Background to this inspection
Updated
21 March 2018
Reeth Medical Centre, Back Lane, Reeth, DL11 6SU is situated in a rural village near Richmond serving the two dales of Swaledale and Arkengarthdale, caring for 1600 patients in an area of 200 square miles. The practice is a dispensing practice, dispensing to 1590 of the 1600 registered patients.
The practice has a predominantly British White population, with an above average population aged 65 years plus. There are less people aged zero to 18 years than the England average. Practice data showed slightly more patients than average with a long-standing health condition (58%),
compared to the national average of 53%. Male life expectancy is above the national average at 80 years and female above at 85 years (national average male 79 and female 83). Information published by Public Health England showed the practice scored seven on the deprivation measurement scale; the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have greater need for health services.
The practice is a partnership made up of a GP partner (male) and non-clinical partner with a second salaried GP (female). There is one practice nurse (female). One GP works at the practice at a time and the nurse is available twenty hours per week. There is a practice manager who is also the non-clinical partner, dispensing staff and a range of administration/secretarial staff.
The practice offers a mixture of open and booked appointments daily. Sit and wait appointments are available every morning from 8.30am with the clinic list closing at 10am, after which the clinic continues until the last patient is seen. Bookable appointments are available from 11.30am. This is usually a single appointment lasting anything between 30 – 60 minutes. This appointment is used for learning disability and dementia patient reviews, memory tests, minor surgery or if the GP wishes to have the option of seeing a patient for longer. This appointment is not time bound. Booked appointments are available from 4pm to 5.30pm (Monday, Wednesday and Friday). On a Tuesday and Thursday a duty arrangement is in place whereby the GP partner or salaried GP is on call and available to see patients if assessed as needed. Emergency appointments are available between the hours of 8am and 6pm daily. Appointments with the nurse are by booked appointment only. The dispensary is open on a Monday, Wednesday and Friday from 8.30am to 1pm and 4pm to 6pm and Tuesday and Thursday from 8.30am to 1pm.
The practice has opted out of providing out-of-hours services to its own patients. The out of hours care is accessed through the 111 service and is provided by Harrogate District Hospital Foundation Trust. The nearest out of hours centre is based at the Harewood Medical Practice, Catterick Garrison.
The practice holds a General Medical Services (GMS) contract to provide GP services which is commissioned by NHS England.
Updated
21 March 2018
Letter from the Chief Inspector of General Practice
This practice is rated as Outstanding overall. (Previous inspection May 2015 - Outstanding
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Outstanding
Are services responsive? – Outstanding
Are services well-led? – Outstanding
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Outstanding
People with long-term conditions – Outstanding
Families, children and young people – Outstanding
Working age people (including those recently retired and students – Outstanding
People whose circumstances may make them vulnerable – Outstanding
People experiencing poor mental health (including people with dementia) – Outstanding
At this inspection we found:
- The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
- The practice was open and transparent, and had systems in place to adhere to the Duty of Candour. When things went wrong, we saw that the practice offered patients an apology and an explanation. Quality improvement was embedded into practice. There was a comprehensive programme of clinical and non-clinical audit that all staff were involved with that was routinely monitored and changes made to practice resulted in measurable improvements to patient care.
- The practice was proactive in identifying new ways of working to streamline services and improve patient experience.
- The practice was strongly committed to multidisciplinary working and could evidence how this had a positive impact on patient care.
- Discussions with staff and feedback from patients demonstrated staff were highly motivated and were inspired to offer care that was kind, caring and supportive and met the needs of the population.
- The practice organised and delivered services to meet patients’ needs. The practice had initiated positive service improvements for their patients. There was a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that met their needs and where possible, their preferences.
- Patients were able to access a wide range of services at the practice, which enabled patients to be treated closer to home.
- The practice improved services where possible in response to unmet needs. They made reasonable adjustments when patients found it hard to access services even if it was only for a small number of patients.
- The practice was passionate about ensuring they always provided their patients with the best care possible. They demonstrated a determined attitude to overcome barriers faced by the practice and the population they served. They focussed on the challenges faced by a rural community and planned their services around this.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
We saw a wide range of outstanding practice. Examples included:
The practice proactively ensured that end of life care was delivered in a coordinated way which took into account the needs of different patients, including those who may be vulnerable because of their circumstances. Nationally reported data showed the number of patients of Reeth Medical Centre dying in their preferred place was significantly above the national data.
The number of patients on the practice’s palliative care register was three times the national average.
The practice funded a local community transport scheme to provide free at the point of use transport for housebound patients so they could attend appointments at the practice. This included using the bus service or someone walking the patient to their appointment. The practice worked closely with the district nursing team hosting their services allowing them to see patients centrally at the practice which after one year, there were 42% fewer district nurse home visits and a high level of satisfaction from the patients using the scheme.
The practice had provided unfunded voluntary support to the Yorkshire Ambulance Service since 2007. This worked by allowing the ambulance service to directly mobilise and inform the practice of incidents in which it was beneficial for the GP to attend (usually the GP could be on scene before the ambulance arrived). On average the practice attended approximately four serious or life threatening incidents a year.
The areas where the provider should make improvements are:
Review the practice’s home delivery service in relation to maintaining an appropriate audit trail.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice