Springbank Surgery

Updated 23 November 2016

Springbank Surgery, York Road, Green Hammerton, York, YO26 8BN is a semi-rural practice situated in Green Hammerton serving this and surrounding villages. There is also a branch practice, Tockwith Surgery, 21 Marston Road, Tockwith, York, YO26 7PR which is approximately five miles from the main practice at Green Hammerton. The registered list size is approximately 5,700 and predominantly white British background. The practice is ranked in the tenth least deprived decile (one being the most deprived and 10 being the least deprived), significantly below the national average. The practice age profile differs from the England average, having a higher number of patients in the 45 – 69 age range and a lower number in the 0 – 9 and 20 – 29 age range. The practice is a dispensing practice and dispenses to approximately 95% of their patients.

The practice is run by a management team consisting of two partners (one female and one male) and a senior team leader. There are three salaried GPs, one of whom is a retainer. 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 currently has a Foundation Doctor (FY2). This is a grade of medical practitioner undertaking a two-year, general postgraduate medical training programme.

The practice employs three practice nurses and two health care assistants. Eight members of staff work in the dispensary, one of whom is a trained Pharmacist and in the role of lead senior dispenser. The practice also receives 10 hours additional support from a pharmacist provided by the CCG. The team is supported by a team of seven receptionists and six administrators.

The main reception at Green Hammerton is open each weekday between 8am and 6pm. Tockwith branch surgery reception is open during surgery times shown below.

                         Morning                                   Afternoon

Monday            8.30am – 12pm                       3pm – 6pm

Tuesday           9am – 12pm                            2.30pm – 6pm

Wednesday      9am – 12pm                           3pm – 6pm

Thursday          9am – 12pm                           closed

Friday              9am – 12pm                            3pm – 6pm

Weekend         closed                                      closed

Green Hammerton appointments are offered at various times throughout the day from 8am to 6pm. Extended hours from 6.30pm – 8pm are offered at this practice one evening a week. Early morning appointments are also available from 7.30am on a Friday. These alternate between Green Hammerton and Tockwith practices.

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.

The practice holds a General Medical Services (GMS) contract to provide GP services which is commissioned by NHS England.

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Springbank Surgery on 14 September 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• The practice carried out a thorough analysis of the significant events. The practice demonstrated they recorded all incidents and near misses and monitored trends over a period of time. All staff were involved in this process.
• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines. The practice used these guidelines to positively influence and improve practice and outcomes for patients.
• The continuing development of staff skills, competence and knowledge was recognised as integral to ensuring high quality care.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice demonstrated a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a strong focus on continuous learning and improvement at all levels within the practice. The practice team was forward thinking and part of local pilot schemes and practice initiated schemes to improve outcomes for patients.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw many areas of outstanding practice, examples included:

• Significant incidents deemed appropriate were reported to the National Reporting and Learning System (NRLS). The practice had been part of an initiative with Harrogate CCG and the Improvement Academy (IA) to embed Human Factors thinking into the management of healthcare thereby improving patient safety and achieving betters lives for people. The IA looked at an example of a significant event from each practice involved. They identified the practices management of the event reviewed as exemplary.
• Dispensing errors which reached patients and near miss dispensing errors were recorded as part of the significant event log. The practice had recognised that themes identified in significant event meetings in relation to the dispensary were not being adequately solved. They subsequently sought the assistance of the Improvement Academy, part of Yorkshire and Humber Academic Health Science Network, who were running a TAPS programme in dispensing. TAPS stands for Training and Action for Patient Safety. The programme recognised themes and the aim of the programme was to improve safety. Participating in the TAPS programme (which reviewed the dispensing arrangements at the practice) had led to significant improvement in how the practice managed significant events and near misses. There was clear evidence of impact, with a reduction of significant events and greater involvement of the practice team.
• A robust system was in place for monitoring prescriptions that had not been collected on a monthly basis. If prescriptions had not been collected within a three month period a note was sent to the GP and an entry was made in the patient’s record and discussed with the patient.
• A GP partner committed 60 hours of their own time to work at the local Out of Hours service. This was to enable a nurse from the practice to attend with them as part of their mentoring arrangements and their competency assessment to triage patients. In addition to this, from March 2016 the practice had commissioned a ‘medical actor’ to attend the practice and play out scenarios with the trainee doctors. To date four trainees had undertaken this as well as the new practice nurse. The actor was scheduled to attend the practice every four months to run scenarios and review the recorded consultations with trainee doctors and other identified staff. The aim being to further improve patient engagement and satisfaction.
• The practice had implemented a system whereby young people could direct message the GPs to ask for an appointment which the GP booked, bypassing the need for them to contact the practice via the reception. Pocket sized cards had been put in place in an age appropriate format to promote this facility and were given out by practice staff and other professionals who kept a stock of these. We were provided with a number of examples to demonstrate how this had made a difference for a number of patients.
• The practice had put in place a system to search electronically for patients with memory problems who had an appointment at the practice that day. This system prompted reception staff to contact the patients to gently remind them of their appointment.
• The practice paid for a member of the public to hand deliver the practice newsletter.
• The practice provided a home delivery service staffed by volunteers. All volunteers had received appropriate checks. As part of the consent for home deliveries, the practice included a photograph, with name, of each volunteer which the patient kept at home for reference. The practice had also generated photo identity badges and prescription signature books which ensured a full audit trail for deliveries.
• The practice had attended local schools to give talks on health related matters at least annually. Children from a local school attended the practice regularly to display their artwork.
• The Patient Participation Group (PPG) was extremely active and beneficial. For example the PPG had organised and facilitated four cardio pulmonary resuscitation (CPR) courses at the practice for patients in the last twelve months.
• It was clear this practice had an excellent learning culture.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 November 2016

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

• Nursing staff had lead roles in chronic disease management.
• Patients at risk of hospital admission were identified as priority.
• Performance for diabetes related indicators was slightly above the national average. For example the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 91% compared to the national average of 88%.
• Longer appointments and home visits were available for patients assessed as needing them.
• 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.
• The practice was about to launch the use of ‘Skype’ for electronic face to face video consultations.

Updated 23 November 2016

The practice is rated as outstanding 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 mixed, mostly slightly lower than the CCG average for under two year olds and higher for five year olds.
• Children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice’s uptake for the cervical screening programme was 87%, which was slightly higher than the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We were provided with evidence and saw positive examples of joint working with midwives, health visitors, school nurses and schools. For example the practice had attended local schools to give talks on health related matters at least annually. Children from a local school attended the practice regularly to display their artwork. The practice felt this encouraged young children to feel comfortable within the practice environment and to encourage their attendance.
• The practice had spoken with a number of older children about the barriers to contacting the practice. As a result of their findings they had implemented a system whereby young people could direct message the GPs to ask for an appointment, bypassing the need for them to contact the practice via the reception. Pocket sized cards had been put in place in an age appropriate format to promote this facility and were given out by practice staff and other professionals who kept a stock of these. We were provided with a number of examples to demonstrate how this had made a difference for a number of patients.

Updated 23 November 2016

The practice is rated as outstanding 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.
• The practice provided at least a weekly visit to three care homes by a lead GP.
• The practice was currently working with the Yorkshire and Humberside Improvement Academy to pilot ‘safety huddles’ in one of the care homes the practice supported. As part of this the lead GP met with the care home staff to look at the risks relating to falls with the aim to reduce the number taking place.
• In 2015, the practice started to implement the STOPP protocol. STOPP stands for Screening Tool of Older Persons’ potentially inappropriate prescriptions. It is a validated tool for reducing risk associated with polypharmacy. The practice has implemented this in all three care homes within the practice area with tangible benefits for patients. In the 12 months, prescribing of such medicine had almost halved and continues to be monitored.

Updated 23 November 2016

The practice is rated as outstanding 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 reflects the needs for this age group.

Updated 23 November 2016

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

• 91% of patients diagnosed with dementia that had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%. The practice had put in place a system to search electronically for patients with memory problems who had an appointment at the practice that day. This system prompted reception staff to contact the patients to gently remind them of their appointment.
• Performance for mental health related indicators was slightly above the national average. 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 (01/04/2014 to 31/03/2015) was 100% compared to the national average of 88%.
• 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.
• The practice used aged appropriate assessment tools which had proven particularly beneficial for younger patients.
• 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. For example the practice had put in place a system to search electronically for patients with memory problems who had an appointment at the practice that day. This system prompted reception staff to contact the patients to gently remind them of their appointment.

Updated 23 November 2016

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

• The practice held a register of patients living in vulnerable circumstances including housebound patients and patients with a learning disability.
• The practice routinely offered extended appointments for patients with a care plan and for other patients assessed as needing it.
• 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.
• The practice had appropriate communication systems in place for vulnerable people. For example the practice used letters with pictures and symbols to recall patients with a learning disability to the practice. The letters included photographs of the staff they would be seeing.

• 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 a home delivery service staffed by volunteers. All volunteers had received appropriate checks. As part of the consent for home deliveries, the practice included a photograph, with name, of each volunteer which the patient kept at home for reference. The practice had also generated photo identity badges and prescription signature books which ensured a full audit trail for deliveries.