Topcliffe Surgery

Updated 14 January 2016

Topcliffe Surgery is located in the village of Topcliffe. There are approximately 2,900 patients on the practice list. The area deprivation is significantly lower than the national average. The largest percentage of patients is in the 0 - 4 age range. Ethnicity is 98% white British. The practice is open between 8am and 6.30pm Monday to Friday (except Thursday) with a closure for lunch between 12.30pm and 1.30pm. On Thursdays the practice opens in the morning only from 8am to 12.30pm.

The practice is a dispensing practice. The dispensary is open from 8am to 12.30pm and 1.30pm to 6.15pm Monday to Friday but closed on Thursday afternoon. When the practice is closed on a Thursday afternoon, the telephones are diverted to Primecare telephone answering service and any calls directed to an on- call GP from Topcliffe.

There are three GPs (two female and one male), two practice nurses (female), a phlebotomist, dispensers and dispensing assistants, a practice manager and administration/reception staff.

Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Harrogate District Foundation Trust.

The practice has a General Medical Service (GMS) contract and also offers a range of enhanced services.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Topcliffe Surgery on 16 November 2015.

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. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care, their involvement in planning and making decisions about their care and treatment was overwhelmingly positive. We were provided with many examples to demonstrate the caring approach of the practice. The examples came from patients, CQC comment cards and staff. This feedback was aligned with feedback from the national GP patient survey results which were consistently significantly higher than the national averages for the areas above.
• Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was significantly high, being above the CCG and significantly above the national averages. The data was significantly higher than the national average in respect of how well appointments ran to time, convenience and suitability of making appointments and getting through to the practice via the telephone. These results were aligned with the patient feedback we received.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• There was a 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 several areas of outstanding practice including:

• The practice provided numerous in house services and tests that would normally be undertaken in hospital as part of locally negotiated ‘out of hospital services bundle’. These services meant patients could be treated closer to home and this was of significant benefit due to the population of the area in their rural location. They also offered other additional services such as acupuncture and minor operations.
• Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was significantly high, being above the CCG and significantly above the national averages. The data was significantly higher than the national average in respect of how well appointments ran to time, convenience and suitability of making appointments and getting through the practice via the telephone. These results were aligned with the extremely positive patient feedback we received.
• We were provided with many examples to demonstrate the caring approach of the practice. The examples came from patients, CQC comment cards and staff. This feedback was aligned with feedback from the national GP patient survey results which were consistently significantly higher than the national averages for the areas above.

• Flu vaccination rates for the over 65 year olds were higher than the national average at 86% compared to 73%. Flu vaccination rates for those patients at risk were higher than the national average at 68% compared to 53%.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Have a programme of audit in place in order to ensure they complete full cycle audits.
• Act on their plan to address outstanding health and safety items such as the replacement of the fire alarm system and the upgrading of the downstairs patient toilet.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 2016

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

• 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 named GP and regular reviews to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Patient self-management was promoted and supported.
• A holistic approach to managing patients with long-term conditions was adopted.
• QOF data for patients with long term conditions was good.
• Admission rates to secondary care for patients with long term conditions were below the national average.

Updated 14 January 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 high for all standard childhood immunisations and for pregnancy related 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 practice’s uptake for the cervical screening programme was comparable to other practices. The practice performance was 83% compared to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives, health visitors and school nurses.
• Staff had received safeguarding training and proactively managed safeguarding.
• The practice provided a range of contraceptive, pre-conceptual, maternity and child health services with reminders sent to patients when certain contraceptives were due. The practice also offered STD/HIV testing for patients not wishing to use ‘Yoursexualhealth’ service.
• Staff demonstrated an acute awareness of the isolation of army personnel wives when they made contact with the practice.

Updated 14 January 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. Monthly liaison meetings were held with the extended primary health care team, elderly mental health, voluntary and Social Services.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.
• The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care.
• It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. All patients over the age of 75 years had a named GP.
• Flu vaccination rates for the over 65 year olds were higher than the national average at 86% compared to 73%.

Updated 14 January 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.

Updated 14 January 2016

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

• The practice QOF scores in dementia were slightly above the CCG and national average.
• 100% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
• 75% of patients had received a health check for mental illness which was below the national average of 86%. Ninety one percent had had an assessment of depression severity which was slightly higher than the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It 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.
• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support people with mental health needs and dementia.
• Counselling services were facilitated from the practice which patients could access.

Updated 14 January 2016

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

• The practice was aware of patients living in vulnerable circumstances including homeless people, travellers, families of army personnel and those with a learning disability.
• It offered longer appointments for people assessed as needing them.
• There were longer appointments available for patients assessed as needing them.
• Home visits were available for those patients who needed them which were of particular importance due to the rural location of the practice.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• Flu vaccination rates for those patients at risk were higher than the national average at 68% compared to 53%.
• It had told 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.