Report for the Health and Well Being Scrutiny Committee
1 Background
This report informs the Health and Well Being Scrutiny Committee of the issues and developments within the Infection Control Team that have arisen over the previous 12 months.
County Durham and Darlington Infection Control Committee monitors and supports the work of the Infection Control Team.
Functions of the Infection Control Team (ICT): • Provide effective leadership. • Be responsible for the control and prevention of infection across NHS County Durham and NHS Darlington. • Produce and review infection control policies, protocols and pathways in line with national guidance. • Deliver education and training. • Carry out surveillance of healthcare associated infections. • Audit infection control policies/practices. • Monitor and evaluate infection control practices. • Maintain effective communication with managers, clinicians and all healthcare workers. • Produce and review patient information leaflets.
2 Infection control policies
The following infection control policies have been reviewed: • Hand Hygiene • MRSA Positive Patients Within In-Patient Facilities • MRSA Positive Patients Within Primary/Community Care • Guidelines for the Decontamination of Equipment (Including Prior to Inspection, Service or Repair) • The Safe Use and Disposal of Sharps • Control of Infection Caused by Ectoparasites (Scabies, Body and Head Lice) and Threadworms • General Infection Control Precautions
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Infection Control Protocols reviewed:
• Laundry • TB
Eleven infection control policies are available on both NHS Darlington and NHS County Durham websites and the provider services website. They are also available on the joint organisations intranet.
3 Patient information leaflets
Nine patient information leaflets are available on both NHS Darlington and NHS County Durham websites and the provider services website. They are also available on the joint organisations intranet. The following patient information leaflets have been reviewed: • Campylobacter • Clostridium difficile • E Coli 0157 • MRSA Inpatient • MRSA • Norovirus • Salmonella • Scabies • Shingles
4 Additional documents produced by infection control team
• Basic Guidelines for Preventing Cross Infection for Staff Working in Dentistry – April 2008. • Decontamination and Sterilization Guidelines for Dentistry – April 2008. • Information for Visiting Workers – January 2009. • New Build – Basic Guidelines: Infection Control – July 2008.
Information leaflets on infection control for visitors to community hospitals and contractors working in primary and community care have been produced.
5 Outbreaks of infection in community hospitals and inpatient hospices
No outbreaks occurred in the community hospitals and hospices during April 2008 – March 2009.
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6 Surveillance of Healthcare Associated Infections (HCAI) within the three community hospitals, inpatient hospices and prisons
The ICT continues to carry out laboratory based/inpatient facility liaison surveillance which entails following up positive microbiological reports, reviewing patients’ nursing/medical notes and ensuring the appropriate infection control measures and precautions are in place.
The number of new positive isolates of Clostridium difficile have been reported monthly to NHS County Durham and NHS Darlington performance management team, along with the MRSA bacteraemia isolates from patients who have been in County Durham and Darlington Foundation Trust for less than 48 hours. A root cause analysis is carried out on all new Clostridium difficile cases which occur in the community hospitals and on all pre-48 hour MRSA bacteraemias.
Significant organisms have been discussed at the Prison Public Health Group and community hospital Matrons’ meetings.
7 Infection control audit
Attached is a list of the areas which were audited using the revised infection control audit tools, developed by the ICT to monitor the compliance and knowledge of staff in infection control policies and practices (Appendix 1). Copies of the audits and action plans are available at the ICT office.
8 Her Majesty’s prisons
Training for infection control within a secure environment has continued over the year across all prisons, and the prison healthcare facilities are visited on a regular basis by the Lead Infection Control Nurse (ICN).
The Lead ICN has continued to be a member of the Prison Public Health Group for the Durham cluster and is a member of the Health and Safety Committee at Low Newton Prison.
8.1 Low Newton An audit of infection control policies and practices has been carried out. There were some areas identified as requiring action.
8.2 Frankland An audit of infection control policies and practice has been carried out. A huge amount of refurbishment has taken place within healthcare with the addition of two refurbished cells for prisoners post surgery or who require more intensive nursing care. Funding has been approved and work is due to commence on the shower area.
8.3 Durham
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An audit of infection control policies and practices has been carried out. The Lead ICN has been heavily involved with the refurbishment of healthcare.
8.4 Deerbolt An audit of infection control policies and practices has been carried out. Work is still outstanding in the dental room.
Copies of the audits and action plans are available through the ICT.
9 New build projects and refurbishments
Infection control advice was given in relation to the projects below.
Name/Location Type Completion Date
Sacriston Health Centre New Build Complete – April 2008 Queen’s Road Surgery New Build Complete – April 2008 Dr Levick, Low Westwood New Build Complete – April 2008 Stanley Health Centre New Build Proposed September 2009 Burnhope Practice Refurbishment Complete – August 2008 Mr Hickson, Optometrist Refurbishment Complete – July 2008 Spennymoor Bridge House Dental Surgery Proposed alterations Complete – March 2009
Healthworks Easington – Darzi New Build Proposed October 2009 Project Murton Clinic New Build Ongoing Tanfield View GP Practice Extension Proposed Completion – April/May 2009 Numerous PCT premises undergoing works as part of the backlog maintenance project.
The Infection Control Nurses have carried out infection control assessments at Peterlee Community Hospital and Shotley Bridge Community Hospital.
10 Training and education
The ICT has continued to develop and deliver training to a range of staff including medical, nursing, professions allied to medicine and administrative. The ICT has facilitated 125 training sessions, training a total of 1618 staff. Figure 1 gives the breakdown by employed/independent contractor staff.
An online Infection Control training package has been developed.
The Infection Control Nurses have taken part in training organised by tissue viability nurses to train 70 carers from nursing homes on basic infection control precautions.
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Figure 1: Infection control training 2008/2009
Infection Control Training 2008/2009
1400 1158 1200 1000 800 600 341 400 200 119 0 Total Number of Total Number of Total Number of PCT Staff GP Staff Dental Staff
. The ICT have been able to commit to participating at two educational sessions held by Healthtec at The Workplace, Newton Aycliffe. This involved providing the attendees, pupils from participating schools who have expressed an interest in healthcare careers, an overview of basic infection prevention and control measures and the role of the IPCN.
The Lead ICN undertook four infection control awareness sessions for executive and non-executive directors between December 2008 and March 2009. The Lead ICN also facilitated an infection control training session for senior managers from NHS Darlington in November 2008.
11 Best practice/clinical effectiveness
The ICT staff were members of the following committees/groups in an advisory capacity: • Clinical supervision group – the ICT staff continue to meet with the Infection Control Nurses from County Durham and Darlington Foundation Trust, Health Protection Unit (HPU) and Tees Esk and Wear Valley (TEWV) NHS Trust to discuss best practice and share infection control information; • County Durham and Darlington Foundation Trust Infection Control Committee; • Prison Public Health Group; • SHA Cluster Leads Meeting; • HPU TB Strategy Group; • HPU Infections Committee; • PCT Enhanced Services; • Patient Environment Action Team (PEAT) Weardale, Sedgefield and Richardson Community Hospitals; • Ad-hoc/on-site new build meetings; • Estates and Facilities Working Group;
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• County Durham and Darlington health economy action plan working group on HCAI; • County Durham and Darlington Foundation Trust Task and Finish Group • Public Health Management Group; • Estates and Facilities Strategic Management Group; • Patient Safety Committee; • Nursing and Allied Health Professional Strategy Group; • Children’s Services Directorate meetings (quarterly); • Community Hospital Matron Infection Control meeting; • Operational Managers meeting (quarterly); • Public Health Risk Management Group; • CDDFT Task and Finish Group.
12 Dentistry
A letter was sent to the 80 dental practices with NHS contracts, in April 2008, offering up to one hour’s training in standard principles of Infection Control. This would be arranged on site for the same time as the visit by an Infection Prevention and Control Nurse to each of the dental premises to complete a monitoring checklist with a member of the practice staff. Visits were carried out to 77 practices (one practice lost its NHS contract in September 2008 before it was visited) between May 2008 and the end of March 2009. Two further practices are to be visited in April 2009. Of these practices, all but 7 took up the offer of the training. In addition, training was given to all the community dentists and dental nurses (employed by NSH Darlington) and visits were carried out to the 12 clinics.
Each dental surgery has been measured against national standards for decontamination and infection control practices. Action plans have been produced and follow-up visits arranged where required (see Appendix 2).
Copies of the action plans are available through the ICT office.
13 Improvement foundation
The ICT have worked in partnership with the Improvement Foundation in providing an infection control education programme for care homes across the region.
14 Communication
Telephone advice is provided to all PCT staff and primary care contractors, with the numbers of calls increasing as the service has developed. The ICT continues to work closely with the Health Protection Unit, County Durham and Darlington Foundation Trust and TEWV NHS Trust, to ensure consistent information and advice is provided to the public, patients and all healthcare staff, and to enable seamless care of patients transferred from secondary to primary and community care.
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15 Visits
The ICT has continued to provide infection control advice and support, discussing infection control policies and making suggestions as to best practice to general practices, optometrists and pharmacists.
16 Study days
The ICT organised and facilitated an Infection Control study day on 23 October 2009 for matrons across the health economy on Infection Prevention and Control. A second study day was organised in November at Hardwick Hall Hotel and was attended by 75 NHS Darlington staff. Both events were very well attended with speakers from the SHA and local experts.
17 National policy implementation
17.1 Essential Steps to Safe, Clean Care The ICT has developed a revised audit tool to capture and reflect health care workers’ knowledge and practices in relation to the information in the Essential Steps tools and local infection control policies. The tool has been accepted by the NHS Darlington provider operational managers group and they have agreed to take it forward across the organisation with support from the audit department. The team also produced a set of guidelines for staff who are undertaking the observations.
17.2 Clean your hands Starting on 1 September 2009 NHS Darlington commenced the National Patient Safety Agency’s (NPSA) clean your hands campaign, which is currently being implemented in phases across healthcare providers in England and Wales.
The campaign supports efforts to improve hygiene generally within a range of healthcare settings, in a bid to reduce infections. It is based on national and international evidence of what works well in improving hand hygiene compliance.
The ICT adopted a personal approach to building support by engaging in face to face meetings with frontline staff and managers and identifying champions. The campaign currently covers adult and children’s services, specialist services and prison health.
Information has been circulated on the campaign through the newsletter, additional information and posters to champions.
Following an informal visit from the NPSA the ICT were asked to take part in a case study in 2009/10. The case study is presented nationally by the NPSA showing how organisations have implemented the clean your hands campaign in their area, it highlights specific challenges and achievements and can enable other similar organisations to improve their delivery of the campaign.
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The impact of the campaign has been measured through observing staff hand hygiene behaviour by using the Essential Steps to Safe, Clean Care tool.
The ICT produced a patient information leaflet on hand hygiene for staff to take into patient’s homes informing them of what they can expect from healthcare staff visiting their home.
17.3 Code of Practice The revised Code of Practice for the Prevention and Control of HCAIs was published in January 2008 and revised in January 2009. The purpose of the Code is to direct NHS bodies in the planning and implementation of measures to prevent and control HCAI.
The ICT has identified measures and subsequently actioned areas achievable by the infection control service. The Lead ICN has highlighted areas requiring action by the PCTs, which have been addressed.
NHS Darlington had an unannounced visit from the Healthcare Commission on 20 November 2008 as part of the national programme of inspections to assess NHS Trust arrangements for Infection Prevention and Control. Four duties from the Hygiene Code were inspected with no breaches or areas of concern identified.
17.4 Care Quality Commission (CQC ) The Care Quality Commission which brings together the Healthcare Commission, Commission for Social Care Inspection and Mental Health Act Commission came into force on 1 April 2009.
The Lead ICN registered NHS Darlington with the CQC in February 2009 as compliant with the Code of Practice for the Prevention and Control of Healthcare Associated Infections: The Health Act 2009.
NHS County Durham was not required to register.
18 Meticillin resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile - national targets and local action
A detailed report on HCAI is presented monthly/bi-monthly to both NHS County Durham and NHS Darlington boards.
MRSA The target for MRSA bacteraemias for 2008/09 was 19 cases across the health economy. The actual number was 38 cases. There was one case of MRSA bacteraemia at the Richardson Hospital. Escalated performance measures were put in place by NHS County Durham, the Strategic Health Authority and Monitor.
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Clostridium difficile The targets for C. difficile were also not met.
Target Actual NHS County Durham 444 525 NHS Darlington 55 111 CDDFT 195 247
As commissioner of health services NHS County Durham must ensure that those hospitals who deliver care to the population of County Durham and Darlington meet the national requirements. The ICT is part of an action planning group with senior representatives from County Durham and Darlington Foundation Trust, the PCTs, Tees, Esk and Wear Valleys NHS Trust and local Health Protection Unit to secure delivery of the HCAI agenda.
The Lead ICN has met monthly with the SHA Patient Safety Team to provide an update on progress. All cases of MRSA bacteraemia are subject to a root cause analysis and any necessary action taken.
All MRSA bacteraemia cases have been discussed at the PCTs’ Infection Control Committee and NHS Darlington Patient Safety Committee and any learning shared across the organisations.
The targets for April 2009 to March 2010 for Clostridium difficile are 54 for NHS Darlington, 414 for NHS County Durham and 169 for County Durham and Darlington Foundation Trust.
The figures to date are:
Clostridium difficile April 2009 – June 2009
Foundation Trust
April 09 May 09 June 09 Target 17 17 16 Actual 16 9 11
NHS County Durham
April 09 May 09 June 09 Target 35 35 35 Actual 36 38 37
NHS Darlington
April 09 May 09 June 09 Target 5 5 5
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Actual 9 6 7
MRSA Bacteraemia April – June 2009
Pre 48 Hour Post 48 Hour April 2009 0 0 May 2009 0 1 June 2009 0 0
19 Risks
Infection control is a growing agenda which requires both strategic overview and support in operational delivery across County Durham and Darlington. The ICT has only three nursing staff and works through leadership, training provision, audit and alert organisms.
The local health economy did not achieve the MRSA bacteraemia target for 2007/08 with a final total of 38 cases. Performance was poor having shown improvement in 2007/08. The C. difficile isolate targets were also not met across the local health economy. Escalated performance measures were put in place by NHS County Durham, the Strategic Health Authority and Monitor.
Risks remain in relation to potential outbreaks of C.difficile in nursing homes or cases arising in nursing homes triggering an outbreak in County Durham and Darlington Foundation Trust. It is important to note that the PCTs (unlike former Health Authorities) have no statutory powers in relation to the quality of care in nursing homes. The work on infection control is a component of the wider work on the quality of care in nursing homes being led by the Head of Patient Safety (NHS County Durham) and the Director of Patient Safety (NHS Darlington) in partnership with the local authorities. The ICT will continue to support this work.
The ICT are currently following up all new cases of Clostridium difficile in care homes. Further IC support will be provided to care homes with two new members of staff joining the team in September 2009.
Jean Armstrong Lead Infection Prevention and Control Nurse
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AUDIT CALENDAR (Actual) APRIL 2008– MARCH 2009
April 2008 May 2008 June 2008 Drs Lambert and Brunt, Dr Le Dune, Derwentside Station View, Escomb Road, Derwentside Durham Dales DNs, Durham and CLS SNs and HVs, Durham and CLS Coundon Health Centre, Durham Dales Ferryhill Surgery, Sedgefield Out of Hours, UHND Wingate Surgery, Easington – follow up visit West Green, Heighington, Sherburn Surgery, Durham and Bridge End Surgery, Durham Sedgefield CLS and CLS Richardson Hospital Burke Street, Darlington Neasham Road Surgery, Darlington – follow up visit Dr Roy, Spennymoor, Dene Valley, Darlington Dr Sanghera, Easington Lane, Sedgefield Easington DNs, Darlington Dr Mansour, Easington Dr Lambert, Louisa Surgery, Dr Patel, Kelloe, Easington Derwentside Dr Partha, Stanley HC, Dr Patel, Thornely, Easington Derwentside West Rainton Surgery, Durham SNs and HVs, Easington and CLS HMP Low Newton
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AUDIT CALENDAR (Actual) APRIL 2008– MARCH 2009
July 2008 August 2008 September 2008 Chastleton Surgery, Durham Burnhope Surgery, Derwentside Wolsingham Surgery, Durham and CLS – follow up visit Dales
HVs and SNs, Sedgefield Kelvin House Surgery, Durham Stanhope Surgery, Durham and CLS Dales
DNs, Easington Gilesgate Medical Centre, St John’s Chapel Surgery, Durham and CLS Durham Dales
West Road Surgery, Framwellgate Moor Surgery, Sherburn Surgery, Durham and Derwentside – follow up visit Durham and CLS CLS – follow up visit
West Green, Heighington, Shinwell Medical Practice, Cestria Health Centre, Durham Sedgefield – follow up visit Easington and CLS
Evenwood Surgery, Durham Dr Chandy, Peterlee Health HVs and SNs, Darlington Dales – follow up visit Centre, Easington
HMP Low Newton, Durham and Hunden’s Lane Rehab Tanfield View Surgery, CLS – follow up visit Derwentside
DNs, Sedgefield St Teresa’s Hospice, Darlington Medic House, Derwentside
Dr Le Dune, Derwentside – Chilton Surgery, Sedgefield follow up visit
Dr Rahman, Derwentside Ferryhill Surgery, Sedgefield – follow up visit
Bridge End Surgery, Durham and CLS – follow up visit
Dr Nagi, Lanchester, Derwentside
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AUDIT CALENDAR (Actual) APRIL 2008– MARCH 2009
October 2008 November 2008 December 2008 West Green, Heighington – Bishopgate Medical Practice, Felix House Surgery, Darlington follow up visit Durham Dales Dr Gupta, Peterlee HC, Coundon Health Centre, Dr Baliga, Shildon Health Easington Durham Dales Centre, Sedgefield Dr Gupta, School Street, Dr Reddy, Deneside Medical Easington Centre, Easington Out of Hours, Shotley Bridge, Craghead Surgery, Derwentside Derwentside SNs, Derwentside Dr Chadwick, Willington, Durham Dales Burke Street, Darlington – follow Dr Fletcher, Great Lumley, up visit Durham and CLS Dene Valley, Darlington – follow Bearpark Surgery, Durham and up visit CLS – follow up visit Cedars Surgery, Derwentside Framwellgate Moor Surgery, Durham and CLS – follow up visit Wheatley Hill Surgery, Gilesgate Medical Centre, Easington – follow up visit Durham and CLS – follow up visit Dr Mansour, Peterlee HC, Dr Austin, Middleton in Easington Teesdale, Durham Dales Parkgate Surgery, Darlington
January 2009 February 2009 March 2009 Harbinson House, Sedgefield Dr Charlton, Darlington Bishopgate Medical Practice, Durham Dales – follow up visit Beveridge House, Sedgefield Park House Surgery, Coundon Health Centre, Derwentside Durham Dales – follow up visit Moorlands Surgery, Darlington North House Surgery, Crook, Wheatley Hill Surgery, Durham Dales Easington – follow up visit St Teresa’s Hospice, Darlington Barnard Castle Surgery, HMYOI Deerbolt, Durham Dales Durham Dales Dr Partha, Derwentside HMP Durham, Durham and CLS Dr Nagi, Langley Park, Peaseway Medical Centre, Derwentside Sedgefield Dipton Surgery, Derwentside Leadgate Surgery, Derwentside Gainford Surgery, Darlington Dr Pollard, Bowburn, Durham and CLS Peterlee Urgent Care Centre, Easington
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DENTAL PRACTICE MONITORING VISITS APRIL 2008 – MARCH 2009
April 2008 May 2008 June 2008 Onward House, Hurworth Community Dentistry, Stanley Community Dentistry, Health Centre Richardson Hospital Mr Bragan, South Moor, Stanley Community Dentistry, Park Community Dentistry, Bishop’s Place Health Centre, Darlington Close, Spennymoor Community Dentistry, Chester le Community Dentistry, Peterlee Street Hospital Health Centre Community Dentistry, Earls Community Dentistry, Hope House Hospital Street Health Centre, Crook Community Dentistry, Ward 4, County Durham Mobile Dental Shotley Bridge Hospital Service, Neasham Road Community Dentistry, Escomb Springs Dental, Yarm Road, Road Annex Darlington Medically Compromised Dental Clinic, UHND Burgess and Hyder, Spennymoor Burgess and Hyder, Chilton Burgess and Hyder, Coundon Mr Bragan, South Moor
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DENTAL PRACTICE MONITORING VISITS APRIL 2008 – MARCH 2009
July 2008 August 2008 September 2008 Mr Burton and Ms Sutton, Mr Stedman, Dunelm Wray and McKenna, Wheatley Middleton St George Orthodontics Hill Mr Gillespie, Shildon Burgess and Hyder, Ferryhill T D Johnson, Easington Colliery Burgess and Hyder, Stanhope Ashby and Atkinson, Shildon Oasis Dental (Bishop Auckland) Ltd Mr Gillespie, Shildon Mr Abraham, Blackhall Colliery Mr Heslop, Annfield Plain GEM Dental, Peterlee Mr Dhanoya, Stanley Neave and Tregoning, Stanley Castle Dental, Barnard Castle Mr Turbitt, Darlington Mr Barber, Seaham Oasis Dental (Durham) Ltd Metcalfe Dental, Durham City Mr Gilbert, Willington GEM Dental, Peterlee Oasis Dental (Shildon) Ltd Burgess and Hyder, Trimdon Mr Cannon, Hunwick Village Shotley Bridge Dental Stuart Cox, Coxhoe Mr Jeyarajan, Neasham Road, Burgess and Hyder, Ferryhill Darlington Mr Wigg, Barnard Castle Mr Cookson Dental, Woodham, Newton Aycliffe Mr Gourlay, Durham City Mr Kulvelkar, Murton, Seaham West Auckland Dental, Bishop Mr Lam, Chester le Street Auckland Mr Jeyarajan, Aycliffe Practice, Mr Plevrakis, Framwellgate Newton Aycliffe Moor
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DENTAL PRACTICE MONITORING VISITS APRIL 2008 – MARCH 2009
October 2008 November 2008 December 2008 Mowbray and Robson, PCT Orthodontics, North Road, Mr Ambler, Peterlee Darlington Durham Jill Graham, Burnopfield Mr Bland, Southend Avenue, Mr R K Glew, Harrogate Hill, Darlington Darlington Mrs Goulding, Darlington Mr Attwood, Bishop Auckland Grenville Moore, Chester le Mr T Robson, Consett Street Mr Gillespie, Shildon Mr J Henley, Darlington Ms Farquhar, Sacriston Skinnergate Dental, Darlington Thomas Robinson, Blackhill Mr G D Matthews, Darlington ADP Spennymoor ADP Bridge House, Durham Oasis Dental (Darlington) Ltd Mr Nepali, Medomsley Mr Thapar, Coxhoe Mr Nightingale
January 2009 February 2009 March 2009 ADP Pelton Lane Ends, Chester Burgess and Hyder, Trimdon Mr Jeyarajan, Neasham Road, le Street Darlington Mr Walton, Darlington Mr Jeyarajan, Aycliffe Dental, Oasis Dental (Darlington) Ltd Newton Aycliffe Falchion Orthodontics, Mr J Bennett, Chester le Street West Auckland Dental Darlington Mr Robson, Seaham Mr M W Alexander, Horden New dental practice – Brandon Lacey, Wright and Kendrew, ADP Willington Darlington Mr Turbitt, Darlington Burgess and Hyder, Sedgefield Nina Proctor, Durham Mr Kirkup, Stanhope Mr Lightfoot, Consett Mr Gillespie, Shildon Oasis Dental (Pelton) Ltd Mr Ridgeway, Chester le Street Mr Kirkup, Crook Mr D L Bragan, Mr Nepali, Consett Burrows and Newton, Old Elvet, Durham
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