Bewicke Medical Centre

Updated 18 February 2016

Bewicke Medical Centre is registered with the Care Quality Commission to provide primary care services.

The practice is located in Howdon and provides primary medical services to patients living in Howdon and parts of Wallsend and North Shields in North Tyneside.

The practice provides services to around 10,200 patients from one location. We visited this address as part of the inspection.

• Bewicke Medical Centre, 51 Tynemouth Road, Howdon, Tyne & Wear, NE28 0AD.

The practice is based in purpose built premises. The building is on two levels with all patient services provided on the ground floor. There is on-site parking, disabled parking, a disabled WC and access is step-free. There is sufficient room for wheelchairs to move around the surgery.

The practice has five GP partners and four salaried GPs (two male, seven female). The practice has a business manager, an administration manager, a nurse practitioner, three practice nurses, one healthcare assistant and 14 staff who carry out various administrative and reception roles. The practice provides services based on a Personal Medical Services (PMS) contract.

The practice is an approved teaching practice where qualified and undergraduate trainee doctors gain experience in general practice. One foundation year 2 (F2) was working at the practice at the time of the inspection.

The practice is open from 8am to 12pm then from 1:30pm to 6pm Monday to Friday. The telephones are answered by the practice between 8am and 6:30pm. When the practice is closed patients are directed to the NHS 111 service. This information is available from the practices’ telephone message, the practice website and the practice leaflet.

Appointments are available from 8:30am until 11:30am in the morning and from 2pm until 5:30pm in the afternoon.

Extended hours surgeries are offered one day each week, either on a Tuesday, Wednesday or Thursday between 6:30pm and 8:15pm. A GP and a nurse are available for these appointments.

The practice is part of NHS North Tyneside clinical commission group. Information from Public Health England placed the area in which the practice is located in the third least deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The service for patients requiring urgent medical care out of hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited.

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bewicke Medical Centre on 9 December 2015. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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 and easy to understand.
• Some patients said they found it hard to make an appointment with a named GP. Urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Staff throughout the practice worked well as a team.

The areas where the provider should make improvement are:

• Complete the work already initiated to ensure training needs are identified and relevant training is undertaken within the required timescales.

• Review arrangements for the distribution of blank prescription forms to take into account national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 2016

The practice is rated as good 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. All of the doctors at the practice also had lead clinical roles. The nurse practitioner was the practice lead for chronic obstructive pulmonary disease (COPD).
• The practice held an unplanned admissions register.
• Nationally reported data showed that some outcomes for patients with long term conditions were below average. For example, the practice had achieved 76.7% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was below the local CCG average of 92.9% and below the national average of 89.2%.

Work had been initiated to address the poor QOF performance for diabetes patients. A diabetic care plan had been introduced in mid-2014, 71% of patients had a diabetic care plan in place. The practice had continued this work to improve the number of diabetic patients with a care plan.

• When patients were identified as being at high risk of developing diabetes the practice had introduced an annual review for these patients.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and received a structured annual review to check that their health and medicines needs were being met. 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 18 February 2016

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

• 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.
• Nationally reported data showed that outcomes for patients with asthma were comparable to local and national averages. For example, the practice had achieved 97.8% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was in line with the local CCG average of 97.6% and the national average of 97.4%.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for cervical screening was 83.4% which was in line with the local CCG average of 83.1% and the national average of 81.8%.
• Immunisation rates were relatively high for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 99.1% to 100% (CCG average 97.3% to 100%) and for five year olds ranged from 92.9% to 99.2% (CCG average 92.2% to 98.4%).
• 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, health visitors and school nurses.
• A full range of contraceptive services were provided by the practice.

Updated 18 February 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in their population. They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice provided services to a local care home, and a GP visited the home each week.
• The practice had completed work to improve the identification of housebound patients. In the last year over 125 additional housebound patients were identified. This allowed the district nurses who worked with the practice to meet the needs of these patients, for example flu vaccinations.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line with local and national averages. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was slightly above local clinical commissioning group (CCG) average (99.9%) and 2.1 points above the England average (97.9%).
• The percentage of people aged 65 or over who received a seasonal flu vaccination was 77.9%, which was above the national average of 73.2%. For at risk groups the practice rate was 50.7% which was below the national average of 52.3%.

Updated 18 February 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 identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Patients could order repeat prescriptions and book appointments on-line. Telephone appointments were available.
• Extended opening hours for appointments were available either on a Tuesday, Wednesday or Thursday until 8:15pm; appointments were available with a GP or nurse.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group.
• Additional services such as health checks for over 45s and travel vaccinations were available.
• The practice website provided a wide range of health promotion advice and information.

Updated 18 February 2016

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

• 86% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months compared to 84% nationally.
• Nationally reported data showed that outcomes for patients with mental health conditions were below average. For example, the practice had achieved 76.9% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was below the local CCG average of 95.2% and the national average of 92.8%.
• Nationally reported data showed that outcomes for patients with dementia were good. For example, the practice had achieved 96.2% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was in line with the local CCG average of 96.8% and above the national average of 94.5%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. They carried out advance care planning for patients with dementia.
• The practice provided services for the Howdon Project, a residential care home for patients with enduring mental health problems.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• There was a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 18 February 2016

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 with a learning disability.
• They offered longer appointments for people with a learning disability if required.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice had told vulnerable patients about how to access various support groups and voluntary organisations. Patients could self-refer to a local talking therapies service.
• 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 normal working hours and out of hours.
• Good arrangements were in place to support patients who were carers. The practice had systems in place for identifying carers and ensuring that they were offered a health check.
• One of the GP partners had a special interest in mental health.