Quaker's Lane Surgery Also known as Drs Kipling, Moon, Mawer & Wilkins

Updated 11 August 2016

Quakers Lane Surgery, Quakers Lane, Richmond, North Yorkshire, DL10 4BB is a semi-rural practice situated in Richmond serving Richmond and surrounding villages. The registered list size is 6,273 and predominantly white British background. The practice is ranked in the eighth least deprived decile (one being the most deprived and 10 being the least deprived), significantly below the national average. The practice age profile is comparable to the England average with the largest age range being 65 years plus. The practice is a dispensing practice and dispenses to approximately 1,474 of their patients. The practice is run by three partners (one female and two male) with a salaried GP joining the practice in August 2016.

The practice employs a part time practice manager, three practice nurses and a health care assistant. The health care assistant works two days a week and is funded by the CCG as part of the nursing workforce project. Two members of staff work in the dispensary. A pharmacist funded by the CCG has been working at the practice two days day a week until the end of June 2016. The team is supported by a senior administrator, two dispensers and a team of secretarial/administration and reception staff.

The practice is open between 8am until 6pm Monday to Friday. Extended opening is offered one evening a week on alternative Tuesdays and Thursdays until 8pm with two GPs and a nurse. GP appointments start from 8.20am to 11am and 3pm to 6pm.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed between 6pm and 8am patients are directed to Primecare who manage the calls.

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

Updated 11 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Quakers Lane Surgery on 7 July 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they felt the practice offered an excellent service and staff were helpful, caring and treated them with dignity and respect. We received a wide range of examples to demonstrate how the practice had supported patients well through difficult circumstances.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• There was a clear 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.
• There was a strong focus on continuous learning, innovation and improvement at all levels.

We saw some areas of outstanding practice:

The practice’s care of older people. The practice was working with two other practices as part of a frailty pathway project. The project was in phase one. The outcome aims of the project included areas such as improved patient satisfaction and quality of life, and improved recognition and diagnosis of frailty. The project was in phase one. Early outcomes clearly demonstrated the aims of the project were being worked towards and that appropriate care and referrals were made to support these patients. For example, of the 33 patients identified for the project 12 had been referred to the falls service, five to the Community Mental Health Team due to significant memory problems, 15 to a geriatrician for a more comprehensive assessment and one patient referred to the Voluntary Sector to provide a be-friending service.

The practice provided medical care to a local community hospital. They had access to six intermediate beds and provided medical care for their own patients who they directly visited. The practice also provided care for patients admitted to this hospital who were not their patients and out of area.

The practice offered a range of services as part of the ‘Out of Hospital Basket’ enhanced service aimed at providing care closer to the patient’s home and avoiding unnecessary travel to hospital. For example ring pessary fitting and replacement.

The practice offered ‘E-Consult’ an electronic way for patients to communicate with GPs for routine queries. This was of particular benefit for this semi-rural practice.

The areas where the provider should make improvements are:

The provider should ensure that systems are in place to ensure training is completed and updated in a timely way.

The practice should ensure recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act (HSCA) 2008. The practice must ensure that all the necessary employment checks are in place for all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 August 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.
• Performance for diabetes related indicators was above the national average. 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 97% compared to the national average of 88%. 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 (01/04/2014 to 31/03/2015) was 80% compared to the national average of 78%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and nurse and a structured review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP and nurse worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 11 August 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 relatively high for all standard childhood immunisations.
• Patients told us that 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 84%, which was comparable to the CCG average of 84% and the national average of 82%.
• Appointments were available outside of school hours. The premises was suitable for children and babies.
• The practice had a dedicated area on their website for young people.
• The practice offered emergency contraception, family planning and sexual health advice including administration of long-acting reversible contraception (LARC).
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 11 August 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 was working with two other practices as part of a frailty pathway project. The project was in phase one. The outcome aims of the project included areas such as improved patient satisfaction and quality of life, and improved recognition and diagnosis of frailty. The project was in phase one. Early outcomes clearly demonstrated the aims of the project were being worked towards and that appropriate care and referrals were made to support these patients. For example, of the 33 patients identified for the project 12 had been referred to the falls service, five to the Community Mental Health Team due to significant memory problems, 15 to a geriatrician for a more comprehensive assessment and one patient referred to the Voluntary Sector to provide a be-friending service.
• The practice provided medical care at a local community hospital. The practice had access to six intermediate beds and provided medical care for their own patients who they directly visited. The practice also provided care for patients admitted to this hospital who were out of area. These patients were in the older people population group and were admitted for rehabilitation or palliative care.

Updated 11 August 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 reflects the needs for this age group.

Updated 11 August 2016

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

• Performance for mental health related indicators was comparable to other practices. Two out of the three indicators were above the national average and one below. 79% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, this was lower than the national average of 84%.The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 93% 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 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 11 August 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 identified as frail, housebound and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability. The practice had a dedicated practice nurse for managing patients with a learning disability. All those that needed a review had had one or had one planned.
• 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.
• 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.