The Village Green Surgery

Updated 13 August 2015

The Village Green Surgery is located near the centre of Wallsend, on the same site as the Sir GB Hunter Memorial Hospital and Wallsend Hall. The practice provides services to just over 9700 patients. The practice provides services from the following address, which we visited during this inspection:

The Village Green Surgery, The Green, Wallsend, Tyne and Wear, NE28 6BB.

The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

The practice has seven GP partners and the practice manager is also a partner. There are also two salaried GPs, three GP registrars (fully-qualified doctors who spend time working in a practice to develop their skills in general practice), four practice nurses, three practice nursing assistants and a team of administrative support staff.

The premises are purpose built and provide fully accessible treatment and consultation rooms for patients with mobility needs. Patient facilities are on the ground floor. There is a disabled WC. There is a car park in the grounds of the practice and nearby parking on the street.

The practice provides a range of services and clinics, including for example, for patients with asthma, diabetes and heart failure.

Surgery opening times are Monday to Friday 8.30am to 6.30pm, with late surgeries Tuesday and Thursday until 8.00pm for pre-booked appointments only. The service for patients requiring urgent medical attention out-of-hours is provided by the 111 service and Northern Doctors Medical Services Limited.

The practice serves an area with higher levels of deprivation affecting children and people aged 65 and over, when compared to other practices in the local CCG, and the England average. It is estimated that 0.9% of the population are from non-white ethnic groups. The practice’s population includes more patients within working age, (between 18 and 65) than other practices in the local CCG area and the England average.

The average male life expectancy is 78 years and the average female life expectancy is 82. These are both one year less than the England average. The number of patients reporting with a long-standing health condition is slightly higher than the national average (practice population 55.9% compared to a national average of 54.0%). The number of patients with health-related problems in daily life is higher than the national average (54.5% compared to 48.8% nationally). There are a higher number of patients with caring responsibilities at 22.8% compared to 18.2% nationally.

Updated 13 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Village Green Surgery on 24 March 2015. Overall, the practice is rated as outstanding.

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. Information about safety was appropriately recorded and reviewed;
• Risks to patients were assessed and well managed;
• The practice was clean, hygienic and good infection control arrangements were in place;
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• The practice had scored very well on clinical indicators within the quality outcomes framework (QOF). They achieved 99.3% for the year 2013/14, which was above the average in England of 96.47%;
• Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their care and treatment;
• Information about the services provided and how to raise any concerns or complaints, was accessible and easy to understand;
• Most patients said they found it easy to make an appointment and urgent same-day access was available;
• The practice had good facilities and was well equipped to treat patients and meet their needs;
• The practice was clean and effective arrangements were in place to reduce the risk of infections;
• There was a clear leadership structure and staff felt supported by management. The practice actively sought feedback from patients;
• We found there was good staff morale in the practice, with high levels of team spirit and motivation. There was a strong learning culture evident in the practice. This came across clearly through staff interviews, but was also evident in the approach to adopting and championing new initiatives and technology. The practice took a leading role in identifying new resources and sharing these with other practices across the locality.

We saw several areas of outstanding practice including:

• The Medicines Optimisation for patients in the local care home resulted in significant reduction in medicines prescribed. (Medicines optimisation is an approach which seeks to maximise the beneficial clinical outcomes for patients from medicines with an emphasis on safety, governance, professional collaboration and patient engagement). The practice calculated the approach had resulted in a 17%decrease in medicines prescribed, with no untoward effects reported. The results of this project were reported on at the National Pharmacy Congress conference in April 2015 as an area of good practice.
• The practice directly employed a pharmacist and we found their support had led to improvement in outcomes for patients.
• The multi-disciplinary diabetic clinic, which supported good outcomes for patients with diabetes. Patients had access to advice from the dietician and retinal screening during the clinic and following the clinic the diabetic team met to discuss any concerns or queries. This service was well regarded by patients. Performance against the Quality Outcomes Framework (QOF) for diabetes mellitus was at 99.8%, which was 5.8 percentage points above CCG Average and 9.7 above England Average.
• There was strong evidence throughout the practice that team spirit and motivation was high. Of particular note was the general feeling of ‘all of us feel valued and of equal importance’.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 August 2015

The practice is rated as outstanding for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. These patients had a named GP and a structured annual review to check that their health and medication needs were being met. The practice had well established procedures for reviewing the needs of patients with diabetes, in conjunction with other health professionals. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 13 August 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were in line with local averages for all standard childhood immunisations. For example, MMR vaccination rates for five year old children were 96.6% compared to an average of 98.3% in the local CCG area. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors. Cervical screening rates for women aged 25-64 were above the national average at 91.8%, compared to 81.9%.

Updated 13 August 2015

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in their population. The practice was using innovative and proactive methods to improve patient outcomes, for example, optimising the use of medicines for older people in care homes and for older people on the practice’s chronic disease registers. Staff were responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 13 August 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 they offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 13 August 2015

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

The practice held a register of patients experiencing poor mental health and there was evidence they carried out annual health checks for these patients. The practice regularly worked with the multi-disciplinary teams in case management of people experiencing poor mental health, including those with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. They had systems in place to follow up patients who had attended Accident and Emergency (A&E). Staff had received training on how to care for people with dementia.

Updated 13 August 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 who misuse substances and those with a learning disability. They carried out annual health checks for people with a learning disability. They offered longer appointments for those who required them.

Staff had told vulnerable patients about how to access various support groups and voluntary organisations. They 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.