Gosforth Memorial Medical Centre

Updated 6 May 2016

Gosforth Memorial Medical Centre is registered with the Care Quality Commission to provide primary care services. It is located in the Gosforth area of Newcastle upon Tyne.

The practice provides services to around 8,800 patients from one location: Church Road, Gosforth, Newcastle upon Tyne, NE3 1TX. We visited this address as part of the inspection. The practice has three GP partners (two female and one male), two salaried GPs (one male and one female), two practice nurses (both female), two healthcare assistants, a practice manager, and 12 staff who carry out reception, and administrative duties.

The practice is part of Newcastle Gateshead clinical commissioning group (CCG). The age profile of the practice population is in line with local and national averages. Information taken from Public Health England placed the area in which the practice is located in the second least deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The practice is a training practice and two of the GPs are accredited GP trainers. At the time of the inspection there were three trainee GPs working at the practice.

The practice is located in a two storey building. Patient facilities are on the ground and first floor. At present there is no lift to the first floor, however, there are consultation rooms on the ground floor which are suitable for patients with mobility problems. There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access.

Opening hours are between 8am and 7.30pm Mondays and Wednesdays and between 8am and 6.30pm on Tuesdays, Thursdays and Fridays. At the time of the inspection the practice was also undertaking a trial of opening at 7.30am each Wednesday morning. Patients can book appointments in person, on-line or by telephone. Appointments are available at the following times:

• Monday - 8am to 12pm; then from 2pm to 7.30pm
• Tuesday – 8am to 11am; then from 2pm to 6.30pm
• Wednesday – 7.30am to 12.10pm; then from 3pm to 7.30pm
• Thursday – 8am to 12pm; then from 1pm to 6.30pm
• Friday – 7.45am to 12pm; then from 2pm to 6.30pm

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

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

Updated 6 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gosforth Memorial Medical Centre on 15 March 2016. Overall the practice is rated as outstanding.

Our key findings were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• 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.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• Extended hours surgeries were offered between 6.30pm and 7.30pm every Monday and Wednesday evening.
• Outcomes for patients with long term conditions were consistently better than national averages.
• Feedback from patients was overwhelmingly positive and the practice achieved high scores in the National GP Patient Survey.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.

• Staff throughout the practice worked well together as a team.

We saw several areas of outstanding practice including:

• The practice engaged with a group of patients with learning disabilities to carry out a ‘health quality check’ of the practice. A team of health quality checkers visited the practice, looked at the premises and spoke with staff. The health checkers commented positively on the practice. One of the healthcare assistants was the first point of contact for patients on the learning disability register. They had built up a rapport with patients and their carers. As a result of this work, 35 out of 36 patients had received their annual health check during the previous 12 months.

• The practice was the preferred practice for patients who lived in a local community based home for patients with chronic mental illness (13 patients). Services were tailored to meet those patients’ individual needs. We were told about several examples of how staff from the practice positively engaged with the patients and had built up relationships. This had resulted in staff being able to carry out routine checks for the patients, which in turn had resulted in a number of new diagnoses, including diabetes and skin problems, which were subsequently addressed by the practice.

• The practice had taken action to ensure patients over the age of 75, who had not been diagnosed with a long term condition, and therefore had not received regular checks, were offered an appointment for a health check. A search of patient records was undertaken to identify those patients. The patients were contacted and offered a health check. The practice carried out a review of the outcomes; this showed that 96 patients were offered a check, 79 patients attended and from this there were 27 new diagnoses or issues identified, for which the practice developed treatment plans.

However, there was also an area of practice where the provider needs to make improvements.

The provider should:

• Replace the carpet in the nurse’s consultation room with flooring suitable for a clinical environment.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 6 May 2016

The practice is rated as outstanding for the care of patients with long-term conditions.

Nationally reported data showed that outcomes for patients with long-term conditions were consistently better than national averages. For example:

• Performance for asthma related indicators was better than the national average (100% compared to 97.4% nationally).
• Performance for mental health related indicators was above the national average (100% compared to 97.2% nationally).
• Performance for dementia related indicators was above the national average (100% compared to 94.5% nationally

Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice had recently carried out a review of the recall systems for ensuring patients were called in for regular reviews. This included inviting patients in during their birthday month. The practice told us patients had made positive comments about the new system.

Updated 6 May 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. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were in line with the CCG averages. For example, rates for the vaccinations given to under two year olds ranged from 92.8% to 98.5% (compared to the CCG averages of between 94.6% and 97.8%) and five year olds from 89.5% to 96.8% (compared to the CCG averages of between 91% and 96.7%).

The practice’s uptake for the cervical screening programme was 88.7%, which was well above the CCG average of 81.2% and the national average of 81.8%.

Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Updated 6 May 2016

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

Nationally reported data showed the practice had 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 with heart failure. This was slightly above local clinical commissioning group (CCG) average (99.6%) and 2.1 points above the England average.

The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, all patients over the age of 75 had a named GP and patients at high risk of hospital admission and those in vulnerable circumstances had care plans. Several patients lived in local nursing homes; there was a named GP for the home; they carried out regular visits and had regular phone contact with staff.

The practice had taken action to ensure patients over the age of 75, who had not been diagnosed with a long term condition, and therefore had not received regular checks, were offered an appointment for a health check. A search of patient records was undertaken to identify those patients. The patients were contacted and offered a health check. The practice carried out a review of the outcomes; this showed that 96 patients were offered a check, 79 patients attended and from this there were 27 new diagnoses or issues identified. Plans were in place to continue the project and review results on a regular basis.

Following a significant event in a nursing home, the practice carried out on audit on the DNAR (do not attempt resuscitation) status of patients registered at the practice, who lived in a nursing home. A review was carried out to ensure that all such patients had care plans in place and had had the opportunity to consider their DNAR status. A new protocol was implemented which included a home visit by a doctor soon after a patient was registered with the practice. A subsequent audit showed that these arrangements had been successful; 15 out of 15 patients had their DNAR status recorded. This work allowed the GP who carried out the audit to take on a wider role within the North of England Commissioning Support Unit to increase the quality of care for patients in nursing homes in the area.

The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Updated 6 May 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 and flexible. Extended hours surgeries were offered between 6.30pm and 7.30pm every Monday and Wednesday for working patients who could not attend during normal opening hours. At the time of the inspection the practice was also undertaking a trial of opening at 7.30am each Wednesday morning.

The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line. Additional services were provided such as health checks for the over 40s and travel vaccinations.

A review of a significant event in relation to the death of a student had prompted staff to consider how they could support students. Arrangements were put in place so that any new students registered with the practice were sent a text welcoming them to the practice and inviting them to attend for a new patient review. Since September, four students had booked an appointment to discuss their mental health concerns.

Updated 6 May 2016

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

Nationally reported QOF data (2014/15) showed the practice had achieved good outcomes in relation to patients experiencing poor mental health. For example, the practice had obtained 100% of the QOF points available to them for providing recommended care and treatment for patients with poor mental health, compared to the national average of 97.2%. Performance for dementia related indicators was also above average (100% compared to 94.5% nationally).

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia. Patients experiencing poor mental health were sign posted to various support groups and third sector organisations. The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.

The practice was the preferred practice for patients who lived in a local community based home for patients with chronic mental illness (13 patients). Services were tailored to meet those patients’ individual needs. We were told about several examples of how staff from the practice positively engaged with the patients and had built up relationships. This had resulted in staff being able to carry out routine checks for the patients, which in turn had resulted in a number of new diagnoses, including diabetes and skin problems, which were subsequently addressed by the practice.

Updated 6 May 2016

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

A register of patients living in vulnerable circumstances, including those with a learning disability was maintained. The practice had engaged with a group of patients with learning disabilities to carry out a ‘health quality check’ of the practice. A team of health quality checkers visited the practice, looked at the premises and spoke with staff. They provided a report on their findings. The report was very positive and highlighted that the practice was proactive in making reasonable adjustments for patients with learning disabilities. The health checkers also commented positively on the communication with patients. The practice worked with the health checkers to develop a number of ‘easy read’ leaflets for patients.

One of the healthcare assistants was the first point of contact for patients on the learning disability register. They had built up a rapport with patients and their carers. As a result of this work, 35 out of 36 patients had received their annual health check during the previous 12 months.

The practice had 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.

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 and referred for a carer’s assessment.