The Kirkbymoorside Surgery

Updated 18 July 2016

The Kirkbymoorside surgery provides a General Medical Service (GMS) to their practice population of 5954 patients. They are also contracted to provide other enhanced services for example: extended hours access and minor surgery. This is a rural practice located in the centre of the market town of Kirkbymoorside. There is a car park and the surgery is easily accessible for patients with mobility difficulties and for patients whose children are small. There is a bus service which runs hourly during the day, to surrounding villages and larger towns.

• There are four GP partners (2 female and 2 male). This is a training practice for qualified doctors who wish to train as GPs. There is currently one GP registrar from the York Vocational Training Scheme (male). There are two female practice nurses and two female health care assistants. There are eight reception team members, this includes a reception team manager.

• The practice is open Monday – Friday from 8am until 6pm. There are extended hours opening on Monday and Tuesday evenings until 7pm. In addition the practice is open on the first Saturday of each month from 8.15am until 11.15am. When the practice is closed and from 6pm each evening the telephone lines are automatically re-directed to the out of hours service.

Updated 18 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Kirkbymoorside surgery on 17 May 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 had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

We saw an area of outstanding practice:

• Support for their elderly patients who were most at risk of unplanned admissions to hospital or potentially could use the Emergency departments and the local hospitalshad resulted in a 50% reduction from 2014-2015 in these numbers. In addition unplanned admissions avoidance had improved, too. In 2014 the avoidance was two in 2015 this had increased to 11.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 July 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.

• The practice provided ‘Patient Pods’ ( where patients could measure their own blood pressure in the practice building) which helped patients with Long Term Conditions feel able to monitor their health and to self-manage their condition or work in partnership with their clinician. The information was sent directly to the patient’s notes for the clinician to review.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) was 87% which was higher than the CCG average of 82% and the national average of 77.5%.

• 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 84% which was higher than the CCG average of 77% and the national average of 78%.

• The percentage of patients with diabetes, on the register, who had had influenza immunisation in the preceding 1 April to 31 March (01/04/2014 to 31/03/2015) was 100% compared to the CCG average of 95.9% and the national average of 94.4%.

• Longer appointments and home visits were available when needed.

• 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.

• There was a Near Patient Warfarin initiation and management which meant patients did not travel to different sites for their dosage to be determined.

Updated 18 July 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, and we saw evidence to confirm this.

• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 81% which was similar to the CCG average of 80% and slightly lower than the national average of 82%. 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.

• A teenage questionnaire had been completed and as a result of the findings the services for teenagers had been adapted to meet their needs.

Updated 18 July 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. A named GP supported patients who resided in local care and nursing homes; they visited weekly and treatment plans were changed according to need. All patients had been reviewed by a care of the elderly consultant and this was to continue annually, in the care homes. This extra support and attention had resulted in a 50% reduction of admissions from 2014-2015. In addition unplanned admissions avoided had improved, too. In 2014 the avoidance was two in 2015 this had increased to 11.

• The York Integrated Care Team’s approach to supporting patients in their homes to avoid unplanned admissions and reduce the number of emergency departments attendances had now been implemented at this rural practice, as a hub.

• The Voluntary Sector Liaison Team, since 2010, led from within the surgery, signposted patients to the most appropriate voluntary service.

• Consent to Share Information Form was developed in house to identify when patients had input from voluntary care organisations with a register of ‘cared for’ and carers maintained. Subsequently this form has been adopted across the wider Ryedale area

• Age UK Hypothermia winter warmer programme was implemented.

• Additional winter sessions were offered by the surgery at high pressure/high volume Christmas/New Year period under the CCG scheme to relieve pressures on acute Emergency Department services

• Leg Ulcer Management within the practice using Doppler equipment shared with Community Nursing team. Patients had this service closer to home, given the rurality of the practice, this enhanced their well-being and assured effective prompt treatment and recovery.

• GPSI dermatology was provided offering dermoscopy, diagnosis, biopsy and minor surgery thus, patients did not have to travel in excess of 20 miles to the hospitals.

Updated 18 July 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.

• This included a range of appointment lengths, times, and formats with Monday and Tuesday providing extended hours sessions.There were monthly Saturday mornings pre-bookable appointments. In addition there were appointments before work, telephone appointments and email consultations readily available.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

Updated 18 July 2016

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

• 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 100% which was higher than the CCG average of 92% and higher than 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 how to access various support groups and voluntary organisations.
• The same day ‘Duty Dr’ service for urgent issues with face to face and telephone appointments available allowed staff to prioritise management of patients in mental health crisis.

• 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 18 July 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 and those with a learning disability.

• 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 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.
• 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 and those with a learning disability.

• 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 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.