Ripon Spa Surgery

Updated 6 October 2017

Ripon Spa Surgery is one of 17 practices within the Harrogate and Rural District Clinical Commissioning Group (CCG). General Medical Services (GMS) are provided under a contract with that CCG. They also offer a range of enhanced services, which include:

• extended hours access
• delivering childhood, meningitis, influenza and pneumococcal vaccinations
• facilitating timely diagnosis and support for people with dementia
• provision of annual health checks for those patients who have a learning disability

The practice is located at Park Street, Ripon, North Yorkshire HG24 2BE. Ripon is a small market town and cathedral city in the Borough of Harrogate. Information published by Public Health England shows the practice is ranked as being in the ninth least deprived decile (one being the most deprived and 10 being the least).

Ripon Spa Surgery is open at the following times:

Monday and Wednesday 8am to 6.30pm

Tuesday and Thursday 8am to 7.30pm

Friday 8am to 6pm

Appointments are available with a GP from 8.30am each weekday. Appointments are available with a nurse from 8am Monday to Friday, with the exception of Wednesday when they commence at 9am.  There is access to extended hours appointments with a clinician on Tuesday and Thursday until 7.15pm.

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.

There are currently 7,150 patients registered with the practice. The majority of whom have a white British origin. There is a small minority of patients with a Polish origin. The practice profile is similar to the national average, however, they do have a higher than average number of patients who are aged 65 years and over.

There are four GP partners (three male and one female). The practice manager is also a partner in the practice. They employ a salaried GP, a long-term locum GP, two practice nurses and a healthcare assistant; all of whom are female. The practice is supported by an experienced team of administration and reception staff, which includes a finance manager and a medical notes summariser.

The practice also has a small dispensary which dispenses to approximately 25% of their patients. There is a team of specifically trained dispensary staff. A CCG Medicines Optimisation Technician also attends the practice one half day every fortnight.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. (The third sector includes a very diverse range of organisations including voluntary, community, tenants’ and residents’ groups.)

Updated 6 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ripon Spa Surgery on 14 November 2016. The findings at that inspection led to an overall rating for the practice of requires improvement. We also issued three requirement notices for breaches in regulations relating to the Health and Social Care Act 2008. The full comprehensive report for that inspection can be found by selecting the ‘all reports’ link for Ripon Spa Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 30 August 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• Systems and processes had been improved and were now embedded within the practice. These included comprehensive processes in place regarding infection prevention and control, medicines management, recruitment, training and appropriate supervision of staff.
• There was evidence of actions, shared learning and reviews of any changes undertaken in relation to reported incidents or near misses.
• We saw that a programme of clinical and non-clinical audit was in place. There was evidence to demonstrate quality improvement as a result of the audits that had been undertaken.
• There was an effective process in place for obtaining patient consent for specific procedures. Consent was clearly documented in a patient’s record.
• There was a system in place and an identified person to support the summarising of patient records.
• There was a system in place to ensure all policies and procedures were in date, reviewed as appropriate and that staff knew where to access them.
• A range of clinical and non-clinical meetings took place within the practice. We saw formal minutes arising from those meetings.
• We saw evidence that staff were up to date with their appraisals and mandatory training; which included safeguarding, mental capacity of patients, infection prevention and control, fire safety and basic life support.
• There was evidence that governance arrangements within the practice were effective. Risks and issues were identified and dealt with accordingly.
• The practice delivered enhanced services and participated in programmes to meet the needs of their patient population.
• There was evidence of strong teamwork and a commitment to deliver a quality service to patients. Staff were clearly valued by the partners in the practice.
• Patients’ comments we received were extremely positive and demonstrated they held the practice and staff that worked there in high regard.

We saw an area of outstanding practice:

• There was evidence of a caring practice, where staff had ‘gone the extra mile’ for patients. For example, providing food, transport and presents for patients who were in poverty or homeless. Dispensing staff had taken prescriptions to patients if they had difficulty getting to the practice due to ill health. The GPs provided their personal mobile numbers to patients with palliative care needs, and/or their families. This allowed for them to contact their own GP at the weekend, during bank holidays or out of normal practice hours. Opportunistic home visits were undertaken on patients who staff may have had some concerns about.

There was an area where the provider should make improvements:

• Ensure that the backlog of the summarising of patient records is completed in a timely way.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 6 October 2017

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

• Nursing staff had lead roles in long term disease management and received training to support them in delivering appropriate care and treatment to those patients.
• All these patients had a named GP and a structured annual review, at a minimum, to check their health and treatment needs were being met.
• Patients who were on high risk medicines were reviewed in line with medicines management guidance.
• Patients who were at risk of hospital admission were identified as a priority.
• Performance for long term condition related indicators was higher than the CCG and national averages.
• Monthly meetings were held to discuss the care and treatment of those patients who had diabetes. 

Updated 6 October 2017

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 accident and emergency (A&E) attendances.
• The uptake rate for childhood immunisations was higher than local and national averages.
• On the day of inspection, patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The uptake rate for cervical screening was higher than local and national averages

Updated 6 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population. Although the avoiding unplanned admissions enhanced service had ceased to be funded, the practice continued to treat frail patients as a priority. They carried out care planning and reviews as appropriate.
• The practice liaised with other health and social care professionals and, with the patient’s consent, shared care records to support an appropriate package of care.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. Patients were involved in planning and making decisions about their care.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Weekly ‘ward rounds’ were undertaken at a local care home, where some patients resided. Regular reviews of patients’ care and treatment were carried out.
• The practice had good links with the local Age UK group and signposted patients as appropriate.

Updated 6 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended opening hours and a triage system.
• The practice was proactive in offering online services, which included the ability to book an appointment online or request a prescription.
• The practice promoted a full range of health promotion and screening that reflected the needs for this age group.
• NHS health checks were offered to patients aged between 40 and 74 years, who had not seen a GP in the last three years.

Updated 6 October 2017

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 higher than CCG and national averages. For example, 100% of patients who were currently being prescribed lithium (medication used to treat the manic episodes of bipolar disorder) had undergone appropriate blood tests in the preceding four months, compared to the CCG average of 95% and the national average of 90%.
• Those patients who were living with dementia or had a complex mental health disorder, had an annual review of their care.
• Patients at risk of dementia were identified and offered an assessment.
• Staff could demonstrate a good understanding of assessing mental capacity and had received appropriate training.
• The practice regularly worked with multidisciplinary teams, such as community mental health services, in the case management of patients experiencing poor mental health.
• There was information available both in the practice and on the website on how patients could access other avenues of support, such as local voluntary organisations or support groups.

Updated 6 October 2017

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

• There was a system in place to identify patients who may be in need of extra support. For example, patients requiring end of life care, patients with a learning disability or carers.
• The practice offered longer appointments for patients who had a complex health need.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Where a patient had been assessed as needing Deprivation of Liberty Safeguards (DoLS), these were identified in the patient’s clinical record. GPs had undergone specific DoLS training.
• Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
• We were provided with many examples, where staff had provided homeless patients with food and small amounts of money to support them. We were also informed of an occasion where staff had taken it upon themselves to provide food, nappies and Christmas presents for the small children of a patient living in poverty.
• There was information about how to access various support groups and voluntary organisations.