm. (Monday to Friday)

GP appointment times:

8am to 6:50pm. (Monday to Friday)

(Registered patients also had access to 13 pre-bookable appointments each day at the walk-in-centre.)

When the practice is closed patients can access out-of-hours care via the Northern Doctors Urgent Care Limited On-Call service, the NHS 111 service and the walk-in-centre based in the same premises.

Updated 10 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Freeman Clinics Limited (also known as Battle Hill Health Centre) on 6 September 2016. Overall, the practice is rated as good.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near-misses, and they are fully supported when they do so. Staff monitored and reviewed the activities carried out by locum GP staff to help them understand potential risks to safety, and obstacles to effective performance, so they could take appropriate steps to minimise them.

• There were clearly defined and embedded systems and processes, which helped to keep patients safe from harm.

• Services were tailored to meet the needs of individual patients and were delivered in a way that promoted flexibility and choice.

• Nationally reported Quality and Outcomes Framework (QOF) data showed that the practice’s overall performance was above the local clinical commissioning group (CCG) and national averages.

• Results from the NHS GP Patient Survey of the practice showed that patient satisfaction levels regarding the convenience of appointments, telephone access and appointment availability, were either above, or broadly in line with, the local CCG and national averages. Staff were committed to improving access for patients.This included the provision of an additional 13 pre-bookable appointments on a Saturday and Sunday, at the walk-in-centre service.

• 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. Data from the NHS National GP Patient Survey of the practice showed patients rated them either higher than, or broadly in line with, local CCG and national averages, for most aspects of care. Staff also demonstrated their caring approach to patients through their participation in events organised by the practice, to raise funds for local charities.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The arrangements for governance and performance management were effective. Clinical audit was used to monitor quality and to make improvements. Staff had completed some very well structured first cycle audits, but now needed to move on to complete the second cycles of these audits.

• The practice had a well-developed vision regarding how they would deliver high-quality person-centre care, and were actively taking steps to deliver this, in collaboration with their commissioners.

We saw an area of outstanding practice:

• The practice had a very effective process in place for managing complaints. Staff genuinely welcomed complaints and saw patient feedback as an opportunity for learning and development. Complaints were handled in a way that allowed a gentle yet effective response to the patient, and which supported and encouraged clinicians to respond openly and learn from errors.

However, there were also areas where the provider needs to make improvements. The provider should :

• Develop a planned, structured approach to carrying out clinical audits.

• Improve the identification of carers within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 November 2016

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

• The QOF data showed the practice had mostly performed above, or broadly in line with, local CCG and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of unplanned admissions into hospital were identified as a priority.

• Patients with long-term conditions were offered annual reviews to check their health needs were being met and that they were receiving the right medication. Longer appointments and home visits were available when needed.

• Clinical staff were good at working with other professionals, to deliver a multi-disciplinary package of care to patients with complex needs.

Updated 10 November 2016

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

• There were systems in place to protect children who were at risk and living in disadvantaged circumstances. For example, regular multi-disciplinary meetings were held where the needs of vulnerable children and families were discussed. All clinical staff had completed appropriate safeguarding training.

• The practice offered a full range of immunisations for children. Publicly available data showed that childhood immunisation rates for the vaccinations given were broadly in line with local CCG averages. For example, childhood immunisation rates for the vaccinations given to children under two years old ranged from 94.2% to 98.6% (the local CCG averages ranged from 97.3% to 98.7%). For five year olds, the rates ranged from 92% to 98% (the local CCG averages ranged from 92.2% to 98.4%).

• The practice had a comprehensive screening programme. The QOF data showed the uptake of cervical screening for females aged between 25 and 64, attending within the target period, was above the national average, (84% compared to 81.8%.)

Updated 10 November 2016

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

• Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed above, or broadly in line with, local clinical commissioning group (CCG) and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

• The practice offered proactive, personalised care which met the needs of older patients. For example, all patients over 75 years of age had a named GP who was responsible for overseeing their care.

• Staff worked in partnership with other health care professionals to ensure that older patients received the care and treatment they needed so that, where possible, emergency admissions into hospital could be avoided.

Updated 10 November 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice was proactive in offering online services, as well as a full range of health promotion and screening that reflected the needs of this group of patients.

• The QOF data showed the practice had mostly performed either above, or broadly in line with, local CCG and England averages, in providing recommended care and treatment to this group of patients.

• Patients were able to access out-of-hours appointments with a GP (8am to 8pm, 365 days of the year) at the walk-in-centre located in the same premises as the practice.

Updated 10 November 2016

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

• There were suitable arrangements for meeting the needs of patients experiencing poor mental health. The QOF data, for 2014/15, showed the practice had performed above, or broadly in line with, local CCG and national averages, in relation to providing care and treatment to this group of patients.

• Patients experiencing poor mental health were given advice about how to access various support groups and voluntary organisations.

• The practice's clinical IT system clearly identified patients with dementia and other mental health needs, to ensure staff were aware of their specific needs.
• Patients diagnosed with dementia, or who had been prescribed dementia medication, had had their needs assessed using a standardised dementia screening tool.
• The practice was working towards achieving accreditation for being a Dementia Friendly organisation. A senior member of staff had completed Dementia Champion training, and they had carried out dementia friends’ sessions with staff, to increase the awareness of how to support patients with this condition.

Updated 10 November 2016

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

• There were suitable arrangements for meeting the needs of vulnerable patients. The practice maintained a register of patients with learning disabilities which they used to ensure they received an annual healthcare review.

• Systems were in place to protect vulnerable children from harm. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns, and they regularly worked with multi-disciplinary teams to help protect vulnerable patients.

• Appropriate arrangements had been made to meet the needs of patients who were also carers. However, the number of carers on the practice's register was low.