Church Lane Surgery

Updated 28 July 2017

Church Lane Surgery, Church Lane, Boroughbridge, York,YO51 9BD is a rural practice serving Boroughbridge and the surrounding villages. There is a branch practice at Main Street, Helperby, York, YO61 2NS.

The practice provides primary care to 10,225 patients under a General Medical Services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community. The National general practice profile shows that only 1% of the practice population is from a non-white ethnic group. The practice is ranked in the tenth least deprived decile (one being the most deprived and 10 being the least deprived).

The practice is a dispensing practice and dispenses medicines to approximately 56% of their patients.

The practice age profile differs from the England average, having a higher number of patients in the 45 – 79 age range and a lower number in the zero to four and 15 – 39 age range.

The practice is run by seven GP partners (three male and four female) and four salaried GPs. The practice is a teaching practice. The practice currently has a GP registrar. This means the GP registrar is currently on a three year GP registration course. The practice also employs one senior practice nurse, five practice nurses and two HCA’s. As part of the new care models pilot the practice is funded to receive pharmacist input at the practice every afternoon five days a week.

The clinical team is supported by a practice manager, an accounts manager, a clinical information manager and a reception team leader who are supported by a large team of administration staff. There is a dispensary manager (based at the branch practice) and dispensary supervisor based at the main practice who are assisted by six dispensary assistants.

Church Lane Surgery is open Monday to Friday from 8am to 6pm with morning appointments available between 8.30am to 12.30pm and afternoon appointments from 2pm to 5.30pm. Extended hours are offered on alternative Friday and Saturday mornings. Appointments on alternative Fridays are from 7am to 10.50am and alternative Saturday mornings from 8am to 9.40am; however the building is open until 1030 am. The dispensary is open Monday to Friday from 8.30am to 6pm. The branch practice at Helperby is open Monday to Friday from 8.30am to 12.30pm with appointments available between 8.40am and 10.50am. The dispensary is open 8.30am to 12.30pm Monday to Friday.

The practice has opted out of providing out-of-hours services to its own patients. Out of hours patients are directed to Harrogate District Foundation Trust (the contracted out-of-hours provider) via the 111 service.

Updated 28 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Lane Surgery on 3 November 2016. The overall rating for the practice was good. However, a breach of the legal requirements was found which resulted in the practice being rated as requires improvement for providing safe services. The full comprehensive report for the November 2016 inspection can be found by selecting the ‘all reports’ link for Church Lane Surgery on our website at www.cqc.org.uk.

In addition to the breach of regulation, at the inspection on 3 November 2016 we also said the practice should consider the following areas:

• Review the arrangements currently in place for revisiting changes introduced by the practice over time to ensure they are effective and embedded within the practice.
• Review the governance arrangements currently in place for monitoring training to ensure the system is effective and affords the management oversight of what training is due to be completed and updated.
• Review the effectiveness of the governance arrangements in place for the recruitment of staff to ensure staff are recruited in a safe and timely way.
• Review the arrangements for supervising dispensing staff to ensure dispensing staff are supervised by a member of staff with detailed knowledge of their role.

This inspection was an announced focused inspection carried out on 5 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulations that we identified in our previous inspection on 3 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• The practice had reviewed their arrangements for the management of medicines and these were managed safely.
• We saw that significant events, near misses and changes within the practice were discussed at relevant team meetings and that minutes were made available to all staff.
• The practice had implemented an improved system to monitor staff training, which enabled the management to review and arrange training in a proactive manner.
• The practice had reviewed the arrangements for the recruitment of staff.
• We found that the arrangements for the supervision of dispensary staff were appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 December 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.
• Longer appointments and home visits were available when needed.
• Performance for the ten diabetes related indicators was higher than the national average in all areas. For example the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less (01/04/2015 to 31/03/2016) was 83% compared to the national average of 76%.
• 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.

Updated 22 December 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.
• Childhood immunisation rates for the vaccinations given were high when compared to the England average for under two year olds and for five year olds. For example childhood immunisation rates for the vaccinations given to under two year olds ranged from 96% to 99% compared to the England average of 73% to 95% and five year olds from 88% to 95% compared to the England average of 81% to 95%. 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 80%, which was comparable to the CCG average of 84% and higher than the national average of 74%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 22 December 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.

Updated 22 December 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 22 December 2016

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

• Performance for the six mental health related indicators was higher than the England average for five out of the six indicators. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 95% compared to the national average of 89%.
• 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.
• A counsellor worked out of the practice once a week which GPs could refer patients to.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 December 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 those receiving end of life care and those with a learning disability.
• The practice offered longer appointments for patients assessed as needing them.
• 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. They were proactive in referring patients to these services. They hosted a range of external support services at the practice on a weekly basis. For example housing and benefit support, healthy living and support for carers.
• The practice placed a strong emphasis on palliative care. We were provided with a considerable amount of positive feedback in respect of the care provided to patients receiving end of life care and bereaved families.
• 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 provided care to patients in three care homes with weekly visits at set times by named GPs.