Scorton Medical Centre

Updated 18 October 2017

Scorton Medical Centre, North Yorkshire, DL10 6HB is located in the rural village of Scorton in Richmond. The practice has 3,545 patients on its practice list. It is a dispensing practice which dispenses medications to approximately 95% of its patients.

The practice team comprises of three GPs (one female and two male), two practice nurses (female), a practice manager, reception/dispensing and administrative staff.

The practice is open between 8.15am and 6.30pm Monday to Friday with extended appointments offered until 7.30pm on a Monday. Open appointments were offered every morning between 8.30am and 10.30am and a mixture of pre-booked and open appointments offered every afternoon from 4.30pm until 6pm. Where patients required a GP outside of these working hours, they could access care through the GP Out of Hours service via NHS 111, provided by Harrogate District foundation Trust. The practice has a General Medical Services (GMS) contract and also offers a range of enhanced services.

The population distribution of the practice area in the age range of 45 years to 85+ years is larger than the England average. The practice scored nine (indicative of relevant affluence) on the index of multiple deprivation (IMD). The lower the Indices of Multiple Deprivation, the more deprived an area is. People living in more deprived areas tend to have greater need for health services.

Updated 18 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Scorton Medical Centre on 17 May 2017. The overall rating for the practice was good, with the key question of safe rated as requires improvement as the arrangements in respect of medicines management did not assure that risks had been minimised. The full comprehensive report published on 23 June 2017 can be found by selecting the ‘all reports’ link for Scorton Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulation we identified in our previous inspection on 17 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• Care and treatment was provided in a safe way for service users through the proper and safe management of medicines for the purposes of the regulated activity.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 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 patients at risk of hospital admission were identified as a priority.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 80% compared with the CCG average of 80% and the national average of 78%.
• T he 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 was 80% compared with the CCG average of 80%and the national average of 78%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All patients had a named GP and there was a system to recall patients for 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 23 June 2017

• The practice is rated as good for the care of families, children and young people.
• From the sample of documented examples we reviewed we found there were systems 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.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, 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. 

Updated 23 June 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.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 23 June 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 daily open access appointments.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. 

Updated 23 June 2017

• The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
• The practice carried out advance care planning for patients living with dementia.
• Nationally reported data from 2015/2016 indicated that 74% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is slightly below the national average of 84%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 90%. This was comparable 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 living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 June 2017

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 with a learning disability.
• E nd of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed 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.