Thirsk Doctors Surgery

Updated 26 January 2017

Dr Trzeciak and Partners, The Doctors' Surgery, The Health Centre, Chapel Street, Thirsk, North Yorkshire, is situated in Thirsk town centre. The practice is housed in a purpose built medical centre. The building is owned by NHS estates and space is limited in the practice. There is limited parking with many of the patients living within walking distance and limited access to public transport. There are 7066 patients on the practice list. The practice scored four 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 a greater need for health services.

There are six GP partners four female and two male. There are, two nurse prescribers and two practice nurses. There are also three heath care assistants (HCAs) and an attached community based practice nurse hosted by the practice and working across three practices. There is a practice manager, departmental leads and administrative staff. The practice is a dispensing practice and there is a dispensing manager and dispensing staff.

The practice is open from 8am to 6.30pm, Monday to Friday. The practice provides extended hours one evening per week until 8pm and on Saturday mornings from 9am until 11am. Appointments can be booked by walking into the practice, by the telephone and on line. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hours emergency service which is manned by a team of local GPs and operates from Northallerton between the hours of 6.30pm to 8am and all day on Saturdays, Sundays and Bank Holidays. The practice holds a General Medical Service (GMS) contract.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Trzeciak & Partners on 26 October 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice promoted a no blame culture and encouraged staff to raise concerns and possible risks.

• 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. When a complaint related to any aspect of clinical work it was raised as a significant event.

• 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 and pre bookable appointments available.

• Feedback from patients about their care was consistently positive.

• The practice had good facilities and was well equipped to treat patients and meet their needs. However the size of the building was limited as the practice population had grown over time.

• There was a clear leadership structure in place. 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. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).

We saw several areas of outstanding practice:

• The practice used innovative and proactive methods to improve patient outcomes. For example the practice funded care for pre-diabetic patients and performed reviews on these patients in order to prevent disease progression.

• The practice worked with the local farming and agricultural communities to improve health screening of this hard to reach group. They provided an innovative approach attending farming events, agricultural and equipment shows and offering discreet three minute health screening that checked cholesterol, blood sugar and blood pressure. They had also worked with other organisations to develop a health education booklet for farmers.

The practice SHOULD

• Implement procedures to record and monitor near misses and dispensing errors to improve the safety of the service. Review procedures to ensure fridge monitoring is in line with national guidance.

• Develop a process to monitor the services provided by NHS estates in relation to repair and fire safety.

• Ensure all staff receive and annual appraisal.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

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. A chronic disease nurse lead was employed by the practice. There was a joint approach in managing these patients with community and district nurses.

• Patients with chronic obstructive airways disease (COPD), asthma and diabetes were managed by nurse led clinics. The practice had designed computer templates informed by the latest national and local guidance.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 87%. This was 4% above the local CCG average and 7% above the England average.

• 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 medicine needs were being met.

• The practice promoted self-management for some long term conditions and referred patients for ongoing support where required. Patients also utilised personal care plans to manage their own conditions and understood when they should ask for help. The practice actively screened for diabetes and had an impaired fasting blood glucose register.

• The practice had supported the recruitment of a long term conditions nurse working across the three practices in the Thirsk area to improve the management of long term conditions and those at risk of admission.

Updated 26 January 2017

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.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 82% compared to the local CCG average of 83% and national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice did not have a dedicated room for breastfeeding although they accommodate mothers in the side rooms when free.

• We saw positive examples of joint working with multidisciplinary teams, health visitors and school nurses meeting monthly. The health visitors had a communication box in the practice reception areas where messages could be left for and by the health visitors.

• The practice provided access to contraception and screening for sexually transmitted diseases (STDs). Two of the partners in the practice held membership of the faculty of Sexual and reproductive Health Care

• The practice offered six week post-delivery checks for mothers and babies.

Updated 26 January 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• All patients over 75 were informed of their named GP and where possible the named GP managed their care. Of the 745 older patients in the practice 99 had a care plan and any changes to care needs were discussed at the monthly meetings.

• The practice was responsive to the needs of older people, and offered home and urgent appointments for those with enhanced needs.

• Each care home or supported living scheme has an assigned a named GP.

• The practice had identified and reviewed the care of those patients at highest risk of admission to hospital. Those patients who had an unplanned admission or presented at Accident and Emergency (A&E) had their care plan reviewed. Care plans were reviewed and discussed with the community matron. The practice also proactively referred to the frail elderly clinic at the Friarage Hospital to promote fast assessment of patients.

• The practice offered extended appointments for older people and home visits were available. Where indicated the practice undertook joint visits with the district nursing team.

• The GPs reviewed 111 contacts and planned follow up care as necessary.

Updated 26 January 2017

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 had appointments available on a Saturday morning and telephone consultations were available.

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

Updated 26 January 2017

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

• Nationally reported data from 2014/2015 showed 88% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the previous 12 months, which was 5% below the CCG average and 1% below the national average.

• Nationally reported data showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 86%, which was also the CCG average and 1% above the national average.

• The practice undertook regular patient reviews in their own home or in the surgery. Those patients who did not attended were followed up an invitation letter or with a phone call from the GP who knew them.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice were able to refer patients to the memory clinic and there was a memory café held in the nearby extra care centre.

• A community psychiatric nurse (CPN) for the elderly attended the monthly multi- disciplinary team meeting.

• The reception staff and Health care assistants had all received dementia awareness training and passed on any concerns about patients to the clinical staff.

• The practice carried out advanced care planning for patients with dementia.

• A consultant psychiatrist attended the practice every three months to provide team updates relating to the management of patients and provide advice.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Patients suffering acute mental health issues were seen on the same day and had access to the crisis team locally.

• 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.

• Patients on medicines requiring regular monitoring and where the practice shared their care with mental health services were monitored regularly.

Updated 26 January 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 and provided a supportive and non-judgemental approach. Examples of these patient groups were people with drug and alcohol problems and those living with a learning disability. There were same day appointments available for those in crisis.

• The practice offered longer appointments for patients with a learning disability. Annual reviews for this group were monitored by the practice, 68% of patients on the register had received an annual review.

• The practice had a named GP for learning disabilities who whenever possible undertook home visits to the local care home for adults with learning disabilities.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. 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 held Gold Standards Framework (GSF) palliative care meetings every four weeks to discuss and agree care plans. This was a way of working that had been adopted locally. It involved the practice working together as a team and with other professionals in hospitals, hospices and specialist teams to provide the highest standard of care possible for patients and their families