Oxford Terrace & Rawling Road Medical Group

Updated 8 November 2017

Oxford Terrace and Rawling Road Medical Group provides care and treatment to approximately 15,311 patients from the Dunston, Dunston Hills, Teams, Team Valley, Chowdene, Harlow Green, Wrekenton, Beacon Lough, Leam Lane, Heworth, Felling, Mount Pleasant, Sheriff Hill, Windy Nook, Deckham and Bensham areas of Gateshead, Tyne and Wear.

The practice is part of the NHS Newcastle Gateshead clinical commissioning group (CCG) and operates on a Personal Medical Services (PMS) contract. The practice provides services from the following addresses; we visited the main surgery during this inspection:

• Main surgery: 1 Oxford Terrace, Bensham, Gateshead, Tyne and Wear, NE8 1RQ
• Branch surgery: 1 Rawling Road, Bensham, Gateshead, Tyne and Wear, NE8 4QS

The main surgery is located in a large, converted ex-residential property. All reception and consultation

rooms are fully accessible for patients with mobility issues. On street parking is available nearby.

The branch surgery is located in purpose built premises. All reception and consultation rooms are fully accessible for patients with mobility issues. An on-site car park is available.

The main surgery is open from 8am to 7.30pm on a Monday and Thursday (appointments from 8.30am to 7.20pm), from 8am to 6.30pm on a Tuesday, Wednesday and Friday (appointments from 8.30am to 6pm) and from 9am to 12 midday on a Saturday (appointments from 9am to 11.50am). The branch surgery is open from 8am to 6pm on a Monday to Friday (appointments from 8.30am to 6pm).

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).

Oxford Terrace and Rawling Road Medical Group offers a range of services and clinic appointments including childhood health and immunisation service, long term condition reviews, minor surgery, travel advice, contraception and sexual health.

The practice consists of:

• Five GP partners (four male and one female) and one practice manager partner (female)

• Six salaried GPs (two male and four female)

• Four nurse practitioners (all female)

• Three practice nurses (all female)

• Four health care assistants (all female)

• 28 non-clinical members of staff including quality and safety manager, operational services manager, registrations clerk, medical secretaries, practice administrators, finance administrator, IT support assistants, recall clerk, data coding administrators, complex care administrator, receptionists and cleaners.

The practice is a training practice and is involved in teaching and training GP registrars, medical students, student nurses, nurse associates and trainee pharmacists. It is also a ‘research ready’ practice and as such is committed to encouraging staff and patients to become involved in primary care research.

The average life expectancy for the male practice population is 76 (CCG average 77 and national average 79) and for the female population 81 (CCG average 81 and national average 83).

52.3%, of the practice population reported as having a long standing health condition is 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. The percentage of the practice population recorded as being in paid work or full time education is 46.2% (CCG average 60.5% and national average 61.5%). Deprivation levels affecting children and adults are higher than the local CCG average and national averages.

Updated 8 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oxford Terrace and Rawling Road Medical Group on 17 October 2016. The overall rating for the practice was good; but was requires improvement for providing safe services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Oxford Terrace and Rawling Road Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 October 2017 to review in detail the actions taken by the practice to improve the quality of care.

The practice is rated as good overall, now including for providing safe services.

Our key findings at this inspection were as follows:

• The practice had implemented an action plan to address the issues identified during the previous inspection. The relevant improvements had been made.
• All non-clinical staff who had not received a DBS check had a risk assessment in their staff file as to why this was not necessary. We looked at a sample of two staff records and saw this to be the case.

• We saw that the process for patient safety alerts had been strengthened. The practice policy was now to add them to the practice meeting agenda. We saw minutes to confirm this. There were copies of the alerts held with relevant action noted.

• Vaccine refrigerators were monitored correctly to ensure they were fit for purpose.

• The practice had the appropriate spillage kits and a cleaning schedule for the spirometer and nebuliser.

At our previous inspection on 17 October 2016 we said the provider should make improvements in some areas. We saw at this inspection that improvements had been made;

• A comprehensive checking process had been implemented to ensure that emergency medicines and equipment were suitable for use.

• Patient group directions (PGDs) were signed in line with recommended guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 February 2017

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

Home visits and longer appointments and home visits were available when needed. Longer appointments were routinely offered to patients with complex needs or those requiring an interpreter. The practice’s computer system was used to flag when patients were due for review and the practice had implemented an effective recall system. Patients with multiple long term conditions were offered an annual comorbidity (multiple conditions) review whenever possible in their birthday month.

The practice had carried out a review and transformation of their nursing team to improve access to appointments and the management of long term conditions. This had resulted in an additional 280 nursing appointments per week being created releasing the equivalent of 8 GP sessions.

The QOF data for 2015/16 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 99.2% of the points available to them in respect of hypertension

The practice had been proactive in the development of a self-help group for young people with type 1 diabetes in the area. A young person with the condition had been appointed as the project coordinator and the practice had employed a diabetes specialist nurse. The aim was to engage young people in managing their condition through the use of electronic information and telecommunication technologies which would allow long distance communication between a patient and a clinician. The practice had been awarded second place in the Bright Ideas in Innovation Awards 2016 for improving services for young children with type 1 diabetes.

The practice hosted a tea dance for patents with long term conditions which was attended by approximately 250 patients and funded by a local university who were carrying out research into supported self-care.

Updated 24 February 2017

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 85.1% to 94.5% (compared to the CCG range of 64.7% to 93.5% and national average of 73.3% to 95.1%). For five year olds this ranged from 73.8% to 92.9% (compared to CCG range of 90.1% to 97.4% and national average of 81.4% to 95.1%).

At 79%, 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 comparable with 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.

Updated 24 February 2017

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

Nationally reported Quality and Outcomes Framework (QOF) data for 2015/16 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, hypertension and osteoporosis.

The practice had developed an in-house Complex Care Team to care for frail and elderly patients in their own home or care home and prevent unnecessary admission to hospital. Comprehensive care plans were in place for high risk, housebound and care home patients. The GPs operated a ward round approach to visiting patients in their linked care homes. For the two larger care homes these visits were carried out in conjunction with an older person’s specialist nurse employed by the practice. The practice had purchased lap tops for GPs to ensure they were able to access and update patient’s notes whilst on ward rounds or home visits.

The practice had been successful in obtaining funding to pilot the employment of a practice based occupational therapist on a secondment basis for 19 hours per week. The aim of this role was to optimise the health and wellbeing of frail older people through timely targeted intervention.

The practice employed primary care navigators. This role involved a holistic approach to ensuring a patient’s medical and social needs were referred or signposted to appropriate support services.

Updated 24 February 2017

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 main surgery was open from 8am to 7.30pm on a Monday and Thursday (appointments from 8.30am to 7.20pm), from 8am to 6.30pm on a Tuesday, Wednesday and Friday (appointments from 8.30am to 6pm) and from 9am to 12 midday on a Saturday (appointments from 9am to 11.50am). The branch surgery was open from 8am to 6pm on a Monday to Friday (appointments from 8.30am to 6pm). 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, antenatal services 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. The practice communicated with patients using social medial and free Wi-Fi access was available to patients in the practice waiting room. Pre bookable telephone consultations were available with a GP. Email consultations were available on request.

The practice had implemented 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 24 February 2017

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 and depression and for those with a mental health condition. The practice had a high prevalence of patients with dementia which was partly attributed to providing care for eight care homes in the area.

Patients were supported by the primary care navigator in accessing various support groups and third sector organisations, such as local wellbeing and psychological support services. As a result of primary care navigator involvement the practice were able to demonstrate an increase in the number of patients being screened and assessed for dementia. This had led to the practice being awarded first place in the Bright Idea in Innovation Awards 2015 for improving dementia care through care navigation and social prescribing.

Updated 24 February 2017

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 137 patients who had a learning disability. Patients with a learning disability were offered an annual health check and flu immunisation which were available as a home visits if required.

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 proactively identified carers and ensured they were offered appropriate advice and support and an annual health check and flu vaccination. They had identified 489 of their patients as being a carer (approximately 3.1% of the practice patient population).

The practice were actively engaged in identifying armed forces veterans who were then offered appropriate support in accessing relevant services by the practice primary care navigator. The practice had also hosted a tea dance for this group of patients as a way of combating possible social isolation. At the time of our inspection the practice had identified 53 patients as being an armed forces veteran.