Archived: Grainger Medical Group

Updated 20 July 2016

Grainger Medical Group is registered with the Care Quality Commission to provide primary care services. It is located to the west of Newcastle upon Tyne. The practice was taken over in February 2015 by Intrahealth Limited, which is a corporate provider of NHS primary care services.

The practice provides services to around 7,450 patients from two locations:

• Meldon Street, Newcastle upon Tyne, NE4 6SH
• 460 Armstrong Road, Newcastle upon Tyne, NE15 6BY.

We visited both addresses as part of the inspection. The practice has two salaried GPs (both female), two advanced nurse practitioners (both female), one practice nurse (female), one healthcare assistant, a practice manager, and 12 staff who carry out reception and administrative duties.

The practice is part of Newcastle Gateshead clinical commissioning group (CCG). Information taken from Public Health England placed the area in which the practice was located in the most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The practice population is made up of a higher than average proportion of patients under the age of 18 (27.6% compared to the national average of 19.2%). Over 50% of the practice population are from non-British ethnic origins.

The main practice is located in purpose built premises. All patient facilities are on the ground floor. There is on-site parking, disabled parking, a disabled WC, wheelchair and step-free access. All patient facilities at the branch practice are on one level. There is no dedicated car park, although cars can park on the street outside. The branch practice also has a disabled WC and step-free access.

Opening hours are between 8am and 7pm on Mondays and Thursdays, between 8am and 6.30pm on Tuesdays, Wednesdays and Fridays and between 9am and 12pm on Saturday mornings. The branch surgery is open between 8am and 6.30pm Monday to Friday; appointments with a GP are available three mornings per week at the branch. Patients can book appointments in person, on-line or by telephone. Appointments with a GP were available at the following times during the week of the inspection:

• Monday – 8.30am to 10.40am; then from 3pm to 6.45pm
• Tuesday – 9am to 11.30am; then from 2pm to 5.30pm
• Wednesday – 9am to 11.30am; then from 2pm to 5.30pm
• Thursday – 9am to 11.30am; then from 3pm to 6.45pm
• Friday – 9am to 11.30am; then from 2pm to 5.30pm
• Saturday – 9am to 12pm

Emergency appointments are available everyday until 6.30pm.

The practice provides services to patients of all ages based on an Alternative Provider Medical Services (APMS) 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 20 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grainger Medical Group on 23 June 2016.

We previously carried out an announced inspection of the practice on 15 October 2015. Breaches of legal requirements were found. Overall, we rated the practice as requires improvement. After the comprehensive inspection the practice wrote to us to say what they would do to address the identified breaches.

We undertook this comprehensive inspection to check that the practice had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Grainger Medical Group on our website at www.cqc.org.uk.

Overall the practice is rated as good.

Our key findings were as follows:

• Since the last inspection the practice had made a number of improvements; including updating the telephone system and recruiting further clinical staff.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• The majority of 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.
• Most patients said they were able to get an appointment with a GP when they needed one, with 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 leadership structure in place. Most staff felt supported by management. However, some staff felt they were unable to raise concerns and that communication between managers and staff could be improved.
• A patient participation group (PPG) had been established to give patients the opportunity to provide feedback to the practice.

The areas where the provider must make improvements are:

• Ensure accurate and complete records are maintained for each patient;the arrangements for reviewing and acting on information about patients within hospital discharge letters were not satisfactory.

In addition, the provider should:

• Take steps to ensure staff complete all training appropriate to their roles.
• Check and document staff’s immunisation against infectious diseases.
• Review arrangements for GPs carrying emergency medicines when carrying out home visits to ensure they are in line with the practice’s policy.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 20 July 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
• 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.
• Patients had regular reviews to check health and medicines needs were being met.
• For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 20 July 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 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 relatively high for all standard childhood immunisations.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice’s uptake for the cervical screening programme was 84.3%, 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 20 July 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 its population. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.

Updated 20 July 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 on Monday and Thursday evenings until 7pm and between 9am and 12pm on Saturday mornings for working patients who could not attend during normal opening hours.

• 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.

Updated 20 July 2016

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

• 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.

Updated 20 July 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.
• Patients with learning disabilities were invited to attend the practice for annual health checks and were offered longer appointments, if required.
• 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.
• Improved 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.