The Discovery Practice

Updated 11 November 2016

The Discovery Practice is located in the heart of the large town centre of Middlesbrough, in Teesside. It is part of the South Tees Clinical Commissioning Group. The total practice patient population is 6352. Housed in a purpose built, modern health centre, the practice is immediately next door to three neighbouring GP practices and situated above a large busy shopping centre.

The proportion of the practice population in the 65 years and over age group is representative of the England average. The practice scored one on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. The overall practice deprivation score is higher than the England average. People living in more deprived areas tend to have a greater need for health services. The practice has a higher than average range of patients aged 20-34 years and many of these patients are students from a nearby university.

The staff team comprises three GP partners, two are female and one is male. There are three female practice nurses and one female healthcare assistant. The practice is managed and supported by a practice manager, administration, secretarial and reception staff. In total there are 13 staff, in addition to the GPs.

The practice reception is open Monday to Friday 8am until 6pm (excluding bank holidays). Appointment times with a GP are available all day, although there are fewer appointments around midday when home visits are conducted. The practice does not routinely offer pre-bookable appointments (although these are available for people with a learning disability, patients requiring a booked interpreter, postnatal appointments and GP reviews). The practice operates a telephone triage system for urgent appointments, through the use of a duty doctor. Face to face appointments are available daily for patients that ring the same day. Out-of-hours care is accessed through the 111 service, provided by Northern Doctors, from 6pm each evening and at weekends and bank holidays. The practice is a teaching practice and teaches third and fifth year medical students.

The practice has a General Medical Services contract with NHS England. They also provide some Directed Enhanced Services, for example they offer minor surgery and the childhood vaccination and immunisation scheme.

Updated 11 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Discovery Practice on 28 September 2016. Overall the practice is rated as good.

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

• 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.

• 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.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the installation of a self-help notice board.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, 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 clear leadership structure and staff felt supported by management. The practice acted upon feedback from staff and patients.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

However there was an area of practice where the provider should make improvements:

• Nursing staff should participate in clinical supervision sessions and these should be documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 November 2016

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

• A practice nurse within the team had an accredited Diabetes qualification.

• In advance of NICE guidance regarding multimorbidity, the practice had set up dedicated monthly clinics for patients with more than one long term condition.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All these patients had a usual 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 had set up a Connect clinic which ran once a month. It offered a ‘one-stop shop’ to patients, enabling them to have blood tests and review their long term conditions conditions and medication, by a range of clinicians in one extended appointment.

Updated 11 November 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. Uptake rates were high for all standard childhood immunisations.

• The practice had a system of follow up when it had been informed that a child had not attended an appointment with an external agency or alternative care provider.

• 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 had close, regular links with midwives, health visitors and school nurses.

• The practice has a high number of university students from the UK and abroad and offers flexibility to meet their needs.

Updated 11 November 2016

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

• The practice demographic indicated a lower than average percentage of older people within its registered list.

• As part of the unplanned admission scheme the practice offered same day telephone appointments with a GP and refer patients who were elderly or vulnerable to community matrons for support.

• The practice offered proactive, personalised care to meet the needs of the older people in its population, including home visits.

Updated 11 November 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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Working in federation with the local STAR (South Tees Access and Response) service, the practice were able to offer extended hours appointments through dedicated hubs.

Updated 11 November 2016

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

• Performance for mental health related indicators was better than the national average.

  The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months was 94% which was around 5% higher than the CCG average and higher than the national average of 88%.

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 74% which was lower than the CCG average of 83% and the national average of 84%

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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.

Updated 11 November 2016

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

• The practice had a good in depth knowledge of its vulnerable patients.

• The practice offered longer appointments for patients with a learning disability.

• 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.

• The practice had good links with the alcohol liaison team.

• There were carers champions within the practice.

• The practice actively promoted dementia friendly activities through the Alzheimer’s society, inviting workers to give talks within the practice premises.