Northgate Surgery

Updated 3 October 2016

Northgate Surgery is located on Northgate, Pontefract, WF8 1NF and provides services for approximately 11,600 patients.

The practice is situation within the Wakefield Clinical Commissioning Group (CCG) and is registered with the Care Quality Commission (CQC) to provide primary medical services under the terms of a general medical services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

The practice was open between 8am and 6.30pm Monday to Friday. In addition to this, extended hours were offered from 7am to 8am on Wednesday and Thursday mornings. A range of appointments were offered throughout the day.

The service is provided by five GP partners (two male and three female) and one female salaried GP. The practice also has a clinical practitioner (former paramedic), an advanced nurse practitioner, two practice nurses and two health care assistants. The clinical staff are supported by a practice manager and an experienced team of administrative and reception staff.

The practice is situated in the centre of Pontefract and is classed as being in one of the more deprived areas of Wakefield. The patient population is predominately white British.

Northgate Surgery is situated in a purpose built building with car parking available.

When the practice is closed out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

Updated 3 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northgate Surgery on 14 June 2016. 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

• The practice were involved in a care homes pilot project, offering a daily ward round service by the Nurse Practitioner. The project contributed to a number of improvements in care, including a 39% reduction in accident and emergency (A&E) attendances, a 42% reduction in A&E admissions and the percentage of residents with a care plan in place rose from 59% to 100%.
• The practice employed a clinical practitioner (former paramedic) to improve patient experience by using existing knowledge of responding to acute situations. The clinical practitioner delivered a number of services which included; minor injuries and treatment clinics, triage service, delivery of home visits to patients (including dementia reviews) and care home visits. This approach had seen diversification of the primary care workforce and the effective utilisation of paramedic skills to deliver primary care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 October 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.
• The practice had a dedicated GP lead for diabetes and the practice nurse had completed a diabetes diploma course.
• The practice provided a high level diabetes service including in-house insulin initiation.
• Outcomes for diabetes related indicators were comparable or better than other practices. For example the percentage of patients on the register who had a flu immunisation in the preceding 12 months was 100% compared to the CCG average of 97% and the national average of 94%.
• 96% of patients with diabetes, on the register, had a record of a foot examination and risk classification, compared to the CCG average of 89% and national average of 88%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice was involved in the Premium Practice Contract which involved care planning for patients with some long term conditions such as diabetes and asthma.
• All patients with a long term condition, who had been identified as a high risk of hospital admittance, received a review by a GP within three days of discharge.

Updated 3 October 2016

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 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.
• The percentage of women who had undergone a cervical screening test was 80% which was slightly below the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice held dedicated baby clinics for six week checks; this was provided by the child health and safeguarding lead.
• A weekly telephone consultation clinic was held every week for young people to talk to the Nurse Practitioner about any problems. At the time of our inspection the practice were undergoing the Young Person Friendly Accreditation.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 3 October 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• All patients over the age of 75 had a named GP.
• The practice were involved in the development of a care homes pilot project offering a daily ward round service by the nurse practitioners. This had resulted in a reduction in unplanned hospital admissions.
• The practice had worked with Age UK to have a stand in the reception area, to signpost patients to a range of services available.

Updated 3 October 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.
• The practice took part in the catch up programme for students aged 17 and above for measles, mumps and rubella (MMR) and Meningitis C vaccinations.
• The practice offered telephone consultations during the day for patients that may not be able to access the surgery during normal hours.
• The practice was proactive in offering online services including appointment booking, as well as a full range of health promotion and screening that reflects the needs for this age group.
• Appointments could be cancelled using an answerphone service or via text message, avoiding patients having to wait to speak to a receptionist.

Updated 3 October 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• All patients were coded on the clinical system and offered a full heath check in dedicated clinics.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• 85% of patients diagnosed with dementia had received a face to face review of their care in the last 12 months, which is comparable to the CCG average of 83% and national average of 84%.
• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, which was better than the CCG average of 90% and the national average of 88%.

Updated 3 October 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice had a sensory impairment champion who had implemented a wide range of improvements such as enlarged font on correspondence and changes to the appearance of notices within the practice to improve visibility.
• The practice had a hearing loop and health check leaflets were available braille and large print.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.